Question: I used cocaine by nasal insufflation about 1gram daily for 9 months and stopped for a month and a half. I started using again since a month and a half ago 1-1.5grams daily. I get these sticky and viscous chunks with my mucus and dried chunks of crust that sticks to my nasal membrane. My questions are:
1. What are these sticky and viscous chunks? Are they nasal tissue lining that's peeling?
2. Are these crusts also nasal tissues?
3. Can I pick my nose with my fingers to remove these chunks and crusts or will it cause further damage?
I use saline nasal spray, will it clean and remove the residues of cocaine that's trapped inside my nose?
4. Will the crusting go away if I stop using cocaine?
5. I have nasal pain on both sides of my nose bridge, what does this mean?
6. I never get dental plaques before, but since cocaine use I get them, what causes this and how to prevent it? Will it cause gingivitis?
7. After snorting cocaine, sometimes the cocaine goes down my throat, will that damage the throat?
8. Cocaine used to make me feel energetic and confident but since a year its effects on me are just numbing to escape from reality and not wanting to talk and social isolation and can just sit the whole day browsing the internet, and haven't been eating. why is this?
I really want to stop, I have noticed a cognitive decline and forgetfulness, if I stop will I regain or restore my cognitive function? I have been taking Nozinan and Rivotril at night for my insomnia and since a month ago, was prescribed Prozac. Is it safe to take Prozac when taking Cocaine? Are there any Vitamins or Supplements you would recommend I should take to restore brain function and to prevent withdrawal when I stop? I am worried about my cognitive decline and I hope you can help me with a remedy to restore it. Thank You.

Than you for your reply Dr. XXXXXXX I have further concerns and questions below:

1. What are these sticky and viscous chunks? Are they nasal tissue lining that's peeling? Are these crusts also nasal tissues?
A: Yes, these sticky, viscous chunks are the dead and peeled out nasal mucosa. Mucosa gets damaged due to reduced blood supply following cocaine insufflation. Once the blood supply is reduced, the secretions in the nose gets dried-up, followed by decreased ciliary movements and finally, leading to crust formation.
Q: Oh no! :( does this these peeled out dead nasal mucosa thin out my nasal membrane? Will it heal and nasal mucosa and nasal tissues repair by itself and restore back to normal if I stop cocaine? Also, will ciliary movement go back to normal function once I stop? and how long does it take? Or do you have any suggestions to treat the damaged nasal mucosa or to speed up healing?
I have noticed a slight deviation of my lower septum, but i don't see or feel any hole inside my nose, can this deviation go back to normal once I stop?

2. Can I pick my nose with my fingers to remove these chunks and crusts or will it cause further damage?
A: Nose picking can further worsen your nasal problems and damage the nasal mucosa. Thus, the damaged mucosa can give way for perforation of the nasal septum in the future.
Q: I've frequently picked my nose to remove the crusts. Do you think I have already damaged my mucosa by nose picking? and how can nose picking damage the mucosa? How do I remove the crusts then? If my mucosa is damaged due to nose picking, will it heal? How do I prevent perforation of the nasal septum and does damage progress even after I stop cocaine or picking my nose?

3. I use saline nasal spray, will it clean and remove the residues of cocaine that's trapped inside my nose?
A: Yes, frequent use of saline spray will help in keeping the nasal mucosa moist, as well as, help in clearing of the nasal secretions.
Q: How often should I use saline spray and do I have to continue after stopping cocaine? Can I blow my stuffy nose after cocaine use or it is not advisable?

4. Will the crusting go away if I stop using cocaine?
A: Yes, the crusts will definitely reduce once you stop using cocaine. Cocaine being a powerful vasoconstrictor will hamper the blood supply to the mucosa; once this action is relieved, the mucosa will get restored to its normal form.
Q: How long does it take to get restored?

5. I have nasal pain on both sides of my nose bridge, what does this mean?
A: Nasal pain is due to drying of the nasal secretions leading to stretching of the nasal mucosa and thus pain.
Q: Is there a treatment or remedy for this? Stretched nasal mucosa means inflammed? Will this heal or go back to normal?

6. I never get dental plaques before, but since cocaine use I get them, what causes this and how to prevent it? Will it cause gingivitis? After snorting cocaine, sometimes the cocaine goes down my throat, will that damage the throat?
A: Snorting can cut down the blood supply into the roots of the teeth and thus cause damage to the teeth. Yes, reduced blood supply to any organ in the body will make it prone for frequent infections and the most common commensal infection is the fungal infection.
Q: How to prevent or treat this?

7. Cocaine used to make me feel energetic and confident but since a year its effects on me are just numbing to escape from reality and not wanting to talk and social isolation and can just sit the whole day browsing the internet, and haven't been eating. why is this?
A: In the initial phase, the dose of cocaine you were taking was sufficient enough to keep you high. Lately, the threshold for cocaine has increased and thus you are finding it ineffective for the previous dose.
8. I really want to stop, I have noticed a cognitive decline and forgetfulness, if I stop will I regain or restore my cognitive function? Is it safe to take Prozac when taking Cocaine?
A: These are the withdrawal effects of cocaine. You need to consult your doctor (preferably a psychiatrist) to put you on low dose of cocaine combined with other drugs. Yes, it is relatively safe to take cocaine in lower doses while taking Prozac. Best, is to consult your doctor regarding this.
Q: I have little left of cocaine and will finish it tomorrow and plan to stop cold XXXXXXX Are there vitamins or supplements to prevent withdrawal?

9. Are there any Vitamins or Supplements you would recommend I should take to restore brain function and to prevent withdrawal when I stop? I am worried about my cognitive decline and I hope you can help me with a remedy to restore it.
A: You can try taking mecobalamin it helps in strengthening the nerves. Consult your doctor he can suggest to better medicines after examining you thoroughly
Q: Mecobalin is B12. I bought Balanced B-100 tabs and it contains 100mcg B12 (as cobalamin), is this the same? and what dose should I take daily?

10. I would like to know what is the extent of damage in my nose and if it can be restored or repaired after stopping cocaine.

11. I had permanent dermal fillers 10 years ago injected on the upper nasal bridge and outer lower septum. Will cocaine alter this or eat it away or destroy it? I have consulted a dermatologist to ask for dermal fillers to correct my slightly deviated septum but they don't want to because they don't know what exactly was injected before. And they can only do non permanent dermal fillers. Will dermal fillers fix my slightly deviated septum? I have also noticed after taking a photo of myself that my lower nose looks like it has slanted to the right side, what can i do about this?

12. I also had permanent dermal fillers on my lips 10 years ago but since months after noticing my slanted nose and slightly deviated septum that seems to bend towards the left, I also noticed my lower lip right side looks protruded and bigger than the left lower lip. Or the lower left side shrunk because of cocaine?

Thank you for writing back. My comments below:

1. Will it heal and nasal mucosa and nasal tissues repair by itself and restore back to normal if I stop cocaine? Also, will ciliary movement go back to normal function once I stop? and how long does it take? Or do you have any suggestions to treat the damaged nasal mucosa or to speed up healing? I have noticed a slight deviation of my lower septum, but i don't see or feel any hole inside my nose, can this deviation go back to normal once I stop?


2. I've frequently picked my nose to remove the crusts. Do you think I have already damaged my mucosa by nose picking? and how can nose picking damage the mucosa? How do I remove the crusts then? If my mucosa is damaged due to nose picking, will it heal? How long does it take to get restored? How do I prevent perforation of the nasal septum and does damage progress even after I stop cocaine or picking my nose? How often should I use saline spray and do I have to continue after stopping cocaine? Can I blow my stuffy nose after cocaine use or it is not advisable?

A: The extent of damage to the nasal mucosa can be determined only after examining the nose. Nose picking will peel of the healing mucosa thus exposing the cartilage. Cartilage is a tissue with poor blood supply and ripping of the covering layer will expose the cartilage to the outer environment which will further damage the cartilage and lead to perforation. Consult your ENT specialist; he will be able to help you in a better way.

Use saline nasal spray as I mentioned in my previous response, it will be definitely beneficial. You can use the spray as many times as you desire and for any number of days you want, it is not harmful. Use saline spray when you are having stuffy nose and do not blow your nose forcefully when there is stuffy nose.

Q: Oh no, I have had habitually picked my nose and blow my nose to remove the crusts and sticky mucus. now my nose is sore --the septum and the nasal mucosa. will applying vitamin e reduce damage or heal it? or petroleum jelly is better?





8. I have consulted a dermatologist to ask for dermal fillers to correct my slightly deviated septum but they don't want to because they don't know what exactly was injected before. And they can only do non permanent dermal fillers. Will dermal fillers fix my slightly deviated septum? I have also noticed after taking a photo of myself that my lower nose looks like it has slanted to the right side, what can i do about this? I also had permanent dermal fillers on my lips 10 years ago but since months after noticing my slanted nose and slightly deviated septum that seems to bend towards the left, I also noticed my lower lip right side looks protruded and bigger than the left lower lip. Or the lower left side shrunk because of cocaine?

A: Dermatologist will not rectify the deviated nasal septum; it will be done by the ENT specialist. Do not worry about the deviated septum, it is not related to snorting.

Q: How can ENT specialist rectify this without surgery?

Thank you Dr. XXXXXXX Please see my Q: below

1. Oh no, I have had habitually picked my nose and blow my nose to remove the crusts and sticky mucus. now my nose is sore --the septum and the nasal mucosa. will applying vitamin e reduce damage or heal it? or petroleum jelly is better?

A: You can try applying saline nasal ointment or alternatively naseptin cream into the nasal cavities. Also use saline saline nasal spray as mentioned in my previous post; please do not use petroleum jelly or any vitamin E. Eat plenty of fruits of fruits and vegetables, this will help in faster healing of the damaged mucosa.

Q: There are no pharmacy here that carries saline nasal ointment and naseptin nasal cream or neosporin. What are the alternatives to heal and reduce damage? Will Fluticasone Propionate Nasal Spray heal, reduce damage and prevent infection?
What are the signs and symptoms to know if my nose is already infected?
I read some people use Vit.E and Petroleum Jelly inside the nose, why is it not advisable? I have rubbed Vit. E and Petroleum jelly inside my nose the other day because of dryness and crusts and pain, what will happen?

2. How can ENT specialist rectify this without surgery?

A: Mild deviation of the nasal septum does not require any surgery. Surgery is indicated in those individuals whose septum is grossly deviated. Deviation of the nasal septum cannot be corrected with medicines.

Q: If mild deviation does not require surgery, what can the Doctor do to rectify without surgery?

Q: I still have nasal pain inside especially behind the bridge of the nose and the area between my eyes and also the lower septum. Does this mean damage or will it go away by itself? or there is a treatment or remedy for this? I am afraid if these symptoms indicates beginning of nasal septum corrosion:( Please let me know if it is. I also have pain on my midline upper gums. What does this mean?

Thank you for your answer Dr. XXXXXXX

My septum has prickly pains and also the nasal walls. I'm afraid it could be infected. Is there a treatment for this?

I also have noticed a mass on the left side of the lower septum, what is this?

If I see an ENT specialist, what are the procedure for diagnosis? I'm afraid if he inserts and instrument inside my nose it might irritate and damage it more?

Thank you for your reply. My comments below:

1. My septum has prickly pains and also the nasal walls. I'm afraid it could be infected. Is there a treatment for this?

A: If you feel it is infected you can try taking antibiotics such as a combination of amoxycillin and clavulanic acid or cefuroxime, a pain reliever such as ibuprofen or diclofenac and continue with the saline nasal spray.
Q: These antibiotics should be combined or I choose one and whats the daily dose and for how many days? What is the best among the 3?
If I visit an ENT will they be able to diagnose if there is an infection? Do you suggest I see an ENT first before taking these antibiotics?

2. I also have noticed a mass on the left side of the lower septum, what is this?

A: If the swelling is over the septum, then it could be a septal spur and if it is located opposite to the septum, then it could be the nasal turbinate which is a normal constituent of the nose.
Q: The swelling is on the lower septum left side beside the center of the septum nasal passage. it is not on the side of my nasal wall. Can this be treated? Or it will repair by itself and be normal again? Could these be cause of cocaine use? or it is sign of infection?

3. If I see an ENT specialist, what are the procedure for diagnosis? I'm afraid if he inserts and instrument inside my nose it might irritate and damage it more?

A: The initial part is just an external nasal examination and if the find anything suspicious or if they want to evaluate thoroughly, then, they might advise for a nasal endoscopy under local anesthesia, which will be relatively painless. Either of the procedures will not traumatize or worsen your present symptoms.

Thank you Dr. XXXXXXX for your answer. Please see my comments below:

1. the best among the 3? If I visit an ENT will they be able to diagnose if there is an infection? Do you suggest I see an ENT first before taking these antibiotics?

A: The first one is a combination (amoxycillin and clavulanic acid) and the second is a different drug. You can take either of them. Best, is to consult your doctor before taking these antibiotics.

Q: I went to ENT specialist and he only examined my vestibules. He said I have Nasal Vestibulitis and prescribed me Co-Amoxiclav (amoxycillin and clavulanic acid) 625mg to be taken 2x a day for 7 days. Also prescribed me Mupircosin
(Bactroban) ointment to be applied in both nasal vestibules 2x a day for a week plus saline spray. But I just read you cannot apply this on intranasal and have to use Mupircosin nasal ointment instead but it's too late, I have already applied 3x! Should I raise concern?

2. The swelling is on the lower septum left side beside the center of the septum nasal passage. it is not on the side of my nasal wall. Can this be treated? Or it will repair by itself and be normal again? Could these be cause of cocaine use? or it is sign of infection?

A: Most probably it could be a septal spur. I am sorry, without an examination I cannot pinpoint the actual diagnosis. Any how, you are planning to consult your ENT specialist, he will be able to tell you the exact nature of your problem.

Q: I read septal spur is growth of the nasal bones? I have this lump that looks like a huge pimple about to have a pus on the left inside the left side of the septum and prominent red veins. I may have to have further examination if you advise.

Thank you.

Do not be apprehensive! Consult your doctor, he is the best person to guide you.

Thank you for your reply Dr. XXXXXXX

What's the maximum number of days can I apply the topical mupircosin inside my nose? Will it also help relieve and heal nasal pain from cocaine use?

The ENT doctor did not tell me the cause nor asked me the cause, he just said I have infection. There is indeed a pimple like follicle over the nasal septum that could eventually lead to a pus he said. He said he hopes the antibiotics will prevent or heal that. but if it does not go away and there is a pus, how can that be removed? can it spread infection up to my sinus and brain?

I would like to see him again this Tuesday for further examination of my septum and nasal cavities and sinus if there are infection or damage. What procedure shall I ask him to perform?

Hi Doc,

If symptoms don't go away after 7 days can I still use Mipurcosin ointment inside my nose? Can it help relieve nasal pain or I have to take Mefenamic Acid (Ponstan 500mg)?

Will it cause further damage on my septum if the my side of my septum should be punctured to drain out the pus filled follicle?

Nasal endoscopy means an instrument will be inserted inside my nose, won't it fracture or worsen the sensitive painful nasal pain and damage? Will this procedure be able to diagnose if my nasal cartilage is damaged?

I read pain inside the nose also indicates damaged nasal cartilage, are there physical signs and symptoms or visible on the external appearance of the nose?

Does damaged nasal cartilage regenerate or heal by itself? Or you can suggest supplements or medications for it to regenerate faster?

Will the ENT doctor be able to tell I have used Cocaine by endoscopy examination?

Thank you.

1. Oh no, the mupirocin ointment will not heal the swollen follicle and the pus? But I am also taking oral antibiotics.

2. How can I tell if my perchondrial layer on the nasal cartilage is destroyed? There is really no way for the cartilage to heal of perchondrial layer is destroyed? :(

Thank you for your answer Dr. XXXXXXX

I have finished taking the oral antibiotics 2x a day for 7 days. The skin or follicle (or septal spur as you said) on the left lower side of my septum (just at the beginning of the opening of the nostrils) is still swollen and both sides have red spider veins. I cannot tell if there is pus on the left side but it is still swollen but not painful. If swelling has not gone down does that mean there is pus? How can it be diagnosed? And if indeed there is pus, shall I wait for it to burst by itself or it has to be drained by the ENT? What is the procedure to puncture it and drain out the pus? I'm afraid it might give me more spider veins on that area? or the spider veins will burst and cause more damage?

I never had any nosebleeds or bloody discharge. but my nose seemed to have tilted to the right side. is this just inflammation or it's permanent deviation?

Hi Doc, Thanks for writing back.

1. My doctor said there is no pus but I don't know why there's still the swelling:( He was not able to give an answer.

2. I did not tell him of cocaine use and he didn't ask.

3. He said I have a slight deviated septum though :(

4. How can I get rid of these spider veins?

5. I've used cocaine again :( My septum has piercing pain and I applied Mupocricin ointment on the nasal cavities and inner sides of my septum. Will Mupocricin ointment relieve pain and repair damaged tissues and lubricate dry nose or help it heal? Will long term use of Mupocricin inside the nose cause more harm or thinning?

6. I still get crusts and viscid mucus :( I really want to stop after this bag. I am afraid doctor :( My nose looked like it widened. Do you think it's just inflammation from cocaine and will it go back to normal when I stop? both sides of the nostrils feels thin and loose or it widened :(

I hope you can answer my nose worries and there are remedies. I also hope you can help me to stop cocaine. I hope you can help me what to do to reverse or reduce nose damage :(

Thank you for your answer Dr. XXXXXXX Please see my comments below:




A: You should have asked your doctor what are the possibilities he can think of? If you can post me a photograph of the lesion, I will be able to tell you what exactly it is.
1. He only said could be because I had an infection but even when infection is gone I asked him how come there is still the swelling. He couldn't really answer. But if swelling is a symptom of after-infection then both sides of the lump or follicle beside my lower septum should have been swollen right? I'm wondering if it could be because of my slightly deviated septum that wasn't deviated prior to my cocaine use. I'll take a photo in jpeg format, but how do I attach the file here? Is it possible to send it here without having it viewed to the public?

A: Unless you stop snorting your problems will not get relieved. Plain Mupirocin is to control the infection and not to lubricate the dry mucosa. To a certain extent, it can help in healing the damaged tissue, but not completely.
2. Ok so I shall continue to help heal and repair the damaged tissue.

A: No, it does not. But avoid using it on a long term basis; as it does not contain enough moisturising property as that of nasal creams. Hence it does not prevent any crusting inside the nasal cavity.
3. What are the are the consequences with long term use of Mupirocin inside the nasal cavity and septum?

A: This is because of the dryness of the nose in the absence of any lubrication and persistent snorting. Please, do not be afraid! stop snorting, every thing will fall into its place. Consult a good psychiatrist to help you in overcoming this problem. The widening of the nostrils is not secondary to snorting, it is just your perception. Use adequate lubricative agents and saline spray, the nasal mucosa will recover soon.
4.Ok I really should stop and hope damage will be reversed and recover. We don't have neseptin nor paraffin here. Do you have any other suggestions for lubricative agents I should apply inside the nose since Mucropin does not contain moisturizing properties? Or I can mix Mucoprin and Petroleum Jelly to hasten healing of nasal tissues and at the same time lubricating the nasal cavities and relieve pain?

5. Can I also show you a photo of my nose that got slanted and lower lip that also slanted to the right? How do I attach photos here? Or you have a private email where I can send it so it wont be available for public viewing?

Many Thanks

Hi Dr. XXXXXXX

I'll attach here 2 photos--one with my septum with the left side of the septum having a mass. One with my nose and lips that seemed to have slanted to the right side:( I hope you can help me and please do not publish these photos in public nor my contact details. Thank you.