Trigeminal trophic syndrome.
Ulceration of the nose may be inadvertently induced by the patient. Although trigeminal trophic syndrome is an uncommon cause of chronic ulcers, healthcare providers should consider the possibility of this disorder when encountering a patient with nasal ulcerations. Trigeminal trophic syndrome most commonly occurs in older women following therapy for trigeminal neuralgia. The ulcers usually involve the nasal ala and paranasal areas. The clinical vignette of a man with a self-induced nasal ulcer secondary to trigeminal trophic syndrome, which was initially suspected to be skin cancer, is presented. Since nasal ulcerations can be secondary to other conditions, a lesional biopsy should be performed to exclude other diagnoses when trigeminal trophic syndrome is entertained. In addition to trigeminal trophic syndrome, the differential diagnosis of conditions that can cause nasal ulcers include factitial disorders with self-induced ulcerations (such as dermatitis artifacta and neurotic excoriations), granulomatous conditions, infectious diseases, malignancy, and pyoderma gangrenosum. Treatment of trigeminal trophic syndrome requires prevention of digital manipulation of the lesion-either by occluding contact with the ulcer, initiating psychotropic medication, or both. Psychiatric and/or pharmacologic intervention should be considered to reduce or resolve further habitual self-inflicted injury before surgical intervention.
Setyadi
Hedy G
HG
Baylor College of Medicine, USA.
Cohen
Philip R
PR
Schulze
Keith E
KE
Mason
Stephen H
SH
Martinelli
Paul T
PT
Alford
Eugene L
EL
Taffet
George E
GE
Nelson
Bruce R
BR
D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D032763:Behavior Control / Q000379:methods*; D001706:Biopsy; D003704:Dementia / Q000150:complications / Q000188:drug therapy; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D011379:Prognosis; D013577:Syndrome; D020433:Trigeminal Nerve Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D014803:Vitamin B Complex / Q000627:therapeutic use*
D014150:Antipsychotic Agents; D014803:Vitamin B Complex