Abstract

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.

Key Points

* Trigeminal trophic syndrome is an uncommon cause of chronic ulcers which can present as a self-induced nasal ulceration.

* The pathogenesis of trigeminal trophic syndrome involves self-manipulation of the skin following either stroke, sensory denervation of the trigeminal nerve, or therapy for trigeminal neuralgia.

* The differential diagnosis of nasal ulcers includes not only trigeminal trophic syndrome, but also factitial disorders, granulomatous conditions, infectious diseases, malignancy, and pyoderma gangrenosum.

* A biopsy of a nasal ulcer is helpful to exclude other conditions in the clinical differential diagnosis of trigeminal trophic syndrome.

* 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.