Daily care and the septal button
Living with it, without making it bigger. Local care does not close the hole, but it reduces crusting, bleeding and pain, prepares the mucosa for possible surgery and is recommended as first-line treatment: rinses, gels, oils, humidification, what to avoid, and the truth about septal buttons.
Written by the Septal Perforation team, patients, from the sources cited · Reviewed by doctors · Updated 2 November 2026 · Method and sources
Advice drawn from patients’ experience; it has not been studied in perforation.
- Drink plenty: 3 to 4 L of water a day, unless you are on a medical fluid restriction (heart or kidney failure, for example).
- Avoid diuretics such as alcohol; never stop a prescribed diuretic without medical advice.
- No more than 6 g of salt a day, and plenty of watery fruit and vegetables, especially greens.
- A diet rich in lean protein, which helps healing.
- Stop caffeine, or at least cut it right down (coffee, tea, soft drinks, energy drinks): it is also a vasoconstrictor.
- Bad smell, pus, yellow or greenish crusts, pain or fever: signs that the edges are infected, often with staph. It is uncommon, but see a doctor promptly: infection damages the tissue and can enlarge the perforation.
- Repeated bleeding: the edges are too dry or damaged; ask an ENT for advice.
- A perforation that grows from one examination to the next, whistling that stops, or a nose that starts to sag: ask for a new measurement.
Which product to choose
17 moisturising products compared
No study has compared these products in people with a septal perforation. This ranking, drawn up by the site's publisher, rests on their ingredients, on studies of dry nose and on how well they suit daily use with no end date. It does not replace advice from your doctor or pharmacist, and we have no link with any manufacturer.
- Evidence on nasal dryness, crusting or healing.
- A useful active ingredient, at a dose that matters.
- Staying power: how long the product stays and protects.
- Tolerance on damaged lining: no essential oils, fragrance, harsh preservatives or allergens.
- Suitability for lifelong use.
- For the edges: a fragrance-free dexpanthenol ointment (Bepanthen), or Rinopanteina ointment if lanolin irritates you.
- Against dryness: pure sesame oil (Nozoil).
- To moisturise often: a preservative-free hyaluronic acid spray (Hyarhinol), which also softens crusts before the ointment.
- If the edges get infected: Nasumel or Plasma Liquid, as a short course and an add-on, not as your base product.
- Avoid day to day: camphor, menthol, eucalyptol, essential oils and benzalkonium chloride.
Top of the list
1 Bepanthen Augen- und NasensalbeOintmentThe best balance of evidence, tolerance and staying power on the edges of a perforation. Details
Not to be confused with Bepanthen sea-water spray (sea salt and dexpanthenol, preservative-free): limited to 30 days in a row, it is not suited to permanent use.
Ingredients: Dexpanthenol 5% (50 mg/g), DL-pantolactone, lanolin (100 mg/g), thick paraffin, white petrolatum, purified water. No colouring, fragrance or preservative.
- The best evidence on the list: dexpanthenol beat placebo for dryness at the front of the nose, in a trial using a spray.
- Proven in practice: the ointment has been used for this since the 1960s, and a 2013 study used it as the reference treatment.
- The right area: this dryness affects the front of the septum, where most perforations sit.
- Good staying power: the petrolatum, paraffin and lanolin base clings to the edges of the hole and protects for a long time.
- Simple formula: one active ingredient, nothing irritating.
- Lanolin can cause contact eczema.
- Once opened for nasal use, the tube keeps for 4 weeks.
2 NozoilOil sprayThe best product against dryness itself, but it does not match Bepanthen for protecting the edges. Details
Ingredients: Pure pharmaceutical-grade sesame oil. Some versions sold outside Europe add an antioxidant.
- A trial on exactly our symptoms: in 79 people, sesame oil did better than saline on dryness, congestion and crusting. 8 in 10 felt better, against 3 in 10 with saline.
- A second trial agrees: in 60 patients, pure sesame oil again beat saline for dry nose.
- Pure formula: a single ingredient, no preservative or fragrance.
- No healing active ingredient.
- An oil spray protects the edges for less time than a thick ointment.
3 Rinopanteina ointmentOintmentOn paper it matches Bepanthen, but its formula is less clean and it has no study of its own. If lanolin irritates you, it moves to the top. Details
Ingredients: Vitamin A palmitate 0.05%, D-panthenol 5%, hydrolysed oat protein, sodium hyaluronate 0.10%, ceteareth-20, sodium benzoate, BHA, mineral oil, white petrolatum, water.
- The most complete formula: the same panthenol dose as Bepanthen, plus hyaluronic acid and a little vitamin A.
- Suitable indications: crusting and dry or atrophic nasal lining.
- Lanolin-free.
- No published study on this product.
- Two preservatives (sodium benzoate, BHA) and an emulsifier: more ingredients, so more risk of intolerance on fragile lining.
As a complement or alternative
4 HyarhinolWater-based sprayAn excellent complement, but not enough on its own for dryness from morning to night. Details
Ingredients: Sodium hyaluronate 0.2%, monosodium phosphate, disodium phosphate, sodium chloride, potassium chloride, water for injection. Preservative-free.
- No limit on how long it can be used.
- A studied ingredient: hyaluronic acid improves the nose’s natural clearance and the look of the lining on endoscopy.
- The gentlest on the list: ideal for frequent top-ups and for softening crusts before the ointment.
- Its water base evaporates quickly. In the dry-nose trial, oil beat saline: Hyarhinol does better than plain saline, but lasts less long than an oil or an ointment.
5 NasumelOintmentA good targeted choice, in rotation, when the edges are irritated or infected. It has less evidence than the panthenol ointments. Details
Ingredients: Pure honey, peanut oil, water, beeswax, glycerol oleate, rose oil. Preservative-free.
- Honey is antibacterial and helps healing, which is useful for crusted edges that get infected easily.
- Suitable indications: crusting, cracks, dry, damaged or infected lining.
- 100% plant-based, low pH.
- No published trial on this product. Medical honey has good data on skin wounds, but not inside the nose.
- It can sting on raw areas.
- Peanut oil is an allergen.
- The texture is sticky.
6 GeloSitinOil sprayA less pure Nozoil, worth it only if you prefer its texture or smell. Details
Ingredients: Refined sesame oil (60%), dicaprylyl carbonate, orange oil, lemon oil, antioxidant blend (tocopherol-rich extracts, ascorbyl palmitate, ascorbic acid, citric acid, ethanol, vegetable oil).
- Same base as Nozoil: the sesame trial results partly apply.
- More fluid: dicaprylyl carbonate helps it spread.
- Long-term use allowed by the manufacturer.
- Only 60% sesame oil.
- Citrus oils and traces of ethanol can sting raw lining.
- The bottle must be finished within 6 to 7 weeks of opening.
7 Vitamin A eye ointmentsOintment, off-labelA good base ointment, but Bepanthen does the same with an active ingredient better proven in the nose. A good alternative in rotation. Details
Vitamine A Dulcis has not been sold since 30 June 2025 and the last tubes expired on 31 January 2026. It has been replaced by medical devices at the same 250 IU/g dose, such as VitA Nuit (the French equivalent of VitA-POS); some are reimbursed in France since February 2026.
Ingredients: VitA Nuit and VitA-POS: retinol palmitate 250 IU/g, liquid paraffin, light liquid paraffin, wool fat (lanolin), white petrolatum. Sterile and preservative-free. The former Vitamine A Dulcis had the same formula.
- Same base as Bepanthen, so the same staying power on the edges; vitamin A replaces dexpanthenol.
- An ingredient recognised for mucous membranes: in Spain, vitamin A nasal ointments are licensed medicines for dry, irritated, crusted nasal lining, with minimal absorption into the blood.
- For the eye, the French health authority (HAS) rated its benefit as moderate for corneal dryness and healing.
- Practical: a fine nozzle to reach the edges. VitA-POS keeps for 6 months after opening.
- Compatible with long-term use: according to the Dulcis leaflet, absorption of vitamin A into the blood is negligible.
- No study in the nose: this is off-label use.
- Very low dose: 50 times lower than the Spanish nasal ointments (12,500 IU/g), so the effect of the vitamin A itself is probably modest.
- Lanolin: risk of contact eczema.
- Expensive per gram: about €7.84 for 5 g of VitA Nuit, against about €4.95 for 10 g of Bepanthen in Germany.
- Pregnancy: best avoided as a precaution.
- Some replacements contain preservatives; the French medicines agency (ANSM) advises checking.
8 Nasaprotect GelWater-based gelThe most complete water-based gel after Hyarhinol. It ranks above NasoGel because it has no benzalkonium, but it protects the edges for less time than an ointment. Details
Ingredients: Kuraci Pharma / Kela. Water, jojoba oil, glycerin, ammonium acryloyldimethyltaurate/VP copolymer, panthenol, acacia gum, prickly pear extract, phenoxyethanol, propylene glycol, propolis extract, ethylhexylglycerin, tocopherol, EDTA, sucrose, silica, octenidine hydrochloride, citric acid.
- Three roles in one: a humectant (glycerin), a light oil (jojoba) and film-forming ingredients (prickly pear, acacia gum). The manufacturer also highlights propolis.
- Practical: it does not run, and it is indicated for crusting in and around the nose.
- Antiseptic: octenidine can help on crusted edges colonised by bacteria.
- Suitable for long-term use.
- Panthenol is probably at a low dose: ingredients are listed by decreasing concentration, and it comes late.
- Propolis is a known contact allergen.
- Phenoxyethanol and propylene glycol can sting.
- A daily antiseptic, for life, brings nothing if the edges are not infected.
- No published study, and €12.29 for 10 g.
9 NasoGel (NeilMed)Water-based gelHyarhinol does the same job without preservatives. If you keep it, choose the tube over the spray. Details
Ingredients: Spray: sodium chloride, sodium bicarbonate, purified water, sodium hyaluronate, aloe vera, allantoin, glycerin, propylene glycol, benzalkonium chloride. Tube: same base, with carboxymethylcellulose and parabens (methyl and propyl) as preservatives.
- A saline gel with hyaluronic acid and aloe vera that lasts longer than a liquid spray.
- Glycerin holds water, and allantoin soothes.
- The tube allows targeted application on the edges.
- The benzalkonium chloride in the spray damages nasal lining cells and cilia in the lab: a problem for use several times a day, for life.
- Propylene glycol can sting.
10 Petroleum jelly (Vaseline)OintmentAn excellent base, but Bepanthen and the vitamin A ointments are this same base with an active ingredient added. Details
Ingredients: Pure petrolatum.
- Maximum coverage, with no irritant or allergen, at very low cost.
- In dermatology it is the reference for moist wound healing. A 1996 trial found it did as well as an antibiotic ointment on surgical wounds.
- No active ingredient.
- It adds no water, it only stops water leaving: apply it on lining that is already moist, for example after Hyarhinol.
Less suited to daily use
11 Filme nasaleOil sprayIt does the same job as Nozoil, without the evidence. Details
Ingredients: Tocopheryl acetate (vitamin E, 20 mg per spray) and medium-chain triglycerides. No fragrance, preservative or essential oil.
- Very well tolerated; the spray forms an oily film.
- Indicated in particular for atrophic rhinitis.
- No published trial in nasal dryness.
- In dermatology, vitamin E applied to the skin has shown no benefit for healing, and it sometimes causes contact eczema.
- It is expensive.
12 Plasma Liquid Nasensprüh-Gel (Regeno)Antiseptic water-based gelUseful as a course when crusts smell or get infected. Not a base product against dryness. Details
Ingredients: Water, sodium hypochlorite below 0.06% (a saline solution activated by electrolysis; below 0.08% according to retailers), lithium magnesium sodium silicate, a synthetic clay that gives the gel texture.
- A mineral gel that moisturises, cleans and decontaminates the lining.
- Its texture clings well.
- It can be used continuously, and it is alcohol-free.
- In the lab it inactivated 99.9% of SARS-CoV-2: a real antiseptic action, of interest for infected crusts.
- It is a decontaminant first, not a moisturiser: no glycerin, hyaluronic acid or oil.
- No study on dryness.
- It should not be applied at the same time as other sprays or ointments, which means spacing them out and complicates the routine.
- Smell and taste of hypochlorite.
- About €20 for 20 ml.
13 Frezyderm Nasal OintmentOintmentImpossible to rank more precisely until its full ingredient list is published. Details
Ingredients: Full list not published anywhere. An anhydrous (water-free) ointment; the manufacturer highlights chamomile oil. An older product sheet also lists mimosa tenuiflora, sage oil, neem oil and corn oil, which suggests the formula has changed. No fragrance, colouring or parabens.
- A water-free base covers well and needs no preservative.
- No fragrance.
- Approved from birth.
- Its exact base is unknown.
- Plant extracts with no evidence in the nose: chamomile (daisy family) is a known allergen, and sage oil can irritate.
- Its “alternative antimicrobial” action is not proven.
14 Emser Nasensalbe sensitivOintmentIts base is good, but it adds exactly the irritants to avoid on a perforation. Details
Ingredients: Per 10 g: 600 mg natural Ems salt, white petrolatum, liquid paraffin, nature-identical flavourings (eucalyptol, racemic camphor, bornyl acetate, levomenthol, chamomile oil), natural chlorophyll-copper colouring.
- Its petrolatum-paraffin base covers well.
- Designed for a dry or irritated nasal entrance and crusting, including age-related dryness.
- No known limit on duration of use.
- Ems salt helps retain moisture.
- Despite the name “sensitive”, it contains camphor, menthol and eucalyptol: a cooling feeling without moisture, which can sting raw areas.
- The leaflet sometimes reports sneezing, itching, burning or irritation.
- Not to be used with asthma or very sensitive airways.
- Studies on Ems salt concern sprays and rinses, not this ointment.
15 Rinopanteina spray (vitamins A and E)Water-based sprayHyarhinol is better as a water-based spray, and Bepanthen is better for panthenol. Details
Ingredients: D-panthenol 1%, vitamin E acetate 0.2%, vitamin A palmitate 0.05%, PEG-40 hydrogenated castor oil, disodium EDTA, sodium hydroxymethylglycinate, potassium sorbate, xanthan gum, natural flavouring, isotonic solution buffered to pH 7.2.
- Panthenol in a spray, in a slightly thickened isotonic solution.
- Only 1% panthenol, against 5% in the ointments.
- Sodium hydroxymethylglycinate is a formaldehyde-releasing preservative. With the added flavouring, it is not ideal on damaged lining several times a day.
16 VitapantolOintmentDesigned for short courses, the opposite of lifelong use. If you keep it, take the low-strength version. Details
Ingredients: Standard version, per 100 g: calcium pantothenate 2 g, retinol acetate 200,000 IU, nicotinamide 1 g, geranium oil, liquid paraffin, polysorbate 80, petrolatum. Low-strength version: half the doses, no geranium.
- The petrolatum base covers well, and vitamin B5 and nicotinamide play a part in tissue repair.
- Its vitamin A is 8 times stronger than in the eye ointments (2,000 against 250 IU/g).
- The leaflet mentions a theoretical risk of vitamin A excess with prolonged use, and recommends use for as short a time as possible.
- The Belgian consumer group Test-Achats notes that no evidence of effectiveness has been provided, and that geranium can irritate.
17 RhinovitaOintmentThe product with the most irritants, and its leaflet forbids continuous use. Details
Ingredients: Vitamin A 2,500 IU/g, vitamin E 1%, eucalyptol, chlorobutanol 0.1%, essential oils of lavender, lemon, geranium, Scots pine, thyme and niaouli, liquid paraffin, petrolatum, water.
- Designed for colds, to clear the nose, not for chronic dryness.
- No more than 30 days in a row.
- Six essential oils, eucalyptol and chlorobutanol, a mild local anaesthetic: irritants and potential allergens on damaged lining.
- The cooling feeling masks dryness without treating it.
Ranking drawn up in October 2026; prices are indicative.
The device
The septal button
A silicone prosthesis made of two discs joined by a stem, fitted in clinic, that plugs the hole without repairing it. It relieves whistling and bleeding. The international consensus reserves it for patients who cannot or do not want surgery, and advises against offering it first-line or as a “trial” before surgery.
If a button is indicated, ask for a custom-made one, 3D-printed, in two magnetic pieces: properly fitted, it moves less, comes out easily and causes fewer complications. A 2026 comparative study shows surgery relieves symptoms more than a prosthesis does.
Risks to know before agreeing to one
Pain, foul smell, purulent discharge or bleeding around a button: seek care promptly to have it removed and examined.
Psychological and pain support
Constant pain, broken nights, hypervigilance about every breath, anger at a treatment that caused harm: the psychological impact of a perforation is real and often underestimated, including by ENTs. Seeing a psychologist or psychiatrist, and a chronic pain clinic if pain persists, is part of the treatment, just as much as the rinses.
Bleeding
If it bleeds: what to do
Bleeding usually comes from the edge of the hole, dried out or damaged by a crust pulled off. It almost always stops with well-applied pressure.
- 1Sit down, lean forwardNot backwards: blood would run down your throat. Spit blood out rather than swallowing it.
- 2Blow your nose once, gentlyTo clear the clots, then stop blowing.
- 3Pinch the soft part of the noseSqueeze both nostrils between thumb and index finger, just below the bone, for 10 minutes by the clock, without letting go to check. Breathe through your mouth.
- 4Cold if you likeA wrapped cold pack on the bridge of the nose can help, alongside the pressure.
- 5The next 24 hoursNo forceful nose blowing, no exertion, no hot drinks, no picking. Then a greasy ointment on the edges and humidification to stop it happening again.
When to call
Call 112 or your local emergency number if bleeding lasts more than 15 to 20 minutes despite pressure, is very heavy, comes with feeling faint, or will not stop while you take an anticoagulant. Repeated bleeding means seeing your ENT soon.
Beyond daily care
A perforation can be repaired
Care brings relief but does not close the hole. Surgery does: in expert centres, more than 9 perforations in 10 close, including those over 2 cm.
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