Skip to main content Accessibility help

Ulceration of the nasal dorsum: a rare cause?

  • F Salim (a1), A Joshi (a1) and C Hopkins (a1)



Non-healing ulcers can be caused by a number of conditions, including vascular disease, diabetes, malignancy and some infections. Drug-related ulcers are rare, and a high index of clinical suspicion is required for diagnosis, in parallel with exclusion of more sinister underlying causes.

Case report:

We present a patient with a complex medical background, who had a 10-week history of a non-healing ulcer on his nasal bridge. Inflammatory, autoimmune and malignant causes for the ulcer were excluded by histopathology.


Nicorandil was deemed to be the most likely cause for the patient's ulcer. Nicorandil is an anti-anginal medication known to cause oral ulceration and skin lesions in the perianal and peristomal regions and around surgical wounds. However, there are no previously reported cases of facial ulcers. The ulcer required surgical debridement and healed completely within six months, following discontinuation of nicorandil. This case highlights the importance of having a high index of clinical suspicion regarding non-healing ulcers, and of considering drugs as an aetiological factor, especially in patients with a complex medical background who are taking numerous medications.


Corresponding author

Address for correspondence: Mr Fakhruddin Salim, ENT Department, 3rd Floor, Southwark Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK E-mail:


Hide All

Presented at the 141st Semon Club Meeting, 2 June 2011, London, UK



Hide All
1Sánchez-Arenas, R, Sánchez-García, S, García-Peña, C, García-Gonzàlez, JJ, Rivera-García, BE, Juárez-Cedillo, T. Drug-drug interactions at hospital admission in geriatric patients in a single facility: a retrospective study. Int J Clin Pharmacol Ther 2012;50:426–30
2Challacombe, SJ, Setterfield, J, Shirlaw, P, Harman, K, Scully, C, Black, MM. Immunodiagnosis of pemphigus and mucous membrane pemphigoid. Acta Odontol Scand 2001;59:226–34
3Yasu, T, Ikeda, N, Ishizuka, N, Matsuda, E, Kawakami, M, Kuroki, M et al. Nicorandil and leukocyte activation. J Cardiovasc Pharmacol 2002;40:684–92
4Reichert, S, Antunes, A, Trechot, P, Barbaud, A. Major aphthous stomatitis induced by nicorandil. Eur J Dermatol 1997;7:132–3
5Patel, GK, Harding, KG. Nicorandil ulcer: moves beyond the mucosa. Ann R Coll Surg Engl 2010;92:451–2
6Shotts, RH, Scully, C, Avery, CM, Porter, SR. Nicorandil induced severe oral ulceration. A newly recognized drug reaction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:706–7
7Desruelles, F, Bahadoran, P, Lacour, J. Giant oral aphthous ulcers induced by nicorandil. Br J Dermatol 1998;138:712–13
8Webster, K. Nicorandil induced oral ulceration. Br Dent J 2005;198:619–21
9Kawamura, T, Kadosaki, M, Nara, N, Wei, J, Endo, S, Inada, K. Nicorandil attenuates NF-kappaB activation, adhesion molecule expression, and cytokine production in patients with coronary artery bypass surgery. Shock 2005;24:103–8
10Ismail, HAF, Khalifa, MMA, Hassan, MK, Ashour, OM. Insights in the mechanisms underlying the anti-ulcer activity of nicorandil. Pharmazie 2007;62:60–6
11Boulinguez, S, Bonnetblanc, JM. Aphthae or painful ulcers induced by nicorandil [in French]. Presse Med 2000;29:1828–32
12Choi, Y, Lee, SE, Fukuda, S, Hashimoto, T, Kim, S-C. Mucous membrane pemphigoid with immunoglobulin G autoantibodies against full-length and 120-kDa ectodomain of BP180. J Dermatol 2010;38:169–72



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed