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CASE REPORT
Year : 1992  |  Volume : 58  |  Issue : 2  |  Page : 116-117

Iododerma




Correspondence Address:
T J Rema


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How to cite this article:
Rema T J, Sarojini P A. Iododerma. Indian J Dermatol Venereol Leprol 1992;58:116-7

How to cite this URL:
Rema T J, Sarojini P A. Iododerma. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2020 Aug 14];58:116-7. Available from: http://www.ijdvl.com/text.asp?1992/58/2/116/3767



  Case Report Top


A 60-year-old man presented with multiple vegetative lesions all over the body of one month duration. A provisional diagnosis of pyoderma vegetans was made. His haemoglobin was 8.5 g I dl and ESR was 100mm /1 st hour. The VDRL test was nonreactive. Chest X-ray showed evidence of healed pulmonary tuberculosis. Pus cultured from the lesion was sterile. He was treated with erythromycin. His lesions regressed and he was discharged. One month later he returned with multiple pustules over the trunk and the extremities

[Figure - 1]. A detailed history revealed that he frequently consumed some expectorants. He was asked to bring the medication. Next week he came with vegetative lesions at the site of the pustules. The expectorant was found to be Asmotone, a proprietary preparation containing, per 5 ml, 100mg of sodium salicylate, 450 mg of sodium iodide, 10mg of ephedrine hydrochloride, 90 mg of anhydrous caffeine, 0.5ml of tincture belladonna with 7 percent ethyl alcohol. He was readmitted, a skin biopsy was taken and he was put on antibiotics. After subsidence of lesions, a challenge dose was given with the same cough syrup and the pustules reappeared within 48 hours [Figure - 2]. His skin biopsy showed changes consistent with iododerma.


  Comments Top


Vegetating iododerma is a very characteristic but rare complication of intake of iodine or its compounds. It has followed intake of iodide containing cough mixtures, [1] after lymphangiography using iodised oils [2] and urography using iodinated contrast media. [3] The lesions may mimic syphilis, deep mycoses, tuberculosis and anthrax. Another important differential diagnosis is blastomycosis-like pyoderma which ' can resemble iododerma both clinically and on histopathology. A history of iodide intake and a positive challenge test help to differentiate the two conditions. Continued exposure to iodides can result in permanent disfiguration [4] and even death. [5]

Iododerma is believed to be a delayed type of hypersensitivity reaction in which iodides act as haptens, combining with serum proteins. No specific treatment is advised, though intravenous sodium chloride and steroids have been tried.

 
  References Top

1.Rosenberg FR, Einbinder, Walzer RA, et al. Vegetating lododerma. Arch Dermatol 1972; 105: 900-5  Back to cited text no. 1    
2.Perroud H, Delacretaz J. Iodides Vegetantes. Annales de dermatologie et de venereologie 1977;104:152  Back to cited text no. 2  [PUBMED]  
3.Heydenreich G, Larsen PO. lododerma after high dose urography in an oliguric patient. Br J dermatol 1977; 97: 567-9.  Back to cited text no. 3  [PUBMED]  
4.Senear FE. Bullous lododerma : rapid recovery following use of intravenous injections of sodium chloride. Med Clin N Amer 1927; 11: 299-332.  Back to cited text no. 4    
5.Hollander L, Fetterman GH. Fatal lododerma : Eleventh case reported in the literature. Arch Derm Syph 1936; 34: 228-41.  Back to cited text no. 5    


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[Figure - 1], [Figure - 2]



 

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