# Crossroads of Neurodermatology: Trigeminal Trophic Syndrome

## TL;DR

An elderly patient with trigeminal neuralgia developed a rare skin ulcer condition called trigeminal trophic syndrome, highlighting the need for better understanding and treatment.

## Contribution

This case report highlights the rare condition TTS in the context of trigeminal neuralgia and emphasizes the importance of understanding its pathophysiology.

## Key findings

- The patient's history of trigeminal neuralgia led to the development of trigeminal trophic syndrome.
- TTS is a rare ulcerative condition that can arise in patients with trigeminal neuralgia.
- Current treatment for TN often fails to prevent the progression to TTS.

## Abstract

A 98-year-old female, with a past medical history of trigeminal neuralgia (TN) and non-melanoma skin cancer, presented with a crescent-shaped ulcer on her right nasal ala that had been present for months. On exam, the patient was aware of her issue, readily admitted to manipulation of the area, and had a past medical history significant for TN. The patient's history and clinical presentation led to a diagnosis of trigeminal trophic syndrome (TTS). TTS is an extremely rare, ulcerative condition that can arise in patients suffering from TN. While TN itself is well-documented, treatment is often challenging and usually focused on achieving symptomatic relief; for this patient, she did not achieve adequate management of her neuropathic symptoms, and her condition progressed to TTS. Thus, given the patient’s ongoing multi-modal TN treatment, she was encouraged not to pick or manipulate the area to the best of her ability to curb the extent of ulceration. Given that TTS is so infrequently seen, we are hopeful that, by identifying the specifics of the underlying neuronal aberrancies in the future, we may be able to better grasp TTS’s pathophysiology, ulcer development, and potential future treatment options.