Risk factors:
(1) high intake of a halide (it may occur in breast-fed infants if the mother has a high halide intake)
(2) impaired renal function
Sources of iodide:
(1) potassium iodide (for thyroid disease, expectorant, sporotrichosis, radiocontrast medium, health "tonic")
Sources of bromide:
(1) over the counter medications containing bromide or hydrobromide
(2) brominated vegetable oils (which may be present in some soft drinks)
(3) pesticide methyl bromide
(4) brominated pool or spa disinfectant
Lesions are commonly found on the face, fingers and hands but may occur on any skin surface.
Skin lesions:
(1) tender erythematous nodules
(2) ulcerated nodules
(3) exudative or vegetative plaques
(4) acneiform eruption (acne bromica)
(5) vesiculobullous
(6) pustular psoriasis
(7) hyperpigmented or urticarial lesions
(8) necrotizing panniculitis
Histologic features:
(1) epidermal hyperplasia, including pseudoepitheliomatous hyperplasia
(2) may show intraepidermal and dermal neutrophils with or without eosinophils
(3) may show a leukocytoclastic vasculitis
(4) may show spongiois and keratinocyte necrosis
(5) may show subepidermal blister formation
(6) may show papillary dermal edema
Culture and stains for micro-organisms are negative.
Differential diagnosis:
(1) deep fungal infection (blastomycosis, other)
(2) leishmaniasis
(3) atypical mycobacterial infection
(4) pemphigus vegetans
(5) Sweet's syndrome (early)
(6) pyoderma gangrenosum
