By Gary M. White, MD

Trigeminal trophic syndrome (TTS) is the self-induced damage to the skin triggered by abnormal sensations from the trigeminal nerve.


A crescent-shaped deformity of the nasal ala is most typical. However, ulceration anywhere in the distribution of cranial nerve V is possible, including the scalp, forehead, eyebrow, eyelid, cornea, temple, cheek, lip, oral cavity, and tongue.


Treatment should be carried out in conduction with a neurologist. The patient should be given insight into the self-induced nature of the skin damage. Treatment options include:


A 68-year-old man suffered from herpes zoster of the V2 distribution on his left face. 2 weeks later, he developed a sore on the left rim of his nostril. He denied picking, but his wife contradicted him, stating he frequently touched and manipulated the area. Washington University Grand Rounds.

An 81-year-old man with dementia presented with persistent left-sided forehead and scalp skin ulceration for 1 year. Dermatology Online Journal 21;8


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