A 53-year-old male, a chronic alcoholic without other comorbidities, presented with progressive, recalcitrant ulceration of the left ala nasi, with extension to the cheek and forehead on the same side, over a period of two-months. Four months earlier, he had been involved in a road traffic accident and sustained a left cerebellar infarct and left lateral medullary syndrome. This resulted in slurred speech, involuntary upper limb tremors, and a tendency to sway to the left side while walking, but without any injury to the left side of his face.
The patient reported a history of pruritus and persistent dysesthesia, which led to frequent rubbing and scratching, culminating in ulceration on the left side of his face. On cutaneous examination, a sharply demarcated superficial ulcer measuring 5 × 3 cm was observed on the left zygomatic region and left ala nasi, following the distribution of the V2 branch of the trigeminal nerve. Additionally, a similar ulcer measuring 6 × 2 cm was also noted on the frontal region, corresponding to the distribution of the V1 branch of the trigeminal nerve [Figure 1]. Neurological examination confirmed trigeminal paraesthesia and a diminished corneal reflex. Ophthalmic examination of the left eye revealed grade 4 cicatricial entropion of the lower eyelid, a corneal ulcer measuring 9 × 4.7 mm with stromal infiltrates, and corneal edema.
Figure 1.
Ulceration of the left ala nasi with extension to the adjacent cheek and forehead on the same side
The patient was diagnosed with trigeminal trophic syndrome, based on clinical features, including facial paraesthesia, a prolonged history of repetitive physical manipulation of the affected area, and the history of head injury.
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