Recurrent epistaxis in adults affects 5–8% of the population, yet its causes often remain unrecognized, and patients receive only local treatment for years without a proper systemic work‑up. This review aims to summarize current evidence on the etiology, diagnosis, and consequences of recurrent epistaxis and to propose a practical diagnostic algorithm for primary care physicians. A narrative review of the literature was conducted using PubMed, Scopus, and E-Library databases over the last 15 years, focusing on systemic causes, diagnostic algorithms, and psychosocial outcomes. In 15-20% of adults with recurrent epistaxis, previously undiagnosed systemic disorders are identified, including hereditary hemorrhagic telangiectasia (HHT), von Willebrand disease, thrombocytopenias, chronic liver diseases, vasculitides, or iatrogenic coagulopathies. Key red flags include telangiectasias on the skin and mucous membranes, a family history of bleeding diatheses, bleeding from other sites, use of anticoagulants or antiplatelets, and systemic symptoms (arthralgias, renal or pulmonary involvement). Minimum laboratory work‑up comprises a complete blood count with platelets, coagulation tests, and liver function tests; when indicated, von Willebrand factor assays, genetic testing for HHT, and vasculitis serology should be performed. Chronic post‑hemorrhagic anemia develops in 40–55% of patients, while psychosocial disturbances (anticipatory anxiety, social isolation, occupational impairment) are found in over 60% of patients but are rarely addressed. Recurrent epistaxis should be regarded as a potential marker of systemic disease. The proposed diagnostic algorithm and differential diagnosis table can serve as practical tools for early detection of treatable conditions and for improving patients' quality of life.
