A biopsy specimen from the edge of the ulceration revealed granulation tissue with acute and chronic inflammation. The results of the Tzanck preparation were negative. Histopathologic changes were not specific and suggested a trauma-induced lesion.
Trigeminal trophic syndrome, which was first described in 1933,1 is a diagnosis of exclusion. The distinctive clinical presentation is damage to the sensory root of the trigeminal nerve, with a variety of paresthesias (numbness, burning, pain, crawling, tingling, or delusion of nasal stuffiness) around the nasal ala, resulting in a crescent-shaped lateral nasal ala ulceration.2- 4 It is unclear why only certain patients with facial anesthesia experience paresthesia and why only a few of these patients develop ulcers.
Asymmetric Ala—Diagnosis. Arch Dermatol. 2005;141(7):897-902. doi:10.1001/archderm.141.7.897-h