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R. Malik, C. Clark, R. Blair, F.C.G. Shaffrali, S. Holmes, Chronic anal ulceration due to nicorandil, British Journal of Dermatology, Volume 152, Issue 4, 1 April 2005, Pages 809–810, https://doi.org/10.1111/j.1365-2133.2005.06501.x
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Sir, We were interested to read the case of nicorandil‐induced anal ulceration described by Passeron et al.1 We too have encountered this unusual drug reaction and, like the case described by Passeron et al. the cause of the ulceration went unrecognized for many months in one patient.
Patient 1. A 64‐year‐old woman had long‐standing essential hypertension and known ischaemic heart disease (IHD). She was commenced on nicorandil 10 mg twice daily for angina and the dosage was increased to 20 mg twice daily. The drug was well tolerated for 3 years. Subsequently, the dose of nicorandil was increased to 30 mg twice daily and within 6–8 weeks she developed large areas of ulceration affecting the vulva, perineum and perianal skin (Fig. 1). She was managed by the colorectal surgeons but the ulceration progressed despite conservative treatment. Multiple biopsies showed a nonspecific chronic inflammatory infiltrate within the dermis. There was no evidence of granulomata, malignancy or vasculitis.
