We present the case of a 49-year-old woman with trigeminal trophic syndrome (TTS), also known as trophic trigeminal neuralgia, trigeminal neurotrophic ulceration, and/or trigeminal neuropathy with nasal ulceration. Our case represents an uncommon report of intractable itching and chronic pain associated with TTS. Emphasis was placed on skin biopsy histology, which revealed no neuronal innervation of the affected scalp despite reports of intractable itching and chronic pain. Trigeminal trophic syndrome of the V1 branch of the trigeminal nerve secondary to herpes zoster (HZ) with correlated histology is described. This article provides a discussion of TTS and correlated histology as well as a brief discussion of intractable itching and postherpetic neuralgia.