Non-healing Ulcers Research Articles

Vessel-by-Vessel Computed Tomography Calcium Scoring of the Foot in Peripheral Artery Disease: Association with Patient-Level Factors.

Objective: Peripheral artery disease (PAD) is associated with increased risk of nonhealing ulcers, amputation, and mortality due to occlusive atherosclerotic plaques. Computed tomography (CT) imaging detects vascular calcification in PAD; however, quantitative vessel-by-vessel analysis of calcium burden in the feet of PAD patients has not been assessed. This study sought to perform quantitative analysis of vessel-specific calcium burden and examine the patient-level determinants of foot calcium burden in PAD patients. Approach: PAD patients (n = 41) were prospectively enrolled and underwent CT imaging of the lower extremities. Manual segmentation of the medial plantar, lateral plantar, and dorsalis pedis arteries was performed. CT image Hounsfield units (HUs) were obtained for each artery to quantify vessel-by-vessel calcium mass using a cutoff value of ≥130 HU. Univariate analyses were performed to evaluate patient-level determinants of calcium burden for each foot artery. STROBE guidelines were used for reporting of data. Results: Univariate analyses revealed that body mass index, diabetes mellitus (DM), and chronic kidney disease (CKD) were significant determinants of foot calcium burden in PAD patients. Image analysis demonstrated that PAD patients with DM had significantly higher calcium mass for the medial plantar (p = 0.005), lateral plantar (p = 0.039), and dorsalis pedis (p = 0.001) arteries compared with PAD patients without DM. Innovation: This is the first study to use CT imaging to quantify vessel-specific calcium burden in the feet of patients with PAD and evaluate the patient-level determinants of foot calcium burden in the setting of PAD. Conclusion: CT imaging quantifies vessel-specific calcification in the feet of PAD patients, which is exacerbated with concomitant DM, CKD, and/or obesity.

Extrinsic Dorsalis Pedis Artery Compression Due to Diabetic Arthropathy in a Non-Healing Foot Ulcer

Extrinsic Dorsalis Pedis Artery Compression Due to Diabetic Arthropathy in a Non-Healing Foot Ulcer

Bowman's membrane lenticule tuck-in: A new approach for the management of neurotrophic ulcers.

To evaluate a new surgical method for managing nonhealing neurotrophic ulcers using a novel technique of tucking-in Bowman's membrane lenticule in the ulcer defect. A total of 22 eyes of 22 patients with neurotrophic ulcers of various etiologies and stages were included and underwent a surgical process where a donor Bowman's membrane lenticule was harvested and fashioned according to the lesion and tucked inside the ulcer after making a recess in anterior one-third of stroma all around 360 degrees. The primary outcomes measured were healing (stable epithelialization at 12 months) and best-corrected visual acuity (BCVA) improvement. Twenty-two eyes of 22 patients with neurotrophic ulcers underwent Bowman's membrane lenticule tuck-in procedure. Complete re-epithelialization was achieved in 21 eyes (95.45%). The average healing time was 2.77 ± 0.79 weeks. The mean corneal thickness improved from 267.36 ± 94.56 mm preoperatively to 435.9 ± 47.71 mm at six months postoperatively. The mean BCVA also improved from 0.05 ± 0.07 preoperatively to 0.24 ± 0.24 postoperatively one year. One patient (4.54%) showed recurrence after one month, and the epithelial defect persisted till the end of the study. Donor Bowman's membrane lenticule tuck-in for neurotrophic ulcers is a safe and highly effective treatment and requires minimal instruments and expertise.

Regional skeletal muscle perfusion distribution in diabetic feet may differentiate short-term healed foot ulcers from non-healed ulcers.

The purpose of this study was to leverage a magnetic resonance imaging (MRI) approach to characterize foot perfusion distribution in patients with diabetes, with or without foot ulcers, and determine the ability of the regional perfusion measurements to identify ulcer-healing status. Three groups of participants (n = 15 / group) were recruited: controls (without diabetes), type II diabetes, and type II diabetes with foot ulcers. All participants underwent MRI evaluating foot perfusion in three muscle layers (from plantar to dorsal) at rest and during a standardized toe-flexion exercise. The exercise perfusion and perfusion reserve values were analyzed around and away from ulcers. Participants with foot ulcers were followed up 3months after the MRI exams to determine the foot healing status. Foot plantar muscle perfusion reserves were progressively lower from controls to diabetes, and to diabetes with foot ulcers (e.g., 2.58 ± 0.67, 1.48 ± 0.71, 1.12 ± 0.35, p < 0.001). In controls, the plantar layer had significantly higher perfusion reserve than the dorsal layer, whereas in either diabetes group, there was no significant difference in perfusion reserve among muscle layers. Using the ratio of total exercise perfusion around ulcers to that away from ulcers, the sensitivity and specificity to differentiate healing from non-healed ulcers were 100% and 86%, respectively. Our study reveals significantly different foot perfusion distribution among controls, diabetes, and diabetes with foot ulcers. The prognostic value of MRI regional perfusion assessments has the potential to monitor interventions to improve ulcer healing outcomes. • Contrast-free MRI permits quantitative assessment of regional foot muscle perfusion at rest and during isometric exercise. • Patients with diabetes and foot ulcers, without clinical evidence of peripheral arterial disease, had significantly impaired foot muscle perfusion and perfusion reserve. • Regional foot perfusion distribution may be used to predict the short-term healing status of foot ulcers in diabetes.

EPITHELIAL CELLS OF ULCERATIVE COLITIS PATIENTS REQUIRE NORMAL LEVELS OF MITOCHONDRIA AND BETA-CATENIN TO UTILIZE BUTYRATE METABOLISM AND PROMOTE ULCER HEALING

Abstract BACKGROUND Under normal conditions butyrate produced by obligate anaerobes (e.g. firmicutes) provides the dominant energy source for colonocytes via β-oxidation and the tricarboxylic acid cycle. Ulcerative Colitis (UC) is an inflammatory bowel disease (IBD) characterized by reduced butyrate metabolism and intestinal epithelial cell (IEC) mitochondria (needed for β-oxidation). Given that nonhealing ulcers in UC are associated with reduced crypt fissioning and branching, we asked whether there was a relationship between mitochondrial deficiency and butyrate-induced crypt branching using colonoid cultures grown from human biopsies. METHODS IECs from biopsies taken from active and uninvolved areas of the same UC patient were grown in colonoid cultures. After the second passage, the colonoids with crypt branching were quantified. In separate studies, we modeled mitochondrial deficiency by shRNA knockdown of transcription mitochondrial factor A (Tfam) in human colonoids, a gene responsible for mitochondrial DNA stability and transcription. Both shControl and shTfam colonoids were treated with 5mM of Na-butyrate overnight. NCM460 cells were also treated with 5mM of butyrate overnight, and both ATP levels and TCF/LEF (b-catenin transcriptional activity) were examined. RESULTS Colonoids from active UC segments demonstrated 27% less crypt branching than uninvolved areas. These areas also displayed reduced mitochondria complex levels by WB of IEC. To directly examine the role of mitochondria in these effects, crypt branching was examined in shTFAM-treated colonoids where crypt branching levels were 31% less than shCont-treated colonoids (Fig. 1). Butyrate treatment of both shCont and shTfam colonoids increased crypt formation by 11% and 8%, respectively compared to untreated groups. In addition, butyrate increased levels of ATP by 55% and b-catenin transcriptional activity (TCF-LEF) by &amp;gt;600%. CONCLUSION This data was consistent with the notion that the failure to heal ulceration in UC patients involves both 1) reduction in butyrate availability from the microbiome (ie reduced stimulation) and 2) reduced mitochondria needed to metabolize butyrate. Upon effective anti-inflammatory treatment, we believe butyrate levels and IEC mitochondrial metabolism increase which contributes to IEC b-catenin signaling and enhanced crypt fissioning/branching needed for effective ulcer healing. We believe this data provide a potential mechanism for how enhanced mitochondrial function contributes to ulcer healing in IBD.

The Association of the Neutrophil-Lymphocyte Ratio With the Outcome of Diabetic Foot Ulcer.

Introduction One of the most common lower-extremity impediments in people suffering from diabetes mellitus (DM) is foot ulceration. Neutrophil-lymphocyte ratio (NLR) is a useful measure in predicting disease-specific morbidity and mortality. Objectives The objective is to study the association between diabetic foot ulcer healing and the NLR. Methodology A prospective analytical study was conducted among 100 patients with diabetic foot ulcers admitted to a surgical ward in a teaching hospital between April and November 2022. Basic demographic details, ulcer examination, and NLR were evaluated on the day of admission, and the status of ulcers was assessed after six weeks and the outcome was compared with the NLR value. Data analysis was done using SPSS version 20 software (SPSS, Inc., Chicago, IL). Results The average neutrophils, lymphocytes, and neutrophil-lymphocyte ratio were, respectively, 94.73%, 14.97%, and 6.65%. 58% had healing ulcers, and 42% had non-healing ulcers. 44% of study subjects had NLR <6, which is normal, and 56% had NLR >6, which is abnormal. Among 58 subjects with healing ulcers, 75.9% had NLR < 6, and among 42 subjects with non-healing ulcers, 100% had NLR >6, which was statistically significant. The mean NLR in the healing group was 5.15 and in the non-healing group was 8.205; this was statistically significant. This shows an increased NLR has a predisposition towards non-healing chronic ulcers with a poor prognosis. Conclusion NLR can be used as a reliable indicator for determining the healing status of diabetic foot ulcers.

Ultrasound Evaluation of Chronic Venous Insufficiency.

Chronic venous insufficiency is a common condition caused by valvular incompetence and/or obstruction of the lower extremity venous system. Chronic venous insufficiency presents in a wide range of clinical presentations, ranging from mild pain or edema to the development of varicose veins and nonhealing venous ulcers. Doppler ultrasound is the preferred imaging modality in the assessment of this condition and provides both anatomical and functional information in a noninvasive, cost-effective, and radiation-free manner. Knowledge of the anatomy and nomenclature, pathophysiology, equipment requisites, scanning protocols, relevant findings, and reporting nuances is essential to the creation of an accurate and clinically actionable report. Evaluation of the superficial and deep venous system for degree and extent of reflux is necessary to establish the diagnosis and to institute appropriate treatment.

Toxinogene Corynebacterium diphtheriae-surinfectie van een chronisch ulcus

Toxigenic Corynebacterium diphtheriae superinfection of a chronic ulcer This article describes the medical history of a 92-year-old Congolese woman with a chronic ulcer on the right inner ankle, present since childhood after scratching small bumps. After returning from a holiday in Congo, the patient had a swollen right lower leg and the ulcer had become remarkably painful. Corynebacterium diphtheriae was cultured from a wound culture and toxin production was demonstrated by a PCR and an immunoprecipitation test (Elek test). Cutaneous diphtheria, usually caused by C. diphtheriae or C. ulcerans, has been on the rise in recent years, primarily due to frequent travelling to endemic areas and migration. The patient was initially treated with azithromycin for 2 weeks, whereafter a control culture showed no evidence of C. diphtheriae. Given the persistent pain symptoms, azithromycin was continued for 2 more weeks. The patient had received only 1 documented vaccine and was thus incompletely vaccinated against diphtheria. A nasopharyngeal carrier status could not be demonstrated. Contact isolation is strongly recommended in patients with toxigenic skin diphtheria since they form a reservoir for secondary transmission with the risk of respiratory diphtheria. Unprotected contacts with the wound exudate should be treated prophylactically with azithromycin 500 mg once a day for 3 days or a single intramuscular administration of 1.2 million units of benzathine-penicillin. Despite large-scale vaccination programs against diphtheria, a physician should include cutaneous diphtheria in the differential diagnosis in case of a non-healing ulcer with a grayish attachment.

Metabolic Profiling Reveals Changes in Serum Predictive of Venous Ulcer Healing.

The aim of this study was to identify potential biomarkers predictive of healing or failure to heal in a population with venous leg ulceration. Venous leg ulceration presents important physical, psychological, social and financial burdens. Compression therapy is the main treatment, but it can be painful and time-consuming, with significant recurrence rates. The identification of a reliable biochemical signature with the ability to identify nonhealing ulcers has important translational applications for disease prognostication, personalized health care and the development of novel therapies. Twenty-eight patients were assessed at baseline and at 20 weeks. Untargeted metabolic profiling was performed on urine, serum, and ulcer fluid, using mass spectrometry and nuclear magnetic resonance spectroscopy. A differential metabolic phenotype was identified in healing (n = 15) compared to nonhealing (n = 13) venous leg ulcer patients. Analysis of the assigned metabolites found ceramide and carnitine metabolism to be relevant pathways. In this pilot study, only serum biofluids could differentiate between healing and nonhealing patients. The ratio of carnitine to ceramide was able to differentiate between healing phenotypes with 100% sensitivity, 79% specificity, and 91% accuracy. This study reports a metabolic signature predictive of healing in venous leg ulceration and presents potential translational applications for disease prognostication and development of targeted therapies.

Chronic non-healing gastric ulcer in a patient with poorly controlled diabetes mellitus.

Chronic non-healing gastric ulcer in a patient with poorly controlled diabetes mellitus.

Mental nerve paraesthesia secondary to nicorandil-induced oral ulceration: a case report

Nicorandil, used as a treatment for angina pectoris, continues to be prescribed in the UK. The association between nicorandil and oral ulceration is well documented. Nicorandil-induced oral ulceration characteristically presents as a persistent, large, deep ulcer that can have a great impact on quality of life. A 63-year-old female was referred to the oral medicine department with a non-healing ulcer and associated paraesthesia of the left lower lip. Her drug history included nicorandil 30 mg once daily. A provisional diagnosis was made of nicorandil-induced oral ulceration with associated paraesthesia, secondary to mental nerve involvement. Following liaison with cardiology, and cessation of nicorandil medication, the ulceration healed, and the patient reported improved sensation to the lower lip. CPD/Clinical Relevance: Nicorandil-induced oral ulceration should be considered in the differential diagnosis of oral ulceration.

EFFICACY OF USING TOPICAL L-LYSINE WITH DEBRIDEMENT IN CHRONIC NON-HEALING ULCERS – A PROSPECTIVE STUDY

INTRODUCTION Chronic non-healing ulceration is a common ailment that can be found all over the world Chronic wounds are those that have not undergone a timely and ordered reparative process to restore anatomic and functional integrity. Poor wound healing may be caused by a number of factors, including ischemia, infection, advanced age, malnutrition, diabetes, venous insufficiency, and renal disease. It has been demonstrated that L-lysine monohydrochloride, also known as L-lysine, is effective in promoting therapeutic angiogenesis in wound healing. MATERIALS AND METHODS STUDY POPULATION AND SAMPLE SIZE: All patients admitted with clinical diagnosis of “NON HEALING NON MALIGNANT ULCERS” under General Surgery care in SRM MEDICAL COLLEGE HOSPITAL AND RESEARCH CENTRE would be taken as Subjects for this study with a sample size of 84 with 42 in each group. All patients presenting with complaints of non-healing, non- malignant ulcers were randomly assigned to receive either Treatment A (topical L-lysine with mechanical debridement) or Treatment B (the control) (betadine with debridement) INCLUSION CRITERIA: Patients of any age or gender who are suffering from noncancerous ulcers that are chronic and do not heal, regardless of their socioeconomic. EXCLUSION CRITERIA: 1. Patients who are suffering from osteomyelitis, ischemic ulcers, and malignant ulcers 2. Patients who are currently receiving chemotherapy, Corticosteroids, or immunosuppressantS RESULTS The difference in mean of Wound dimension, Rate of granulation tissue formation between study group was statistically significant. (p value &lt;0.05). When compared to conventional care the rate of closure was three times faster with lysine gel treatment. DISCUSSION In our study, the graft failure was very minimal in both the groups The difference in mean of Wound dimension, Rate of granulation tissue formation between study groups was statistically significant. Majority of the patients did not develop complications in both the groups. However, Pain was the common complication in lysine group and infection was the common complication in conventional treatment group To achieve the best augmentation of the ulcer closure, treatment must start as soon as the initial wound is debrided CONCLUSION The use of topical l-lysine with debridement in chronic non-healing ulcers is effective treatment strategy in bringing better clinical outcomes, recommending its use from the initial phase of ulcer treatment. We recommend that lysine can be used over the conventional treatment which is beneficial in cosmetic wound appearance size and increased rate of granulation. This is also found to be useful in bypassing the complications of ulcers such as pain and infection. Therefore, we advise topic al lysine as an effective treatment in chronic non-healing ulcers

A Manifold Approach to Assuage the Management of Vishaja-Vrana - A Case Study

The Vrana which are produced by different types of Visha such as Sthavara Visha Jangama Visha and Kritima Visha are known as Vishaja Vrana. Acharya Sushruta elaborately described various types of Vrana and its management in Sushruta Samhitha and also Vishaja Vrana has been exclusively mentioned in Kalpasthana. On the basis of Nidana Vrana can either be classified into Nija or Aganthuja. Vrana caused by any assault or an injury from human beings animals etc. can be considered as Aganthuja Vrana hence Vishaja Vrana can be included as one among the Aganthuja Vrana. Acharya Sushruta has voiced about Shasti Upakramas for the management of Vrana and the same can also be employed for Vishaja Vrana. A 54 year old male subject presented with a non-healing ulcer over his left lower leg due to an accidental bite by his own dog 20 days ago was treated with internal medications and other Upakramas. Under aseptic precautions ulcer was cleaned and dressing was done with Gomutra-Arka Tankana-Bhasma and later changed to Jatyadi Thaila along with Prakshalana and Jalukavacharana. The clinical signs of Vishaja Vrana were improved within 14 days and complete healing was achieved through a period of two months without any complications and other invasive techniques. After detailed study on Vishaja Vrana Chikitsa it was found that all the treatment modalities of Vrana were summarized in Shashti Upakramas of Chikitsasthana. Among these Seka Rakthamokshana Shodhana and Ropana Upakramas were employed in this case study for the management of Vishaja Vrana. Vishaja Vrana remains to be a clinical challenge due to its non-healing nature hence adapting the treatment modalities as per our Acharyas helps in its management by promoting healing and minimizing complications.nbsp

Indolent ulcer and discharging sinus on the eyelid of healthy Indian children and an adult: Orbital tuberculosis, a spot-diagnosis

Five cases of tuberculous osteomyelitis of the fronto-zygomatic (F-Z) region presented with a non-healing ulcer or discharging sinus in the eyelid skin in healthy children and an adult. Lack of awareness about peri-ocular manifestations of extra-pulmonary tuberculosis and delayed referral to specialists, along with poor compliance to long-term ATT, could be the reason for its underreporting in India.

Bacteriological profile and antibiotic sensitivity pattern in diabetic foot ulcer: A retrospective study

Background: Diabetic foot ulcers (DFUs) pose a significant risk for individuals with long-standing diabetes mellitus, leading to hospitalizations and potential amputations. The prevalence of diabetes in India is expected to reach 57 million by 2025. DFUs are resolvable complications, with proper treatment resulting in healing rates of 75–80%, while a percentage of cases may require amputations. Effective management requires a multidisciplinary approach, including sterile dressing, meticulous foot care, and appropriate antibiotic therapy. The irrational use of antibiotics, often based on random choices before obtaining culture reports, contributes to the burden. DFUs impact the quality of life, exacerbate the economic burden, and affect low socioeconomic groups disproportionately. This study proposes an antibiotic policy to reduce irrational antibiotic use until sample reports are available, promoting more rational prescribing practices. Aim and Objectives: The aim of the study was (i) to identify commonly infecting organisms in DFU cases; (ii) to look for the prevalence of antimicrobial resistance in cases of DFU; and (iii) to come up with a disease and region-specific antibiogram. Materials and Methods: The culture and sensitivity reports of DFU swabs were retrospectively procured from multiple microbiology labs between September 2018 and September 2019. The data collected were tabulated into Excel worksheet and analyzed. The results were then simplified into pie and bar charts. Many descriptive statistical tools such as percentage and mean were used to come to a conclusion. Results: 159 cases of DFUs were examined, revealing that 81% of cases occurred in men and the incidence increased with age, with 65% of cases being over the age of 50 years. Staphylococcus aureus was the most common infecting organism (20.75%), followed by Klebsiella, Escherichia coli, and Pseudomonas. Non-healing ulcers in 9.7% of cases showed no bacterial growth. Amikacin exhibited the highest sensitivity (60%), whereas ceftazidime demonstrated the highest resistance (66%). Over 80% of patients had long-standing diabetes for over 15 years. Conclusion: The study highlights the prevalence of antibiotic-resistant organisms and the need for a well-defined antibiotic protocol. Uncontrolled diabetes increases the risk of DFUs. Empirical antibiotic treatment is crucial before culture reports, and amikacin, cefazolin, and vancomycin combination therapy is effective. Ceftazidime, amoxicillin/clavulunate, and cefotaxime should be avoided. The patient education on foot care is vital.

Basal Cell Carcinoma Arising From a Nonhealing Lower Extremity Ulcer: A Case Report

Introduction. BCC is a malignancy that arises from the basal cells of the epidermis. Despite being the most common cancer worldwide, it rarely occurs in the setting of long-standing ulceration. Malignant transformation of wounds and scars is typically associated with the development of SCC, as with an MU. Reports in the literature of BCC arising within nonhealing, lower extremity wounds are limited. Case Report. The authors report a case of a 65-year-old man with several comorbidities who presented to the clinic with a nonhealing wound on the right lateral ankle. The wound first began as warts during childhood that had necessitated frequent debridement. The lesions persisted and, 7 years ago, developed into an ulcer with a large fungating mass associated with pain, bleeding, and foul-smelling exudate. Biopsy findings were consistent with infiltrative-type BCC. He was not a surgical candidate given his comorbidities and was instead treated with radiation therapy. No evidence of metastasis was seen on follow-up imaging. Conclusion. This case highlights the importance of prompt biopsy and cultures in patients with suspicious ulcers and wounds that do not respond to appropriate treatment.

The Effectiveness of a Medical Cocktail Therapy for Nonhealing Refractory Ischemic Diabetic Foot Ulcers

Abstract Diabetic foot ulcers are a serious complication of diabetes mellitus. Healing of ischemic or neuroischemic foot ulcers is most challenging as conventional therapies often fail to achieve adequate vascularity. Heel ulcers can be very severe and strenuous to treat and can eventually lead to amputation of the limb due to poor vascularity. Optimizing therapies to improve vascularity should, therefore, be a major goal in treating such cases. Here, we report two cases of chronic nonhealing ischemic ulcers of the heel. Patients approached us after conventional medical treatments failed to achieve healing. We treated them with a cocktail (Diabcare protocol) that we formulated using existing medications along with appropriate wound care and antibiotics. Diabcare protocol comprises rosuvastatin, aspirin, rivaroxaban, cilostazol, tadalafil, and zinc sulfate. Serial measurements of ulcers revealed progressive healing and wound contraction. Vascularity improved significantly, and fresh granulation appeared within days to weeks of initiation of therapy. Ulcers healed completely, with spontaneous epithelialization in the first case and after a split skin graft (SSG) in the second case, within a mean period of 3 months.

Management of nonhealing venous leg ulcer: A case report

Management of nonhealing venous leg ulcer: A case report

Synthetic Hybrid-Scale Fiber Matrix for the Treatment of Complex Lower-Extremity Wounds.

Chronic, nonhealing wounds are a growing health-care problem in the United States, affecting more than 6.5 million patients annually and costing the health-care system over $25 billion. Chronic wounds, including diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs), are often difficult to treat, and patients commonly fail to heal even with the most advanced therapies. The present study was designed to evaluate the efficacy and utility of the synthetic hybrid-scale fiber matrix in the treatment of complex chronic nonhealing lower-extremity ulcers refractory to advanced therapies. A retrospective analysis of 20 patients with a total of 23 wounds (DFUs, n = 18; VLUs, n = 5) who underwent treatment using the synthetic hybrid-scale fiber matrix was conducted. The majority of ulcers (78%) included in this study were refractory to one or multiple previous advanced wound therapies and therefore considered difficult-to-heal ulcers with high failure risk for future therapies. Subjects had a mean wound age of 16 months and presented with 132 secondary comorbidities and 65 failed interventions and therapies. Treatment of VLUs with the synthetic matrix resulted in complete closure of 100% of the wounds over 244 ± 153 days with an average of 10.8 ± 5.5 applications. Treatment of DFUs with the synthetic matrix resulted in complete closure of 94% of the wounds over 122 ± 69 days with 6.7 ± 3.9 applications. Treatment with the synthetic hybrid-scale fiber matrix resulted in the closure of 96% of complex chronic ulcers refractory to existing therapies. The inclusion of the synthetic hybrid-scale fiber matrix in wound care programs provides a critical and needed solution for costly, long-standing refractory wounds.

Trigeminal trophic syndrome, a rare and often overlooked cause of facial ulceration: a case report and literature review

Trigeminal trophic syndrome (TTS) is an uncommon and relatively unknown cause of facial ulceration that occurs after damage to the trigeminal nerve. It characteristically involves non-healing facial ulceration(s) with accompanying anesthesia, paresthesia, and dysesthesia along the distribution of a trigeminal dermatome. The ulcerations are believed to be self-induced in response to paresthesia. The disease is most common in middle-aged women, manifesting as a unilateral crescent-shaped ulceration on the ala nasi, with sparing of the nasal tip. The diagnosis is clinical and mostly based on exclusion of other possible causes of facial ulcerations, with emphasis on neoplasms, infection-associated vasculitis, and factitial disorders. There are no specific histological or laboratory signs. There is no standard treatment protocol; however, a number of different successful strategies have been reported, including pharmaceutical and surgical interventions, transcutaneous nerve stimulation, and simple occlusion dressings. Due to the self-inflicted nature of this disorder, the cornerstone of management is patient education with behavioral modification. Here, we report a case of TTS following herpes zoster ophthalmicus and review the current literature on this subject.