Intake of iodide or bromide may be associated with a delayed hypersensitivity skin reaction termed iododerma or bromoderma. These can be quite a challenge to diagnose unless the halide intake can be identified.


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


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