Trigeminal trophic syndrome (TTS) arises when a central or peripheral nervous system lesion impairs trigeminal nerve function and denervates an area of skin. Different causes of neurological damage can cause TTS including surgical ablation of the trigeminal nerve, vascular disorders including vasculitis, brainstem infarction and acoustic neuroma. An ulcerative skin lesion results if the denervated skin is not allowed to heal, in most described cases this is due to repeated picking of skin.

A single interventional case report displaying history, examination and management.

A 59-year-old male with a background of frontal lobe stroke presented one month post varicella zoster ophthalmicus with a non-healing skin ulceration in the distribution of the right-sided ophthalmic branch of the trigeminal nerve. There was significant cicatricial upper lid ectropion with secondary exposure keratopathy and severe corneal ulceration. The patient underwent upper lid full thickness skin grafting and levator recession, however he continued to pick his skin resulting in failure of the graft. Subsequent contraction of the forehead skin resulted in gross facial distortion.

Trigeminal trophic syndrome (TTS) is a rare skin condition characterised by self-inflicted ulceration affecting a distribution of the trigeminal nerve. We describe a case in which cutaneous varicella zoster infection affecting the ophthalmic division of the trigeminal nerve resulted in severe contraction and scarring, with secondary conjunctival and corneal exposure. This case presented many challenges in management.