Dear Sirs,

We thank Dr Trechot for his letter and interest in our paper entitled ‘Ulceration of the nasal dorsum: a rare cause?’ While we appreciate that the location of the ulceration is unusual for a nicorandil-related ulcer, I can reassure Dr Trechot that we considered the use of a full-face continuous positive airway pressure (CPAP) mask as a causative factor of the ulcer. One of the first interventions upon discovering the ulcer was changing the patient's mask to a different low-pressure fitting mask. Furthermore, the patient discontinued using the full-face mask as the ulcer was causing too much pain.

Despite these measures, the ulcer failed to heal after a waiting period of several months. Attempts at primary closure were also unsuccessful. It was not until nicorandil was completely discontinued that the ulcer started to heal. We appreciate that we cannot rule out the full-face CPAP mask as a precipitating factor; however, we feel very confident that nicorandil played a significant role in the ulcer failing to heal in this particular case.