Penile Ulceration Associated with Nicorandil Therapy

Patient selection: penile ulcer

Clinical features:

(1) The patient is taking nicorandil.

(2) Other causes of penile ulceration are excluded, with careful exclusion of malignancy.

Differential diagnosis:

(1) squamous cell carcinoma

(2) syphilis or other sexually-transmitted disease

(3) Crohn's disease

(4) trauma

(5) dermatitis herpetiformis

(6) Behecet's disease

Nicorandil needs to be discontinued and alternative therapy initiated.

Circumcision may be necessary but should be deferred until there is clear evidence of re-epithelialization (O'Neill et al).