Ulceration of the nasal dorsum: a rare cause?
BACKGROUND
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.


METHODS
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.


CONCLUSIONS
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.
ENT Department, Guy's Hospital, London, UK.
F
F
Salim
ENT Department, Guy's Hospital, London, UK.
A
A
Joshi
ENT Department, Guy's Hospital, London, UK.
C
C
Hopkins
D003646:Debridement; D005881:Gingiva / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000187:drug effects; D017202:Myocardial Ischemia / Q000188:drug therapy; D020108:Nicorandil / Q000009:adverse effects* / Q000627:therapeutic use; D009666:Nose / Q000473:pathology* / Q000601:surgery; D010392:Pemphigus / Q000139:chemically induced; D016896:Treatment Outcome; D014456:Ulcer / Q000139:chemically induced* / Q000601:surgery; D014665:Vasodilator Agents / Q000009:adverse effects* / Q000627:therapeutic use
D014665:Vasodilator Agents; D020108:Nicorandil