Halogenoderma Clinical Presentation

  • Author: Lajos Kemeny, MD, PhD, DSc; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Nov 22, 2011
 

History

  • Papulonodular eruptions, having an acneiform appearance, may occur after the ingestion of certain bromide and iodide preparations. The eruptions are less common with fluoride ingestion.
  • Fluoride gel preparations for the prophylaxis of postirradiation dental caries may cause fluorodermas when they are applied to the teeth.[5]
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Physical

Bromoderma tends to be evident as pustules or vegetating plaques; sometimes, plaques with a periphery of pustules appear. In bromoderma, the pustules usually appear on the lower extremities. In iododerma, the pustules are more likely to occur on the face, they appear less papillomatous, and they may become ulcerated.

  • Iododerma is characterized by vesicular, pustular, hemorrhagic, suppurative, and/or ulcerative lesions that occur on the areas of the skin with the highest concentration of sebaceous glands, such as the face; however, the mucous membranes, the extremities, and the trunk can also be affected. Vegetating iododerma has also been reported to be associated with pulmonary infiltrates.[6] Some patients have had swelling of salivary glands (iodide mumps).[7] Localized pustulosis had been reported after povidone-iodine sitz baths.[8]
  • Bromoderma is characterized by multiple, vegetative, ulcerating, and pustular lesions with elevated papillomatous borders, especially on the legs. Bromoderma can appear as a follicular eruption on any hair-bearing body surface and can also occur in the butterfly area of the face.
  • Fluoroderma that develops after the skin is exposed to fluoride-containing preparations resembles iododerma; the papulonodular lesions are numerous and scattered.
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Causes

  • In past years when iodine was used as expectorant, sedative, anti-inflammatory, and antithyroid agents, iododermas were more common. Nowadays, the administration of iodide-containing radiopaque contrast medium[9] for cholecystography[10] and urography is the most common cause, especially in patients in renal failure. 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]
  • Bromoderma develops after an individual consumes bromide-containing drugs.[13] For example, potassium bromide is frequently used as an anticonvulsant drug in the treatment of epilepsy.
  • Fluoride gel preparations, applied topically to the teeth, are prophylactically used as effective cariostatic agents in patients receiving radiation therapy.
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Contributor Information and Disclosures
Author

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.

Coauthor(s)

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

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: American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics, Canadian Dermatology Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and 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, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Bel S, Bartralot R, García D, Aparicio G, Castells A. Vegetant bromoderma in an Infant. Pediatr Dermatol. Jul-Aug 2001;18(4):336-8. [Medline].

  2. 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].

  3. Stone OJ. Proliferative iododerma. A possible mechanism. Int J Dermatol. Nov 1985;24(9):565-6. [Medline].

  4. 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. May 1990;15(3):232-3. [Medline].

  5. Blasik LG, Spencer SK. Fluoroderma. Arch Dermatol. Nov 1979;115(11):1334-5. [Medline].

  6. 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].

  7. 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. Jul 2007;99(1):93-8. [Medline].

  8. Aydingöz IE, Göktay F, Serdar ZA, Yasar S, Aslan C. Iododerma following sitz bath with povidone-iodine. Australas J Dermatol. May 2007;48(2):102-4. [Medline].

  9. Chang MW, Miner JE, Moiin A, Hashimoto K. Iododerma after computed tomographic scan with intravenous radiopaque contrast media. J Am Acad Dermatol. Jun 1997;36(6 Pt 1):1014-6. [Medline].

  10. Boudoulas O, Siegle RJ, Grimwood RE. Iododerma occurring after orally administered iopanoic acid. Arch Dermatol. Mar 1987;123(3):387-8. [Medline].

  11. Wilkin JK, Strobel D. Iododerma occurring during thyroid protection treatment. Cutis. Oct 1985;36(4):335-7. [Medline].

  12. 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].

  13. Smith SZ, Scheen SR. Bromoderma. Arch Dermatol. Mar 1978;114(3):458-9. [Medline].

  14. Cordoliani F, Rybojad M, Morel P, Puissant A. Halogenoderma and monoclonal gammopathy. J Am Acad Dermatol. Dec 1991;25(6 Pt 1):1099. [Medline].

  15. Rosenberg FR, Einbinder J, Walzer RA, Nelson CT. Vegetating iododerma. An immunologic mechanism. Arch Dermatol. Jun 1972;105(6):900-5. [Medline].

  16. Alagheband M, Engineer L. Lithium and halogenoderma. Arch Dermatol. Jan 2000;136(1):126-7. [Medline].

  17. Belaïch S, Crickx B, Schwartz C, Auclerc G, Grossin M. [Vegetating iododerma following lymphography]. Ann Dermatol Venereol. 1985;112(9):699-700. [Medline].

  18. Soria C, Allegue F, España A, Rocamora A, Harto A, Ledo A. Vegetating iododerma with underlying systemic diseases: report of three cases. J Am Acad Dermatol. Mar 1990;22(3):418-22. [Medline].

  19. Zevin S, Hershko C, Rosenmann E. Halogenoderma of the forearm caused by 2-chlorodeoxyadenosine treatment. Am J Hematol. Nov 1996;53(3):209-10. [Medline].

 
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