Halogenoderma
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Halogenodermas are skin eruptions that result after exposure to halogen-containing drugs or substances. The terms iododerma, bromoderma, and fluoroderma are used to describe skin lesions that occur after an individual consumes iodide-, bromide-, or fluoride-containing preparations. Fluoride-contaminated groundwater runs the risk of cutaneous and visceral adverse effects, a particular concern in Pakistan. [1]
Bromoderma is a cutaneous reaction caused by the use of products containing bromide. The administration of a syrup that contains sodium bromide is one cause. [2] An infant also developed it from a calcium bromide–containing syrup for colic. [3] When cardiac catheterization is performed with iodinated contrast material, vegetating cutaneous nodules can occur. [4]
Halogenoderma may represent a delayed hypersensitivity allergic response. In some studies, the results of lymphocyte transformation tests with iodinated human serum albumin have been positive, suggesting that iodine may act as a hapten.
Iodides can increase the movement of polymorphonuclear leukocytes into the areas of inflammation. Inflammatory mediators released from neutrophils might be responsible for the hyperproliferative and vegetative aspects of the skin lesions. [5] Perhaps, in some cases, these mediators may account for the histopathologic changes of leukocytoclastic vasculitis that are sometimes evident. [6]
In past years when iodine was used as an expectorant, sedative, anti-inflammatory, and antithyroid agent, iododermas were more common. Nowadays, the administration of iodide-containing radiopaque contrast medium [7, 8] for cholecystography [9] and urography is the most common cause, especially in patients in renal failure. Acute iododerma due to iodinated contrast media has been well described. [10] Iodine I 131 treatment for hyperthyroidism [11] has also been reported to induce iododerma of the ankles and feet in approximately 2% of the treated patients. [12] . Oral potassium iodide for hyperthyroidism may produce an acneiform eruption of the face. [13] It may rarely develop after topical use of iodine following topical povidone-iodine application. [14] Iododerma may occur from iodinated multivitamins. [15]
Bromoderma develops after an individual consumes bromide-containing drugs. [16, 17] For example, potassium bromide is frequently used as an anticonvulsant drug in the treatment of epilepsy. Bromocriptine is a dopamine agonist used for pituitary adenomas. [18] It has also been used as a sedative. It may produce bromoderma in infants too. [19]
Fluoride gel preparations, applied topically to the teeth, are prophylactically used as effective cariostatic agents in patients receiving radiation therapy.
Patients with iododermas should be instructed to avoid iodine in their diet, medications, and future radiographic studies.
Rasool A, Farooqi A, Xiao T, Ali W, Noor S, Abiola O, et al. A review of global outlook on fluoride contamination in groundwater with prominence on the Pakistan current situation. Environ Geochem Health. 2017 Dec 19. [Medline].
Bel S, Bartralot R, García D, Aparicio G, Castells A. Vegetant bromoderma in an Infant. Pediatr Dermatol. 2001 Jul-Aug. 18(4):336-8. [Medline].
Hoefel ID, Camozzato FO, Hagemann LN, Rhoden DL, Kiszewski AE. Bromoderma in an infant. An Bras Dermatol. 2016 Sep-Oct. 91 (5 suppl 1):17-19. [Medline].
Miranda-Romero A, Sánchez-Sambucety P, Esquivias Gómez JI, Martínez Fernández M, Bajo del Pozo C, Aragoneses Fraile H, et al. Vegetating iododerma with fatal outcome. Dermatology. 1999. 198(3):295-7. [Medline].
Stone OJ. Proliferative iododerma. A possible mechanism. Int J Dermatol. 1985 Nov. 24(9):565-6. [Medline].
Vaillant L, Pengloan J, Blanchier D, De Muret A, Lorette G. Iododerma and acute respiratory distress with leucocytoclastic vasculitis following the intravenous injection of contrast medium. Clin Exp Dermatol. 1990 May. 15(3):232-3. [Medline].
Rothman LR, Levender MM, Scharf MD, Herman SP, Jabbari A. Iododerma following serial computed tomography scans in a lung cancer patient. J Drugs Dermatol. 2013 May 1. 12(5):574-6. [Medline].
Chang MW, Miner JE, Moiin A, Hashimoto K. Iododerma after computed tomographic scan with intravenous radiopaque contrast media. J Am Acad Dermatol. 1997 Jun. 36(6 Pt 1):1014-6. [Medline].
Boudoulas O, Siegle RJ, Grimwood RE. Iododerma occurring after orally administered iopanoic acid. Arch Dermatol. 1987 Mar. 123(3):387-8. [Medline].
Young AL, Grossman ME. Acute iododerma secondary to iodinated contrast media. Br J Dermatol. 2014 Jun. 170(6):1377-9. [Medline].
Wilkin JK, Strobel D. Iododerma occurring during thyroid protection treatment. Cutis. 1985 Oct. 36(4):335-7. [Medline].
Paul AK, Al-Nahhas A, Ansari SM, Islam N. Skin eruptions following treatment with Iodine-131 for hyperthyroidism: a rare and un-reported early/intermediate side effect. Nucl Med Rev Cent East Eur. 2005. 8(2):125-7. [Medline].
Frankel AJ, Ahmad M, Perl M, Yao J, Pereira F. Acute onset of a vesiculopustular rash in an ICU patient. Dermatol Online J. 2014 Jan 15. 20(1):21249. [Medline].
Aliagaoglu C, Turan H, Uslu E, Albayrak H, Yazici S, Kaya E. Iododerma following topical povidone-iodine application. Cutan Ocul Toxicol. 2013 Apr 8. [Medline].
Torkamani N, Sinclair R. Iododerma in pregnancy secondary to iodinated multivitamins. Australas J Dermatol. 2015 Aug. 56 (3):235-6. [Medline].
Smith SZ, Scheen SR. Bromoderma. Arch Dermatol. 1978 Mar. 114(3):458-9. [Medline].
Oda F, Tohyama M, Murakami A, Kanno K, Sonobe N, Sayama K. Bromoderma mimicking pyoderma gangrenosum caused by commercial sedatives. J Dermatol. 2016 May. 43 (5):564-6. [Medline].
Maeda S, Kajihara I, Ogata A, Johno T, Jinnin M, Ihn H. Bromoderma in a pituitary adenoma patient treated with bromocriptine. J Dermatol. 2017 May. 44 (5):e95-e96. [Medline].
Paloni G, Mattei I, Ravagnan E, Cutrone M. Infantile Bromoderma. J Pediatr. 2013 May 4. [Medline].
Blasik LG, Spencer SK. Fluoroderma. Arch Dermatol. 1979 Nov. 115(11):1334-5. [Medline].
Pranteda G, Grimaldi M, Salzetta M, Di Molfetta M, Palese E, Panasiti G, et al. Vegetating iododerma and pulmonary eosinophilic infiltration. A simple co-occurrence?. Acta Derm Venereol. 2004. 84(6):480-1. [Medline].
Gilgen-Anner Y, Heim M, Ledermann HP, Bircher AJ. Iodide mumps after contrast media imaging: a rare adverse effect to iodine. Ann Allergy Asthma Immunol. 2007 Jul. 99(1):93-8. [Medline].
Aydingöz IE, Göktay F, Serdar ZA, Yasar S, Aslan C. Iododerma following sitz bath with povidone-iodine. Australas J Dermatol. 2007 May. 48(2):102-4. [Medline].
Cordoliani F, Rybojad M, Morel P, Puissant A. Halogenoderma and monoclonal gammopathy. J Am Acad Dermatol. 1991 Dec. 25(6 Pt 1):1099. [Medline].
Rosenberg FR, Einbinder J, Walzer RA, Nelson CT. Vegetating iododerma. An immunologic mechanism. Arch Dermatol. 1972 Jun. 105(6):900-5. [Medline].
Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi
Disclosure: Nothing to disclose.
Lajos Kemeny, MD, PhD, DSc Professor and Head, Department of Dermatology and Allergology, Albert Szent-Gyorgyi Medical Center, University of Szeged, Hungary
Disclosure: Nothing to disclose.
David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, Association of Military Dermatologists, Phi Beta Kappa
Disclosure: Nothing to disclose.
Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center
Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society
Disclosure: Nothing to disclose.
Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.
Neil Shear, MD Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women’s College Health Sciences Center and Women’s College Hospital, Canada
Neil Shear, MD is a member of the following medical societies: Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Dermatology Association, American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics
Disclosure: Nothing to disclose.
Halogenoderma
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