Nose picking: understand it and stop
Almost everyone picks their nose. On a fragile septum, this habit keeps a wound open that can turn into a hole, and it explains most re-openings after a repair. It can be treated: simple steps, barriers, and a method with real evidence behind it.
Written by the Septal Perforation team, patients, from the sources cited · Reviewed by doctors · Updated 2 November 2026 · Method and sources
In brief
Picking is rarely a disorder: most patients concerned simply have a bad habit, fed by a crust that bothers them.
What works best: remove the crust with a greasy ointment, treat any infection, add barriers, and follow habit reversal therapy.
Before a repair, picking must be addressed: when a closed perforation re-opens, it is almost always because of the finger.
Why people pick their nose
More than 9 people in 10 put their fingers in their nose. It is an ordinary gesture, not a character flaw.
A small number of people have a true compulsion, rhinotillexomania, close to obsessive-compulsive disorders. But most patients whose septum has been damaged by picking have simply picked up a bad habit, often to get rid of a crust that bothers them.
Some gestures are not felt as picking and yet count: for example, pushing a tissue inside the nose every time you blow it to "clean" it.
- Telling your ENT frankly is the first step of the diagnosis: it changes the treatment.
- The textbook insists on an open, non-judgemental approach, from patient and doctor alike.
- Once the hole exists, the finger can reach its back edge and even the side wall of the nose: the gesture keeps doing damage without you noticing.
The crusting cycle
At the front of the septum, a small wound is enough to start a cycle that keeps itself going.
If it goes on
- 1The mucosa changesIt turns into a skin-like tissue (squamous metaplasia). No cream brings it back to normal.
- 2The crust becomes permanentIt no longer falls off, and neither does the urge to pick.
- 3Infection settles inStaphylococcus aureus is very common in people who pick.
- 4The cartilage is lostDeprived of its mucosa, it disappears: the hole appears, then grows.
After nose surgery, the risk is higher
After a septoplasty or other nose surgery, the mucosa can stay numb. Pain no longer acts as an alarm: you can damage the septum without feeling anything.
The need to clear crusts, and the fear of poor healing, also push people to handle their nose more often.
After a repair, the riskiest moment is when the silicone sheets (splints) come out, because the operated mucosa is still numb.
Thiel & Harvey, ch. 6, Springer 2026 ; Thiel & Harvey, ch. 7, Springer 2026
Key point
When a closed perforation re-opens, it is "almost always" because of the finger.
This is not a fault: it is why teams keep silicone sheets in longer for patients who pick, and insist on ointment and barriers.
Thiel & Harvey, ch. 7, Springer 2026.
How to stop
- 1Talk to your ENTWithout shame. They will look for what keeps the crusts going and adapt the care.
- 2Remove the crust that triggers the urgeSaline rinses loosen crusts but moisturise little. A greasy ointment protects better; even a plain unscented lip balm does better than saline. Apply it with the pad of your finger. The rule: "never a dry finger in the nose".
- 3Treat what keeps the crusts goingIf infection is visible: a swab first, then an antibiotic matched to the result. Against Staphylococcus aureus, the reference ointment is mupirocin, on prescription. Changed mucosa does not heal with any cream: it must be removed surgically.
- 4Use barriersSilicone sheets stitched to the septum for weeks or months protect it, help break the habit and can stabilise the perforation before a repair. Simpler: a plaster on the "guilty" finger for a few weeks, or a menthol or capsaicin ointment on the finger.
- 5Follow habit reversal therapyA form of cognitive behavioural therapy: the method with the best evidence. Its steps are detailed below.
- 6Medicines, only on medical adviceAs an add-on, never alone: see the box below.
Questions to ask my ENT
- Are the edges of my perforation stable, or red, crusted and granular?
- Should a swab be taken before any antibiotic?
- Has my mucosa changed from picking? Does it need to be removed?
- Could a silicone sheet protect my septum for a few weeks?
- Can you refer me for habit reversal therapy?
- Become aware of the gesture and describe it yourself.
- Spot your triggers and write them in a notebook: when, where, which emotion.
- Avoid these situations, or change them.
- Learn to relax.
- Keep your hand away from your face when stressed.
- Adopt a replacement gesture: clench your fists, squeeze a ball, sit on your hands.
- Get help from someone close, who encourages or reminds you.
- Track your progress in the notebook.
- N-acetylcysteine.
- Memantine: in a trial on hair pulling and skin picking, 60.5% of patients clearly improved, versus 8.3% on placebo.
- SSRI antidepressants, with variable effect.
None of these treatments has been studied specifically for nose picking. Do not start anything without your doctor.
Before surgery
Treat first
A repair attempted while picking continues leads to failures, in the short and long term.
Sheets kept in longer
In patients who pick, teams keep the silicone sheets in longer: 6 weeks in the case presented by the textbook.
Follow-up of at least a year
Re-openings can happen late. Ointment and vigilance continue well after healing.
Frequently asked questions
Does everyone pick their nose?
Almost: more than 90% of people do. The problem arises when a wound on the septum forms a crust that bothers you: the gesture stops it from healing.
Is an ointment enough?
It helps a lot, because it removes the crust that makes you want to pick. But if the mucosa has changed, no cream heals it: it must be removed surgically. And if there is an infection, you need a swab, then a matched antibiotic.
Do I need to have stopped before surgery?
Yes. A repair attempted while picking continues fails more often, and when a closed perforation re-opens, it is almost always because of the finger.
My perforation re-opened after surgery. Is it picking?
It is the most common cause according to the textbook. It is not a fault: the operated mucosa is often numb and pain no longer warns you. Talk to your surgeon, who can suggest barriers and closer follow-up.
Sources
Every figure on this page comes from one of these publications. The year is the year of publication.
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