phenylephrine-hydrochloride and Skin-Ulcer

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 orretrospective controlled studies are necessary to make more reliable recommendations, though may be challenging given the rarity of TTS.

Topics: Face; Humans; Nose; Skin Ulcer; Syndrome; Ulcer

The case of a 75-year-old Caucasian woman with a trigeminal trophic syndrome (TTS) is presented and discussed. TTS of the ala nasi subsequent to a herpes zoster infection has not been described previously. We provide a review of the literature with insights into the pathogenesis and current therapeutic strategies.

Topics: Aged; Female; Follow-Up Studies; Herpes Zoster; Humans; Nose; Skin Ulcer; Surgical Flaps; Syndrome; Tomography, X-Ray Computed; Treatment Outcome; Trigeminal Neuralgia; Wound Healing

Topics: Adult; Cranial Nerve Diseases; Diagnosis, Differential; Humans; Hypesthesia; Male; Nose; Skin Ulcer; Trigeminal Nerve

Trigeminal trophic syndrome (TTS) is an uncommon and relatively unknown cause of facial ulceration that occurs after damage to the trigeminal nerve. It characteristically involves non-healing facial ulceration(s) with accompanying anesthesia, paresthesia, and dysesthesia along the distribution of a trigeminal dermatome. The ulcerations are believed to be self-induced in response to paresthesia. The disease is most common in middle-aged women, manifesting as a unilateral crescent-shaped ulceration on the ala nasi, with sparing of the nasal tip. The diagnosis is clinical and mostly based on exclusion of other possible causes of facial ulcerations, with emphasis on neoplasms, infection-associated vasculitis, and factitial disorders. There are no specific histological or laboratory signs. There is no standard treatment protocol; however, a number of different successful strategies have been reported, including pharmaceutical and surgical interventions, transcutaneous nerve stimulation, and simple occlusion dressings. Due to the self-inflicted nature of this disorder, the cornerstone of management is patient education with behavioral modification. Here, we report a case of TTS following herpes zoster ophthalmicus and review the current literature on this subject.

Topics: Face; Female; Humans; Middle Aged; Nose; Paresthesia; Skin Ulcer; Syndrome

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.. In this single case report, a thermoplastic mask was sutured in place overlying the chronic ulcerations of TTS in a 57-year-old man.. Significant re-epithelization of the chronic ulcerations of TTS was seen after only 6 weeks of thermoplastic mask attachment.. 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.

Topics: Humans; Middle Aged; Nose; Paresthesia; Skin Ulcer; Syndrome; Ulcer

Topics: Adult; Granulomatous Disease, Chronic; Humans; Nose; Skin Ulcer

Topics: Acantholysis; Aged; Biopsy; Diagnosis, Differential; Folliculitis; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 3, Human; Humans; Male; Nose; Skin; Skin Ulcer; Varicella Zoster Virus Infection

Topics: Adult; Anti-Bacterial Agents; Cheek; Contact Tracing; Humans; Injections, Intramuscular; Male; Nose; Penicillin G Benzathine; Physical Examination; Primary Health Care; Sexual and Gender Minorities; Skin Ulcer; Syphilis; Tongue Diseases; Treatment Outcome

Topics: Anti-Bacterial Agents; Brain Infarction; Diagnosis, Differential; Disease Management; Forehead; Humans; Male; Middle Aged; Mupirocin; Nose; Occlusive Dressings; Skin Ulcer; Trigeminal Nerve Diseases

Topics: Acute Disease; Aged; Drug Eruptions; Female; Foot Dermatoses; Hand Dermatoses; Humans; Male; Methotrexate; Middle Aged; Nose; Severity of Illness Index; Skin Ulcer

Topics: Diagnosis, Differential; Female; Humans; Middle Aged; Nose; Nose Diseases; Skin Ulcer; Trigeminal Nerve Injuries

Topics: Humans; Male; Middle Aged; Nose; Nose Diseases; Skin Ulcer; Stroke; Syndrome; Trigeminal Nerve Diseases

An example of trigeminal trophic syndrome presenting as ulceration of ala nasi in a case of borderline tuberculoid leprosy is reported. To the best of our knowledge, this is only the second case report of this manifestation in leprosy to be documented.

Topics: Biopsy; Humans; Leprosy, Borderline; Leprosy, Tuberculoid; Male; Middle Aged; Nose; Skin Ulcer; Syndrome; Treatment Outcome; Trigeminal Nerve; Trigeminal Nerve Diseases

Topics: Education, Medical, Continuing; Facial Injuries; Female; Humans; Lacerations; Middle Aged; Nose; Paresthesia; Skin Ulcer; Trigeminal Nerve Diseases

Topics: Adult; Chronic Disease; Facial Dermatoses; Female; Humans; Lateral Medullary Syndrome; Nose; Skin Ulcer; Trigeminal Nerve Diseases

Trigeminal trophic syndrome (TTS) is an uncommon medical condition that may be encountered by otolaryngologists and facial plastic surgeons. TTS begins with damage to the trigeminal nerve or its central sensory connections, causing anesthesia in a dermatomal distribution. With repeated scratching and manipulation, an ulceration occurs, often in the alar region. In this multi-institutional report, we summarize a small series of patients with TTS. Treatment options are discussed along with a review of the relevant literature. Although rare, it is important that practicing otolaryngologists be familiar with the classic signs and symptoms of this condition in order to avoid delays in diagnosis and treatment.

Topics: Adult; Female; Follow-Up Studies; Humans; Hypesthesia; Male; Middle Aged; Nose; Nose Diseases; Postoperative Complications; Reoperation; Rhinoplasty; Skin Ulcer; Surgical Flaps; Trigeminal Nerve; Trigeminal Nerve Diseases; Trigeminal Neuralgia

Surgical site infections (SSIs) after dermatologic surgery cause pain, prolong healing, result in unaesthetic complications, and lead to excessive use of antibiotics. The pathogenesis of wound infections is complex and is dependent on bacterial load and diversity, among several factors.. To investigate bacterial dynamics at dermatosurgical sites at different time intervals and assess the correlation with postoperative outcomes and to examine different endo- and exogenous factors that may contribute to SSIs.. Eighteen patients undergoing skin grafting of the face were studied. The following SSI-related factors were registered: age and sex of the patient, ulceration of the lesion, diabetes, immunosuppressive therapy, smoking, anticoagulative therapy, and use of antibiotic prophylaxis. Wounds from each patient were swabbed preoperatively, intraoperatively, and postoperatively. The bacterial composition of the swabs was then analyzed quantitatively and qualitatively.. Sixteen of 18 surgical sites contained varying quantities of surface-associated bacteria. Coagulase-negative staphylococci and Propionibacterium acnes were the predominant bacteria isolated at all times. Intraoperative analysis was not predictive of SSIs. Use of antibiotic prophylaxis was the only registered SSI-related factor that showed significant variation in bacterial load between pre- and postoperative samples. Postoperative bacterial load was found to be lower than preoperative load in patients who received antibiotics. This was in contrast to patients who did not receive antibiotics, who had significantly higher postoperative levels (p=.02). The presence of high postoperative bacterial loads, regardless of the bacterial species isolated, showed a statistically significant positive correlation with a complicated postoperative outcome (p≤.001).. This study provides novel insights into the bacterial dynamics of dermatologic surgery-induced wounds and the variation of this over time. The results highlight the potential relevance of quantifying bacterial loads, as well as determining specific types of bacteria, in dermatologic surgery.

Topics: Aged; Aged, 80 and over; Antibiotic Prophylaxis; Bacterial Load; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cheek; Facial Neoplasms; Female; Floxacillin; Forehead; Humans; Keratosis, Actinic; Male; Middle Aged; Nose; Perioperative Period; Propionibacterium acnes; Skin Neoplasms; Skin Transplantation; Skin Ulcer; Staphylococcus; Surgical Wound Infection; Treatment Outcome

Topics: Accidental Falls; Aged; Biopsy; Facial Dermatoses; Facial Injuries; Female; Humans; Immunocompetence; Mycobacterium tuberculosis; Nose; Skin Ulcer; Tuberculosis, Cutaneous; Wound Infection

The local anesthetics used in dentistry are considered very safe and have a low incidence of adverse reactions associated with their administration. A frequent finding by clinicians engaged in treatment of children is, following a dental appointment requiring local anesthesia to treat dental disease, a child may bite his or her lip out of curiosity associated with the unfamiliar sensation of being numb or inadvertently because no pain is felt. We describe two unusual case reports of postanesthetic self-inflicted injuries in this article. The first being the ulceration due to lip biting and the scratch injury on the chin after inferior alveolar nerve block. The second report presents an unusual scratch injury on the ala of nose following maxillary infiltration anesthesia. The common treatment modalities and the possible methods of prevention are discussed.

Topics: Anesthesia, Dental; Bites, Human; Child, Preschool; Chin; Follow-Up Studies; Humans; Lip; Male; Mandibular Nerve; Nerve Block; Nose; Skin Ulcer

Topics: Dermatitis; Facial Dermatoses; Factitious Disorders; Female; Humans; Middle Aged; Nose; Skin Ulcer

Two dogs were presented with dermal arteritis of the nasal philtrum associated with repeated episodes of bleeding. Described treatment for this condition consists of long-term, usually life-long medication with various combinations of immune suppressant and anti-inflammatory medication. This paper describes a novel surgical approach to the condition that induced long-term remission in both cases.

Topics: Animals; Arteritis; Dog Diseases; Dogs; Female; Hemorrhage; Male; Nose; Plastic Surgery Procedures; Skin Diseases, Vascular; Skin Ulcer; Treatment Outcome

Trigeminal trophic syndrome (TTS) is a rare but well-described syndrome consisting of the triad: paraesthesia, anaesthesia and crescent-shaped ulceration of the ala nasi. We report a case of a 62-year-old woman presenting with TTS after operative excision of an acusticus neurinoma. She attended several different specialized physicians and multiple biopsies were performed before attention was brought to the syndrome due to a history of trigeminal nerve damage combined with the aforementioned triad.

Topics: Diagnosis, Differential; Female; Humans; Middle Aged; Neuroma, Acoustic; Nose; Paresthesia; Postoperative Complications; Skin Ulcer; Syndrome; Trigeminal Nerve

Topics: Aged; Female; Humans; Nose; Skin Ulcer; Syndrome; Trigeminal Nerve Diseases

Pulmonary and disseminated forms of histoplasmosis are very common in AIDS, but primary cutaneous histoplasmosis is rare. We report a case of primary mucocutaneous histoplasmosis in the setting of HIV.

Topics: Adult; Agricultural Workers' Diseases; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Diagnostic Errors; Drug Resistance, Fungal; Ecthyma; Fluconazole; Histoplasmosis; Humans; Itraconazole; Male; Maxillary Sinus; Meningitis, Cryptococcal; Nose; Palate; Skin Ulcer; Tuberculosis, Miliary

Trigeminal trophic syndrome is a rare entity characterized by the presence of ala nasi ulceration, trigeminal anesthesia, and paresthesia. It arises secondary to trigeminal nerve injury. Patients with this diagnosis often undergo repeated skin biopsies to rule out suspected nonmelanoma skin cancer due to the clinical appearance. Recognition of this entity is paramount to avoid unnecessary surgical intervention and to attempt therapy.

Topics: Aged, 80 and over; Female; Humans; Lip; Lip Diseases; Nose; Nose Diseases; Paresthesia; Skin; Skin Ulcer; Syndrome; Trigeminal Nerve Diseases; Trigeminal Nerve Injuries

Topics: Humans; Intubation, Gastrointestinal; Nose; Skin Ulcer; Surgical Tape

Treatment of trigeminal trophic syndrome is challenging and often unsatisfactory, particularly in patients with cognitive impairment. We report the novel use of a thermoplastic dressing in two patients with trigeminal trophic syndrome. Use of the dressing resulted in successful healing of ulceration in both patients, which has been maintained in the short term, representing a simple and economical therapeutic option in the management of this difficult condition.

Topics: Aged, 80 and over; Bandages; Female; Humans; Hypesthesia; Male; Middle Aged; Neurosurgical Procedures; Nose; Postoperative Complications; Skin Ulcer; Syndrome; Trigeminal Nerve Injuries; Trigeminal Neuralgia; Wound Healing

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Brain Neoplasms; Carbamazepine; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Neuroma, Acoustic; Neurosurgical Procedures; Nose; Ointments; Risk Assessment; Skin Ulcer; Treatment Outcome; Trigeminal Nerve Injuries

Topics: Gout; Humans; Joint Diseases; Male; Middle Aged; Nose; Polynesia; Skin Ulcer; Toe Joint

Topics: Aged, 80 and over; Cheek; Facial Dermatoses; Humans; Male; Nose; Pemphigus; Scalp; Skin Ulcer

Two female patients, aged 74 and 91 years respectively, had a skin ulcer on a nostril and ipsilateral sensory paralysis in the area covered by the N. trigeminus. This is known as trigeminal trophic syndrome. It may be caused by (iatrogenic) damage to the trigeminal nerve by chronic manipulation of the senseless skin. Only in case of doubt, histological examination of a tissue sample is advised to exclude malignancy. The main treatment consists of instructing the patient not to manipulate the skin. In some patients surgical reconstruction is necessary.

Topics: Aged; Aged, 80 and over; Female; Humans; Nose; Skin Ulcer; Syndrome; Trigeminal Nerve Injuries; Wound Healing

Nasal augmentation rhinoplasty is a common cosmetic procedure. Alloplastic or synthetic materials are frequently used with Silastic, the most commonly used type worldwide. In the Orient, this common procedure has a low complication rate. However, infection and extrusion of the implant through the skin may occur and patients may be reluctant to report the augmentation procedure to the dermatologist. Therefore, the dermatologist needs to be highly suspicious and include this complication in the differential of ulcerated nasal tip nodules.

Topics: Anti-Bacterial Agents; Combined Modality Therapy; Device Removal; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Prostheses and Implants; Prosthesis-Related Infections; Reoperation; Rhinoplasty; Skin Diseases, Bacterial; Skin Ulcer; Staphylococcal Infections; Staphylococcus aureus; Transplantation, Homologous

A patient developed a trophic ulceration of the nose after an acute bulbar ischemia with infarction of the right trigeminal nuclei. Neurologic examination showed symptoms of a Wallenberg syndrome including ipsilateral hyp- and paresthesia of the second trigeminal branch and disturbed sensibility and temperature sense on the contralateral half of the body. The right ala nasi showed the characteristic sickle-shaped defect (ulcération en arc). The differential diagnosis and therapeutic approaches are discussed.

Topics: Aged; Brain Stem Infarctions; Dominance, Cerebral; Humans; Lateral Medullary Syndrome; Magnetic Resonance Imaging; Male; Nose; Nose Diseases; Skin; Skin Ulcer; Trigeminal Nuclei

Topics: Chronic Disease; Cranial Nerve Diseases; Female; Habits; Humans; Middle Aged; Nose; Reflex; Sensation Disorders; Skin Ulcer; Syndrome; Trigeminal Nerve

Topics: Aged; Eye; Female; Humans; Nose; Pemphigoid, Bullous; Skin Ulcer

Topics: Granulomatous Disease, Chronic; Humans; Infant; Male; Nose; Serratia Infections; Serratia marcescens; Skin Ulcer

The skin ulcer in Leishmania major infection is known to be variable according to the inoculation sites even in a susceptible host. The present study traced the immunoblot patterns by the site of inoculation and duration of infection in BALB/c mice. L. major were subcutaneously inoculated on the nose, footpad, and back of the mice, in a dose of 3 x 10(6) promastigotes. Sera of the mice were collected every 10 days after inoculation. SDS-PAGE separated soluble protein bands of the promastigotes and immunoblot was carried out with the infection sera. The skin ulcer first appeared on the nose at 15 days, and on the footpad at 17 days after inoculation. The ulcer on the back appeared after 90 days. In the mice with ulcer on the nose or footpad, serum IgG antibody reacted to 202, 139, 98, 83, 81, 67 65, 62, 59, 54, 52, 42, 26 and 23 kDa bands at 20 days after inoculation. In mice inoculated on the back, however, the immunoblot showed visible reactions with 202, 83, 81, 74, 67, 65, 62, 59, 54, 52, 20 and 17 kDa bands at 90 days after inoculation. The present result showed that the antigenic protein bands of L. major promastigotes were differed by the inoculation site and duration of infection. Since the skin ulcer and the serum antibodies to antigenic bands between 67-52 kDa appeared simultaneously, it is suggested that the serum IgG antibodies may play a role in formation of the skin ulcer in BALB/c mice.

Topics: Animals; Antibodies, Protozoan; Antigens, Protozoan; Back; Foot; Immunoblotting; Immunoglobulin G; Leishmania major; Leishmaniasis, Cutaneous; Mice; Mice, Inbred BALB C; Nose; Skin Ulcer; Time Factors

Seven cases of trigeminal trophic syndrome are reported. In this rare condition, neurotrophic ulcers occur on the face, especially in the ala nasi area in a dermatome of the trigeminal nerve that has been rendered anesthetic, usually as a complication of trigeminal ablation by surgical means or injection for treatment of trigeminal neuralgia. The period from time of trigeminal nerve injury to onset of the ulcer varies from weeks to several years, with a mean of 1 to 2 years. Self-induced trauma is believed to produce the tissue destruction. Once the ulcers appear, they are extremely persistent.

Topics: Adult; Aged; Facial Dermatoses; Female; Humans; Male; Middle Aged; Nose; Skin Ulcer; Syndrome; Time Factors; Trigeminal Nerve

To determine the prevalence and clonality of non-toxigenic Corynebacterium diphtheriae biovar gravis in a community with two cases of endocarditis caused by this organism.. A Koorie (Aboriginal) community in Gippsland, eastern Victoria, in 1994.. Nose and throat swabs were collected from 359 community contacts of the cases and cultured for C. diphtheriae. Strains isolated from the contacts were compared by pulsed-field gel electrophoresis (after digestion with Sma1, Not1 and Sfi1) with those from the invasive cases in the same community, another invasive case in Victoria, a cluster of invasive cases in New South Wales (NSW) (1990-1991), and other stored strains isolated from skin ulcers and sore throats.. Non-toxigenic strains of C. diphtheriae biovar gravis were isolated from throat swabs of five of the case contacts. Uniform DNA patterns were found for the two community cases, the other Victorian case, nine of ten isolates from NSW, and the five throat isolates from case contacts.. An invasive clone of C. diphtheriae biovar gravis appears to have been responsible for the three Victorian cases of endocarditis. It was also present among case contacts and responsible for previous invasive cases in NSW. Prophylactic treatment should be considered for clearly defined contacts in all instances where C. diphtheriae is isolated from a normally sterile site, regardless of the toxigenic nature of the strain.

Topics: Adult; Arthritis, Infectious; Australia; Carrier State; Child; Chronic Disease; Corynebacterium diphtheriae; Corynebacterium Infections; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Native Hawaiian or Other Pacific Islander; Nose; Pharynx; Prevalence; Skin Ulcer

Topics: Child; Cytokines; Female; Humans; Immunologic Deficiency Syndromes; In Vitro Techniques; Interferon-gamma; Mitogens; Mycobacterium Infections; Necrosis; Nose; Opportunistic Infections; Recombinant Proteins; Skin Ulcer; T-Lymphocytes

Neurotrophic ulceration of the face is a rare but well recognized sequel to division of the trigeminal nerve. Trauma is an important contributory factor and thought to be due in part to paraesthesiae, which encourages picking and scratching, with resultant chronic and persistent ulceration. A case is described of an 82-year-old woman with severe trigeminal neurotrophic ulceration which improved substantially with pimozide, given for treatment of unrelated paranoid symptoms. The possible relevance of this to the established use of pimozide in delusional parasitosis is briefly discussed.

Topics: Aged; Aged, 80 and over; Atrophy; Cognition Disorders; Facial Dermatoses; Female; Humans; Nose; Pimozide; Skin Ulcer; Trigeminal Nerve

A 61-year-old man consulted for two long-standing ulcerations on the scalp and one on the nose, following an acute vascular disorder of the brain stem (Wallenberg's syndrome). The aetiology and pathogenesis of neurotrophic ulcers are briefly discussed.

Topics: Humans; Lateral Medullary Syndrome; Male; Middle Aged; Nose; Scalp; Skin Ulcer

Topics: Aflatoxins; Animal Feed; Animals; Drug Interactions; Glycine max; Lip; Male; Mouth; Necrosis; Nose; Oryza; Penis; Skin Ulcer; Swine; Swine Diseases; T-2 Toxin; Zea mays

Topics: Face; Female; Humans; Nose; Skin Ulcer; Surgical Flaps

Topics: Ear; Face; Facial Neoplasms; Humans; Nose; Prostheses and Implants; Radiation Injuries; Skin Transplantation; Skin Ulcer; Surgery, Plastic; Transplantation, Autologous

Topics: Face; Female; Humans; Nose; Skin Ulcer; Trigeminal Neuralgia

Snout rubbing led to ulceration and necrosis in pigs subjected to it. Only animals of specific colouring were attacked.

Topics: Animals; Behavior, Animal; Darkness; Female; Housing, Animal; Male; Muscles; Necrosis; Nose; Skin; Skin Pigmentation; Skin Ulcer; Swine; Swine Diseases

Topics: Adipose Tissue; Aging; Ankle; Bony Callus; Cataract Extraction; Chymotrypsin; Cryosurgery; Female; Foot; Hair; Humans; Middle Aged; Nose; Radiography; Skin; Skin Ulcer; Werner Syndrome

Topics: Cerebrovascular Disorders; Diagnosis, Differential; Herpes Labialis; Humans; Hyperesthesia; Intracranial Embolism and Thrombosis; Lateral Medullary Syndrome; Male; Middle Aged; Necrosis; Neurologic Examination; Neurologic Manifestations; Nose; Physical Examination; Skin Ulcer

Topics: Carcinoma, Basal Cell; Diagnosis, Differential; Ear, External; Eyeglasses; Female; Humans; Male; Middle Aged; Nose; Rheumatoid Factor; Rheumatoid Nodule; Skin Ulcer

Topics: Carcinoma, Basal Cell; Diagnosis, Differential; Geriatrics; Humans; Neurosurgery; Neurosurgical Procedures; Nose; Postoperative Complications; Skin Ulcer; Trigeminal Nerve; Trigeminal Neuralgia

Topics: Humans; Neurosurgery; Neurosurgical Procedures; Nose; Postoperative Complications; Skin Ulcer; Trigeminal Nerve; Ulcer