Sir, statins are inhibitors of 3-hydroxy-3-methylglutarylcoenzyme A (HMG-CoA) reductase that have revolutionised the treatment of hypercholesterolemia. Their beneficial effects have been well documented. According to the British Heart Foundation, over 66 million statins prescriptions were written last year: a figure which has trebled in the past ten years.1

Adverse drug reactions (ADRs) to cardiovascular medication were outlined recently in the literature.2,3 The prevalence of oral manifestations of ADRs is not fully known, and the pathophysiological mechanisms for which these occur have yet to be fully elucidated; there have been reports in the literature associating oral ADRs to simvastatin use.

A 62-year-old gentleman recently presented to our clinic with a 12-month history of a recurrent keratotic lesion with areas of small ulceration on the right lateral border of tongue, which became symptomatic when exposed to acidic or spicy foods. He took regular atorvastatin for hypercholesterolemia; he was a non-smoker and recorded very occasional alcohol intake.

Histopathological analysis through an incisional biopsy suggested candidiasis with focal ulceration. A two week course of systemic fluconazole and topical nystatin were given; despite this the lesion persisted. Three months later, the patient presented with two additional healing aphthous-type ulcers in the buccal sulcus adjacent to the upper left canine and lower right second permanent molar.

Statins were suggested as a potential cause for the ulcerations and so were stopped. Six weeks later, the patient reported complete resolution of symptoms and no episodes of ulceration in this time had been noted. Whilst many patients with oral ulceration have complex polypharmacy, statins are medications that could potentially be stopped without immediate complications and hence a potential causative link could be established or excluded.