Halogenoderma

What is a halogenoderma?

A halogenoderma is a rare skin reaction related to high levels of halogen in the body. Halogens are a group of natural elements with similar chemical properties. Examples of clinically relevant halogens are bromine and iodine, and when these are part of compounds, such as medications, they are called bromides and iodides. The skin eruption It can be named for the specific halogen involved: bromoderma and iododerma.

Who gets halogenoderma?

Bromine and bromide

Bromides have been widely used orally as sedatives, antiepileptics, antineoplastics (chemotherapy), spasmolytics (used for colic) and expectorants (cough medicines).

Bromide can still be prescribed in:

• Carbromalhydroxyzine hydrochloride (short-acting sedative)
• Pipobroman (alkylating agent for myeloproliferative disorders, e.g. some types of leukemia)
• Potassium bromide (for epilepsy)
• Ipratropium bromide (bronchodilator)
• Dextromethorphan hydrobromide (cough suppressant in cough mixtures)
• Scopolamine bromide (to treat colic in babies).

Bromoderma has been reported in breastfed babies when the mother was taking a bromine-containing medication.

Bromine poisoning may occur in 1 to 10% of exposed patients.

Citrus-flavored soft drinks may contain brominated vegetable oil as an emulsifier and flavoring. carrier. Excessive consumption of cola drinks and “Ruby Red Squirt” has been reported to cause bromoderma.

Other sources of bromine have included the pesticide methyl bromide, brominated spa pool disinfectants, flame retardants, permanent hair ripple solutions and silver bromide used in photographic films/papers.

Iodine and Iodide

Iodine is used topically, orally, and by injection.

Iodine is commonly used in current antiseptics and there have been rare reports of iododerma after long-term use of iodine-containing antiseptics applied to large areas of broken skin, for example burns and after surgery where the wound has been left open to heal.

Oral iodine is used in the treatment of some thyroid diseases and potassium iodide for skin diseases. erythema nodosum and sporotrichosis. It is found in some expectorants, multivitamins and tonics. Amiodarone, a medicine used to treat angina pectoris and heart arrhythmias (palpitations), has rarely been reported to cause iododerma after 18-24 months of use. Iodine can also be ingested in high-iodine foods such as seaweed, shellfish and iodized salt, with rare cases of iododerma reported after a prolonged and excessive period ingestion.

Iodine is used as a radiological contrast medium for x-rays, including Connecticut examination, cholecystogram and pyelogram, either orally or by injection into the bloodstream. However, the majority of iodine administered in this way would generally be excreted by the kidneys within 24 hours of administration.

The amount of iodine required to cause an iododerma reaction is variable.

The accumulation of halogen in the body appears to be necessary for this reaction, so it usually occurs with:

• Prolonged or excessive use, and/or
• Acute or chronic kidney failure, as the kidneys excrete halogens from the body.

A possible association between halogenoderma and polyarteritis nodosa or myeloproliferative disorders such as multiple myeloma has been suggested.

Proposed mechanisms for halogenoderma

Several theories have been put forward to explain the development of halogenoderma.

1. Delayed hypersensitivity reaction/allergic reaction. Iodine binds to proteins in the bloodstream and it is believed that an allergic reaction develops against this complex. Lymphocytes transformation tests with iodinated humans serum albumin has been positive in some cases.
2. Excretion of halogen through sweat or sebaceous glands can cause a inflammatory Skin reaction.
3. Halogens can generally produce nopathogen or harmless skin microorganisms pathogen.

Clinical features of halogenoderma

It generally takes months of continuous exposure to a halogen to develop a halogenoderma. However, in some cases it may be acute within a few days, particularly after administration of iodine-containing radiological contrast medium for radiographs in patients with renal failure.

Lesions appear most frequently on the face and upper body, but involvement of the extremities and mucous membranes (mouth, conjunctiva of the eye) can also occur.

There are a number of clinical presentations of halogenodermas:

• like acne eruption – pustules and small red bumps (acne medications)

• Vegetation /fungating nodules – raised firm bumps
• exudative plates – large, slightly raised weeping areas
• Vegetating or necrotic ulcer with pustules
• Blisters: small or large; clear, filled with pus or blood
• Tuberous bromoderma: Occurs mainly in babies and begins as small red bumps or pustules that quickly coalesce license plate, most commonly on the face, scalp and legs
• Halogen panniculitis (inflammation fat): red, tender swellings under the skin, usually 1-2 cm in diameter, but can measure up to 10 cm. Abscesses form that can ulcerate and scar. This is part of a systemic disease, initially with fever and diarrhea, but with continued exposure to halogens, abdominal and muscle pain develops, as well as worsening of initial symptoms.

More than one of these skin patterns may occur in an individual. injuries like ulcers and the plates can be solitary or multiple.

Inflammation of the major salivary glands (parotid, submandibular) has been reported after iodine-containing contrast medium and has been termed “iodine mumps.”

In rare cases there may also be systemic symptoms and signs of halogen. toxicity. Bromism includes muscle weakness, personality changes, abnormal gait and seizures while walking. Toxic The effects of iodine include low blood pressure and slow heart rate, kidney failure, inflammation of small blood vessels (leukocytoclastic vasculitis), overactive thyroid and abnormal liver function.

How is the diagnosis of halogenoderma made?

The diagnosis of halogenoderma is usually made on the basis of:

• History of exposure to halogens.
• Clinical features
• Histopathology of a skin biopsy. skin biopsy sample neutrophils white blood cells with eosinophils and lymphocytes at epidermis forming small abscesses. There may also be some swelling in the dermis and involving blood vessels. Bromoderma also tends to show thickening of the epidermis (pseudoepitheliomatous hyperplasia)
• Blood tests, which can confirm the high level of halogen.

However, none of these tests is diagnostic and it is the combination that makes the diagnosis.

Halogenoderma treatment

Stopping halogen will usually result in resolution in 4 to 6 weeks. Bromide has a long half-life in the body, about 12 days, so it takes a while for the blood level to fall. The clinical improvement is parallel to the fall in the blood level of halogen.

Wound care may be necessary for ulcers.

Sometimes active treatment may also be required, including liquid tablets (e.g., frusemide or ethacrynic acid) or intravenous fluids to increase excretion of the halogen by the kidneys, and/or anti-inflammatory medications, such as topical or oral corticosteroids or oral cyclosporine.

Mild post-inflammatory pigmentation or scarring may persist after skin lesions have healed. Very rarely, halogenoderma can be fatal.