How do you approach treating patients with trigeminal trophic syndrome?

Very difficult to treat but I have found some success with compounded topical gabapentin (I use gabapentin, amitriptyline, lidocaine from skinmedicinals) +/- PO neuromodulator drugs (gabapentin, TCA) followed by reconstructive surgery with a flap of innervated skin as a last-line.

For an itching trophic neuropathic syndrome, you can try intranasal butorphanol, PO NAC or surgical nerve ablation with pain management or neurosurgery.