Persistent facial ulcers
PATIENT PRESENTATION A 73-year-old widow presents with a six-month history of non-healing sores on the right side of the face. These started on the alar aspect of her nose and extended to involve her cheeks and forehead. Her past history revealed she had developed right ophthalmic shingles three years previously with severe post-herpetic neuralgia requiring trigeminal ganglion ablation for pain control. Although the procedure successfully controlled the pain, within a few months she started developing these dramatic ulcers. What is the cause of these ulcers? ...