Trigeminal Trophic Syndrome
A 48-year-old woman complained of nonhealing painless progressive ulcer over the left nostril and skin over the upper lip of 6-months duration. She had herpes zoster affecting the left side of face 1-year back. For the facial ulcer, she was treated with both topical and systemic steroid and multiple antibiotics without any improvement. The ulcers were painless located on ala nasi, extending medially into the nasal septum, superiorly over the skin of the nose and inferiorly involving the skin over the upper lip on the left side. Their margins were clearly delineated [].\nThere were no vesicles around the ulcer or anywhere over the face. There were no hypopigmented patch or peripheral nerve thickening. Neurological examination revealed left-sided lower motor neuron type of facial palsy, decreased level of pain, and temperature sensation over the trigeminal area. Corneal and mastication reflexes were diminished. Her vitals and other systemic examination revealed no abnormality. Tzanck smear from the ulcer showed neutrophils and there were no acantholytic or multinucleate giant cells. Touch smear for bacteria and slit skin smear for acid fast bacilli were negative. Antinuclear, antineutrophil cytoplasmic; hepatitis B and C, and antibodies were negative. Tests for HIV and syphilis were nonreactive. Her blood glucose, renal, and liver function tests were within normal range. Electrocardiography (ECG) and chest radiography, computed tomography (CT) scan, and magnetic resonance imaging (MRI) of the brain were normal.\nTTS was diagnosed and the ulcer was treated with saline soaks and topical antibiotics. Patient was counseled and advised to avoid scratching or rubbing the site. There was remarkable improvement and the ulcer healed in 2 weeks time []. Patient is being followed-up and there is no recurrence since 1 year.