TRIGEMINAL TROPHIC SYNDROME
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.
- Usually the damage (e.g. self-mutilation) is of the nasal ala, but may occur anywhere along the distribution of the trigeminal nerve (cranial nerve V).
- Causes of trigeminal nerve damage leading to TTS include trigeminal ablation, infarction, vertebrobasilar insufficiency, acoustic neuroma, astrocytoma, meningioma, spinal cord degeneration, Mycobacterium leprae neuritis, herpes zoster, syringobulbia, postencephalitic parkinsonism, and trauma.
- TTS may also occur after ablation of the trigeminal nerve in the treatment of trigeminal neuralgia.
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:
- Patient education to prevent future damage and allow healing.
- Prosthetic device, e.g. face mask, bandage, coverings.
- TENS unit
- Surgical, e.g. reconstruction of area.
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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