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Đorđević Betetto L, Bajuk V. Trigeminal trophic syndrome, a rare and often overlooked cause of facial ulceration: a case report and literature review. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2023. [DOI: 10.15570/actaapa.2023.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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Trigeminal Trophic Syndrome: A Comprehensive Review of a Surgical Approach. J Craniofac Surg 2022; 33:1809-1812. [PMID: 35034087 DOI: 10.1097/scs.0000000000008466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Trigeminal trophic syndrome (TTS) is an exceedingly rare disease that causes facial ulceration, most commonly at the nasal ala. The overall incidence of TTS is not known, with less than 150 cases published in the literature.We searched the United States National Library of Medicine National Institutes of Health (PubMed) using the terms "Trigeminal Trophic Syndrome" and "TTS" as keywords. Publications in all languages were included if an English abstract was available. We reviewed 111 cases of TTS described in 75 publications from 1979 to 2021.Fourteen cases involved surgical reconstruction. Of these, the lesions completely healed in 7 cases (50%), recurred in 5 (36%), and were unspecified in 2 (14%). Reconstruction was completed in a 2 to 3-stage approach in 6 cases; of these, healing without recurrence was observed in 5 cases (83%). When donor tissue from the affected side was used as a basis for reconstruction, healing without recurrence was observed in 2 cases (50%). This is in comparison to the use of contralateral, sensate tissue in which there was healing without recurrence in all 3 cases (100%).The surgical management of TTS remains a topic of controversy. The rates of success remain comparable despite the use of various flap types. However, the use of contralateral, sensate flaps and a staged surgical approach appears to be effective based upon the best available evidence in the literature. Further prospective or retrospective controlled studies are necessary to make more reliable recommendations, though may be challenging given the rarity of TTS.
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Pisano C, Fox M, Reichenberg J. An innovative approach in the treatment of trigeminal trophic syndrome. J DERMATOL TREAT 2021; 33:2373-2375. [PMID: 34256671 DOI: 10.1080/09546634.2021.1950599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Trigeminal trophic syndrome (TTS) is a rare disorder that presents as ulceration of the nasal ala, and less often ipsilateral cheek, cutaneous lip, and forehead, following damage to the trigeminal nerve. TTS is often very difficult to treat due to anesthesia and paresthesia along the distribution of the trigeminal nerve, which often leads to a large behavioral component of this disease. METHODS In this single case report, a thermoplastic mask was sutured in place overlying the chronic ulcerations of TTS in a 57-year-old man. RESULTS Significant re-epithelization of the chronic ulcerations of TTS was seen after only 6 weeks of thermoplastic mask attachment. CONCLUSION While TTS is a chronic and difficult to treat disease, the use of a thermoplastic mask in the treatment of this disease can significantly decrease the self-manipulation component and allow for re-epithelization and healing of the chronic ulcerations.
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Affiliation(s)
- Catherine Pisano
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Matthew Fox
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Jason Reichenberg
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, Texas
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Surgenor L, Campbell V, Hunter H. "Atypical unilateral facial ulceration in a 6-year-old boy". Pediatr Dermatol 2021; 38:285-286. [PMID: 33630373 DOI: 10.1111/pde.14466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Laura Surgenor
- Department of Dermatology, Royal Victoria Hospital, Belfast, UK
| | | | - Helen Hunter
- Department of Dermatology, Royal Victoria Hospital, Belfast, UK
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Gkini MA, Ahmed A, Aguilar-Duran S, Assalman I, Kentley J, Shah R, Taylor R, Bewley AP. Atypical variant of trigeminal trophic syndrome successfully treated with pregabalin: a case report series. Clin Exp Dermatol 2019; 44:225-228. [DOI: 10.1111/ced.13627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M.-A. Gkini
- Dermatology Department; Royal London Hospital; Barts Health NHS Trust; London UK
| | - A. Ahmed
- Dermatology Department; Luton and Dunstable University Hospital; Luton UK
| | - S. Aguilar-Duran
- Dermatology Department; Royal Infirmary of Edinburgh; Edinburgh UK
| | - I. Assalman
- Liaison Psychiatry Department; Royal London Hospital; Barts Health NHS Trust; London UK
| | - J. Kentley
- Dermatology Department; Royal London Hospital; Barts Health NHS Trust; London UK
| | - R. Shah
- Dermatology Department; Royal London Hospital; Barts Health NHS Trust; London UK
| | - R. Taylor
- Liaison Psychiatry Department; Royal London Hospital; Barts Health NHS Trust; London UK
| | - A. P. Bewley
- Dermatology Department; Royal London Hospital; Barts Health NHS Trust; London UK
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Steinhoff M, Schmelz M, Szabó IL, Oaklander AL. Clinical presentation, management, and pathophysiology of neuropathic itch. Lancet Neurol 2018; 17:709-720. [PMID: 30033061 DOI: 10.1016/s1474-4422(18)30217-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 05/15/2018] [Accepted: 06/01/2018] [Indexed: 12/19/2022]
Abstract
Unlike conventional itch, neuropathic itch develops in normal skin from excess peripheral firing or dampened central inhibition of itch pathway neurons. Neuropathic itch is a symptom of the same central and peripheral nervous system disorders that cause neuropathic pain, such as sensory polyneuropathy, radiculopathy, herpes zoster, stroke, or multiple sclerosis, and lesion location affects symptoms more than aetiology. The causes of neuropathic itch are heterogeneous, and thus diagnosis is based primarily on recognising characteristic, disease-specific clinical presentations. However, the diagnosis of neuropathic itch is challenging, different subforms exist (eg, focal vs widespread, peripheral vs central), and the mechanisms of neuropathic itch are poorly understood, resulting in reduced treatment availability. Currently available strategies include treating or preventing causal diseases, such as diabetes or herpes zoster, and topical or systemic medications that calm excess neuronal firing. Discovery of itch mediators such as gastrin releasing peptide, receptors (eg, neurokinin-1), and pathways (eg, Janus kinases) might encourage much needed new research into targeted treatments of neuropathic itch.
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Affiliation(s)
- Martin Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar; HMC Translational Research Institute, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar; College of Medicine, Qatar University, Medical School, Doha, Qatar.
| | - Martin Schmelz
- Department of Experimental Pain Research, CBTM Mannheim, Heidelberg University, Mannheim, Germany
| | - Imre Lőrinc Szabó
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anne Louise Oaklander
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Neuropathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Khan AU, Khachemoune A. Trigeminal trophic syndrome: an updated review. Int J Dermatol 2018; 58:530-537. [PMID: 29931799 DOI: 10.1111/ijd.14098] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/12/2018] [Accepted: 05/25/2018] [Indexed: 11/28/2022]
Abstract
Trigeminal trophic syndrome (TTS) is a rare disease process that is thought to occur after insult to the trigeminal nerve. The earliest descriptions of this condition were provided in the early 20th century, yet it remains relatively unknown, with approximately 200 cases since described. Most commonly seen in older women, TTS characteristically involves persistent facial ulceration with loss of sensation and paresthesia along the distribution of the trigeminal dermatome. Ulceration often occurs in the alar region, following self-manipulation in response to paresthesias. Time of onset of TTS after trigeminal insult may vary from weeks to decades, and emergence of ulceration may be associated with psychiatric disorders. Diagnosis is clinical and made by exclusion of similarly presenting conditions. Histology is nonspecific yet necessary to exclude other causes of facial ulceration. Although there is not yet a standard management strategy, a number of successful approaches have been reported including pharmaceutical and surgical interventions, installation of a protector, and transcutaneous nerve stimulation. However, because of the self-inflicted manifestations of this disorder, behavioral modifications remain of the utmost importance. This review serves to address the history, epidemiology, pathogenesis, clinical presentation, histology, diagnosis, differential diagnosis, and management options for TTS.
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Affiliation(s)
- Ayesha U Khan
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amor Khachemoune
- Veterans Affairs Medical Center, Brooklyn, NY, USA.,Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA
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Zagarella S. Nerve entrapment syndromes in dermatology: Review and practical approach to treatment. Australas J Dermatol 2018; 59:286-290. [PMID: 29676437 DOI: 10.1111/ajd.12822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/07/2018] [Indexed: 11/28/2022]
Abstract
A good understanding of cutaneous nerve entrapment syndromes is important for physicians to provide early and accurate diagnosis and treatment. These syndromes have traditionally been managed with analgesics, antidepressants or antiepileptic medication but this approach is often inadequate and causes frequent adverse medication effects. With early diagnosis and treatment, many nerve entrapment syndromes can be successfully managed with physical, non-pharmacological approaches including stretches, exercises and physiotherapy.
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Affiliation(s)
- Samuel Zagarella
- Department of Dermatology, Concord Hospital, University of Sydney Medical School, Sydney, New South Wales, Australia
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Abstract
Dermatologists face a wide range of pain control challenges in daily practice, from the transient pain of dermatologic surgery to the persistent pain that plagues some chronic dermatologic conditions. Although the pathophysiology of pain is well described and the profound impact of dermatological pain on patients' quality of life is well appreciated, there is an identified need for clear therapeutic plans for providing symptomatic pain relief of common painful dermatoses. In this paper, we will review and clearly outline approaches to pain management of a number of common painful dermatoses such as herpes zoster and post-herpetic neuralgia, ulcers, oral dermatoses, dysesthesias, and many others.
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Shumway NK, Cole E, Fernandez KH. Neurocutaneous disease. J Am Acad Dermatol 2016; 74:215-28; quiz 229-30. [DOI: 10.1016/j.jaad.2015.04.059] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/06/2015] [Accepted: 04/22/2015] [Indexed: 02/01/2023]
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Upshaw WN, Bilyeu CW. Carbamazepine as a Treatment for Trigeminal Trophic Syndrome: A Case Report and Literature Review. PSYCHOSOMATICS 2015. [DOI: 10.1016/j.psym.2015.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- Dominique C Pichard
- Department of Dermatology, Georgetown University Hospital/Washington Hospital Center, Washington, DC
| | - Edward W Cowen
- Dermatology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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