Background
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] Exposure to iodine, including radiographic contrast media, wound irrigation with povidone–iodine solution, iodide supplement use, and amiodarone intake may produce iododerma. [2]
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. [3] An infant also developed it from a calcium bromide–containing syrup for colic. [4] Potassium bromide has also been linked. [5] When cardiac catheterization is performed with iodinated contrast material, vegetating cutaneous nodules can occur. [6]
Pathophysiology
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. [7] Perhaps, in some cases, these mediators may account for the histopathologic changes of leukocytoclastic vasculitis that are sometimes evident. [8]
Etiology
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 [9, 10] for cholecystography [11] and urography is the most common cause, especially in patients in renal failure. Acute iododerma due to iodinated contrast media has been well described. [12] Iodine I 131 treatment for hyperthyroidism [13] has also been reported to induce iododerma of the ankles and feet in approximately 2% of the treated patients. [14] . Oral potassium iodide for hyperthyroidism may produce an acneiform eruption of the face. [15] It may rarely develop after topical use of iodine following topical povidone-iodine application. [16] Iododerma may occur from iodinated multivitamins. [17]
Bromoderma develops after an individual consumes bromide-containing drugs. [18, 19] 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. [20] It has also been used as a sedative. It may produce bromoderma in infants too. [21]
Fluoride gel preparations, applied topically to the teeth, are prophylactically used as effective cariostatic agents in patients receiving radiation therapy.
Patient Education
Patients with iododermas should be instructed to avoid iodine in their diet, medications, and future radiographic studies.
