Illicit and licit drugs causing perforation of the nasal septum.

Examination of three patients who were presented for routine physical examinations revealed significant perforations of the anterior nasal septum. A 26-year-old male and 28-year-old female with this defect have been chronic abusers of cocaine by nasal inhalation. A 69-year-old female showed a similar defect by overuse of a common over-the-counter nasal spray containing the decongestant phenylephrine. Both drugs are powerful vasoconstrictors that reduce blood flow to the local area. With prolonged use there is persistent deprivation to the tissue of oxygen necessary for cell viability, with resultant necrosis. Additionally, the physical irritation from the impingement by these drugs on the nasal membranes further hastens the destructive process. Finally, the tissue breakdown is complete with perforations of various sizes.