Herpetic Trigeminal Trophic Syndrome

Abstract

REPORT OF A CASE An 87-year-old white man came for treatment of an arciform ulcer of the left side of the nose, nasolabial fold, and maxillary area that had been present for 10 weeks. The lesion had begun as an itchy growth that progressively expanded and broke down. The patient admitted to picking at the affected area. Previous treatment by another dermatologist with topical and oral antibiotics and oral acyclovir (200 mg by mouth five times a day) had been unsuccessful; a superficial biopsy was nondiagnostic. Twenty years previously, the patient had undergone a left frontal sinus operation and repair of a deviated nasal septum and subsequently developed recurrent, severe, left trigeminal neuralgia, requiring repeated nerve blocks. He also described a peculiar sensation of constant drainage in the nasopharynx. Physical examination demonstrated a crescentic, uniformly deep ulcer on the left ala nasi, maxillary region, and nasolabial fold (Figure 1). There