Halogenoderma Workup

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

Laboratory Studies

  • Serum or urine bromide and iodide levels should be measured.
  • Serum immunoelectrophoresis should be performed. Monoclonal gammopathy has been reported in some patients with iododerma and bromoderma.[14] Therefore, serum immunoelectrophoresis should be considered.
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Histologic Findings

Cutaneous halogenoderma produces a suggestive pattern of epidermal and dermal changes. Papillomatosis may be observed, sometimes to the level of pseudoepitheliomatous hyperplasia or acanthosis. Often, intraepidermal abscesses form with neutrophils, eosinophils, and, at times, necrotic or even acantholytic keratinocytes within them.[15] These epidermal changes tend to be more pronounced in bromoderma than in iododerma, in which case the epidermis may be more likely to become eroded or ulcerated.

The epidermal and dermal alterations in fluoroderma tend to be milder than those of the other 2 eruptions.

In the dermis, a dense infiltrate of mainly neutrophils and some leukocytoclasia may be initially observed around areas of dermal necrosis. True vasculitis may be present. Eosinophils may also be evident; at times, these may be numerous. Later, the infiltrate becomes more chronic, with a predominance of histocytes that have abundant cytoplasm and large nuclei.

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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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