Bromoderma is a type of medicinal dermatosis caused by the accumulation of bromine in tissues and increased sensitivity to its compounds. The symptoms of the disease have some variability. There are several clinical forms, in general, skin manifestations are reduced to the development of rashes, pustules or plaques. Diagnosis is made on the basis of drawing up an anamnesis and interviewing the patient (identifying the source of bromine intake into the body), determining the concentration of this element in tissues. Treatment includes the rejection of the use of bromine-containing drugs, desensitizing therapy, prevention of secondary skin infections.
Bromoderma is a toxicoderma caused by prolonged use of bromine preparations, such as sodium or potassium bromide. A number of researchers believe that the presence of hypersensitivity to bromine and its compounds also plays an important role in the development of pathology. For the first time this disease was described by the German dermatologist Pini in 1895, who was able to associate a severe rash of a patient with taking bromine-containing substances and called this condition bromoderma. Currently, this pathology is relatively rare, especially the so-called tuberous form of the disease. Most often, the development of bromoderma is preceded by either long-term treatment with bromine compounds (especially potassium bromide) or their single intake in a large dose.
Bromoderma is caused by the accumulation of bromine-containing compounds in the body, in particular in the skin. At the same time, if a person has hypersensitivity to this element, then an allergic reaction occurs, which is the cause of the development of symptoms of the disease. The participation of allergic processes in the development of bromoderma proves the fact that not every person develops a real disease even when taking high doses of bromine. Only in an organism with signs of sensitization to this element can this skin disorder manifest itself. The pathogenesis of bromoderma has not been studied enough, and the reasons for the development of this or that clinical form of the disease are also not completely clear. Presumably, in addition to sensitization, the reactivity of the body, the level of the immune system and other factors play an important role in the development of the bromoderm.
Bromoderma is characterized by the appearance on the surface of the skin (most often it is the skin of the face, knees, shins, buttocks, sometimes the whole body) of various rashes in their morphology. They may have papular, erythematous, urticular or vesicular character, warty and papillomatous rash is less common. Most patients with bromoderma have a combination of different types of rashes of different structures. Nevertheless, in dermatology, three main clinical forms of bromoderma are conditionally distinguished, characterized by a different symptom complex: generalized rash, brominous acne, tuberous bromoderma.
Generalized rash – this form of bromoderma is the easiest, most often children suffer from it. Shortly after a single dose of a large dose of bromine compounds, an erythematous rash in the form of small red spots appears on a significant part of the body. In rare cases, bubbles may appear on the surface of the skin. Rashes in this form of bromoderma quite often disappear quickly and spontaneously, and in the absence of further bromine intake into the body, complete recovery occurs.
Bromide acne is a clinical form of bromoderma with more pronounced symptoms, the main manifestation of which is the formation of follicular pustules with a diameter of 1-4 millimeters and nodular elements. Basically, rashes affect the area of the face, back, buttocks and lower extremities. Pustules and nodules in this form of bromoderma often have an inflammatory character and are surrounded by a red border. With their resolution, scars of various sizes with a characteristic bluish-purple color may remain on the surface of the skin. Bromide acne is the most common form of bromoderma.
Tuberous bromoderma, often called vegetative, is the rarest and most severe form of this toxicoderma. It is always preceded by long–term administration of bromine preparations in significant doses, most patients are young (up to 30 years old) women. The beginning of the development of tuberous bromoderma is characterized by the appearance of plaques with a diameter of 0.5–3 centimeters on the skin of the lower extremities (sometimes hands and face). They rise above the surrounding unchanged skin by 0.5-1 centimeter. The surface of the plaques is covered with dense crusts, during the separation of which the ulcerative surface is exposed, pressure on the formation leads to the expiration of pus, but the soreness is expressed slightly. Over time, plaques with tuberous bromoderm merge with each other, forming a continuous lesion with a diameter of up to 10-12 centimeters. After healing of this formation, scars and areas of atrophy remain on the skin.
It is noteworthy that the same patient may have different types of rash on different parts of the body, characteristic of different clinical forms of bromoderma. In this case, the type of disease is determined by the most pronounced and affected by a large area of the skin rash. Brominous acne and tuberous bromoderma can often be complicated by secondary skin infections, which requires the use of antiseptics, and in some cases, antibiotics.
Diagnosis of bromoderma is made on the basis of examination of the patient’s skin, examination of his anamnesis, as well as measurement of the concentration of bromine ions in the blood serum. Upon examination, rashes characteristic of the disease are detected (depending on the form – rash, bubbles, plaques). But a much greater role in the diagnosis of bromoderma is played by the study of the patient’s anamnesis – what medications he took in the last days, weeks and months and in what dosage. Among them, it is necessary to identify medicines containing bromine compounds in their composition. An additional method for diagnosing bromoderma is to determine the serum concentration of bromine ions, which will be increased. Differential diagnosis is carried out with urticaria, tuberculous and syphilitic skin lesions, some dermatomycoses and gangrenous pyoderma.
A prerequisite for starting treatment of bromoderma is the complete cancellation of taking bromine-containing drugs that caused this condition. In some cases (for example, with generalized erythematous rash), these measures will be enough to quickly disappear the symptoms of the disease. In the case of more pronounced clinical forms of bromoderma, desensitizing therapy is necessary – calcium chloride solution, antihistamines (chloropyramine, mebhydroline) are prescribed. To speed up the recovery process, it is necessary to force the withdrawal of bromine compounds from the body – droppers with saline solution, diuretics (furosemide) are prescribed, table salt is taken inside.
To prevent infectious complications of the bromoderm, especially in the vegetative form of the disease, antiseptic agents (miramistin, hydroxymethylquinoxalindioxide) are externally used in the form of solutions and ointments. Physiotherapy is also used – mainly irradiation with ultraviolet rays (UVI) of the affected areas of the skin. In severe bromoderma, corticosteroid drugs can be used, in case of a pronounced secondary infection, broad-spectrum antibiotics are prescribed.
Prognosis and prevention
In dermatology, bromoderma does not belong to severe and difficult to treat toxicoderma – the cancellation of bromine-containing drugs and other therapeutic measures most often contribute to a rapid recovery. However, the prognosis regarding the consequences of this disease varies in its various clinical forms – if the generalized rash disappears without a trace, then acne and tuberous plaques can leave behind noticeable scars. Prevention of bromoderma consists in the moderate use of drugs containing this element, when conducting long-term therapy, it is necessary to provide for periods between courses of administration. Also, simultaneous administration of nicotinic acid together with bromine preparations can reduce the likelihood of developing toxicoderma.