Nicorandil-induced cutaneous ulceration on a pacemaker implantation wound

Background: Nicorandil is a potassium-channel activator used to prevent angina. While mucosal ulceration is a well-known adverse effect of this drug, skin ulcers have been described only rarely, and always in association with mucosal ulcers.

Methods: An 86-year-old woman presented ulceration on a pacemaker implantation scar despite complete initial wound healing. Nicorandil had been initiated three months earlier. None of the usual causes of ulceration of a pacemaker scar were seen. Complete and permanent wound-healing was achieved 12 days after discontinuation of nicorandil.

Conclusions: This is the first reported case of cutaneous ulceration on a vulnerable area of skin ascribable to high-dose nicorandil.