An acneiform eruption secondary to iododerma

Hesseler, Michael J.; Clark, Matthew R.; Zacur, Jennifer L.; Rizzo, Jason M.; Hristov, Alexandra C.

doi:10.1016/j.jdcr.2018.02.005

Cited by 13 publications

(25 citation statements)

References 11 publications

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“…Iododerma, a type of halogenoderma, is a rare neutrophilic dermatosis occurring after exposure to iodine including ICM, irrigation of wounds with povidine iodine, ingestion of iodide supplements and the use of amiodorone. In total, 17 cases of iododerma caused by ICM have been identified (Table ) . These comprised 10 women and 7 men, with an average age of 59 years (range 49–81 years).…”

Section: Reactions To Iodinated Contrast Mediamentioning

confidence: 99%

Contrast media and cutaneous reactions. Part 2: Delayed hypersensitivity reactions to iodinated contrast media

et al. 2019

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Contrast media (CM) are an indispensable part of modern medical imaging. Adverse reactions to CM are uncommon, but frequently involve cutaneous symptoms. This two-part article reviews adverse events secondary to CM that are relevant to the practising dermatologist. Part 1 covers the classification of CM, immediate hypersensitivity reactions to CM and the newly described condition, gadolinium deposition disease. Given that there has only been two case reports to our knowledge of a delayed adverse reaction to gadolinium-based CM, this second part will focus on cutaneous delayed reactions caused by iodinated CM (ICM). Delayed hypersensitivity reactions to ICM commonly present as maculopapular exanthems, but more rarely, they can manifest as fixed drug eruptions, acute generalized exanthematous pustulosis, drug-related eosinophilia and systemic symptoms, Stevens-Johnson syndrome/ toxic epidermal necrolysis, symmetrical drug-related intertriginous and flexural exanthema, graft-versus-host disease, vasculitis and iododerma. Delayed reactions to ICM may be underdiagnosed, as cutaneous symptoms may be attributed to oral medications, particularly if patients are on multiple drugs.

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Section: Reactions To Iodinated Contrast Mediamentioning

confidence: 99%

Contrast media and cutaneous reactions. Part 2: Delayed hypersensitivity reactions to iodinated contrast media

et al. 2019

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“…5 The differential diagnosis includes Sweet syndrome, dimorphic fungal infections, pemphigus vegetans and pyoderma gangrenosum. 1,3 In our case, we considered the diagnosis of bullous Sweet syndrome, but the patient lacked two minor criteria by von den Driesch (did not have a fever nor infection/vaccination/malignant tumours, and laboratory did not show neutrophil predominance). 6 Thus, based on the clinical and histological findings, the diagnosis of iododerma was made.…”

Section: Discussionmentioning

confidence: 99%

“…It most commonly occurs after systemic use of iodine‐containing contrast agents, such as radioactive iodine, supersaturated solution of potassium iodide (for the treatment of deep fungal infections, erythema nodosum or thyroid disease, and sometimes found in expectorants), iodine‐containing supplements and amiodarone. More rarely, iododerma may occur after topical povidone–odine application …”

Section: Discussionmentioning

confidence: 99%

“…Treatment is generally supportive, as resolution depends on the clearance of the absorbed iodine, and may include the use of diuretics and renal replacement therapy. Corticosteroids, ciclosporin and thalidomide may be used in severe cases . We started our patient on prednisone 1 mg/kg/day.…”

Section: Discussionmentioning

confidence: 99%

“…More rarely, iododerma may occur after topical povidone-odine application. 1,2 The aetiology of iododerma remains unknown, but the most widely accepted pathogenic theory is that it represents a delayed hypersensitivity reaction in susceptible individuals and, in some cases, may be caused by serum accumulation of iodine. The main risk factors are acute or chronic renal failure, leading to decreased clearance of iodine.…”

Section: Discussionmentioning

confidence: 99%

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Vegetating lesions from contrast material in a patient with chronic renal failure

et al. 2019

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A 51-year-old hypertensive woman with a history of chronic renal failure, who was receiving haemodialysis through a permanent catheter in the right internal jugular vein, presented with progressive facial oedema and sudden hoarseness. Cavography with iodine contrast was performed, which showed 95% obstruction of blood flow through the superior vena cava, and the patient was diagnosed with superior vena cava syndrome. Several hours later, painful pustules developed on the patient's face. Cavography was repeated to remove the catheter from the jugular vein, and a new catheter was placed in the right femoral vein. One day later, the patient developed pruritic, tense haemorrhagic bullae on her arms and legs. The facial pustules coalesced into vesicles and vegetating lesions appeared, with drainage of purulent secretion on the patient's face (Fig. 1). The patient was afebrile with stable vital signs. Laboratory studies indicated eosinophilia (35% eosinophils; normal range 1-4%), while white cell count was normal (9.85 9 10 9 /L; normal range 4-11 9 10 9 /L). Histopathological findingsThe results of microbiological studies were negative. Histopathological examination of an arm lesion revealed epidermal necrosis with ulceration and a mixed infiltrate with predominance of neutrophils in the dermis, dermal and epidermal necrosis with haemorrhagic areas and a superficial neutrophilic infiltrate (Fig. 2). Figure 1 (a) Tense haemorrhagic bullae on the patient's arms; (b) vegetating lesions draining purulent secretion on the patient's face.ª

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