C. Trigeminal trophic syndrome
As the patient was unaware of the self-inflicted nature of the injuries, he was advised to wear cotton gloves to prevent further skin damage due to unintentional scratching, and the ulcers were treated with daily occlusive antiseptic dressings. All lesions healed almost completely within 7 weeks, while hypoesthesia and paresthesia of the right face also resolved. The pneumonia responded to antibiotic therapy, while the erythrocyte sedimentation rate and C-reactive protein levels normalized.
Trigeminal trophic syndrome is a rare disease following peripheral or central damage to the fifth cranial nerve.1,2 Unilateral ulcers in the sensory distribution of the trigeminal nerve are characteristic.2 The ulcers are most frequently located in the area supplied by the maxillary division of the trigeminal nerve, that is, on the nasal ala, cheek, and upper lip, sparing the nasal tip.2 Hypoesthesia is often combined with paresthesia in the form of a burning, crawling, and itching sensation. As a result, self-inflicted lesions develop, secondary to unconscious traumatic rubbing and scratching.2 Like skin ulcers from external trauma in general, they typically have sharply demarcated, pauci-inflammatory borders and can be geometrically shaped. There is also the lack of a primary lesion such as pustule, vesicle, or inflammatory papule.