Monika Kałwak, Patryk Dłubis, Sviatlana Filitaryna, Monika Wiatr, Magda Marciniak, Cezary Orzechowski, Michał Gutowski, Wojciech Wojas, Justyna Żabicka, Kinga Lichtarska, Aleksandra Foryś
Background: Rhinitis medicamentosa (RM) is a non-allergic condition caused by the prolonged use of topical nasal decongestants. Despite its prevalence, it remains frequently underdiagnosed in clinical practice. Objectives: This review synthesizes current knowledge on the pathophysiology, diagnostic criteria, and multifaceted treatment approaches for RM. Methods: A comprehensive literature search was conducted across PubMed (up to 2026) focusing on alpha-adrenergic agonist-induced mucosal changes and therapeutic interventions. Results: Chronic administration of sympathomimetics, such as xylometazoline, leads to adrenoceptor downregulation, secondary vasodilation, and permanent mucosal remodelling. Clinical presentation is characterized by rebound congestion and tachyphylaxis. Management centers on immediate or tapered decongestant cessation, supplemented by intranasal corticosteroids. In refractory cases involving turbinate hypertrophy, surgical intervention (e.g., conchoplasty) remains a definitive option. Conclusions: RM represents a significant clinical challenge. Increasing clinical awareness and patient education regarding the risk of decongestant overuse are crucial for prevention and successful long-term outcomes.