Single-plaque vegetating bromoderma

Ulcerative neutrophilic dermatitis resembling human bromoderma in a dog

A dog was referred because of the presence of painful ulcers with violaceous borders and multiple dermal and subcutaneous haemorrhagic nodules on the bridge of the nose, on the dorsal aspect of the front paws, and on all four legs. Lesions had not responded to antibacterial and immunomodulatory therapy. Nine months earlier, the dog had been diagnosed with idiopathic epilepsy and treated with potassium bromide ever since. Histopathological examination of lesions revealed an interstitial neutrophilic dermatitis multifocally extending to the subcutaneous tissue. All special stains were negative for infectious agents, and due to the lack of tropism for follicular structures as well as negative bacterial and fungal cultures, a diagnosis of a sterile neutrophilic process similar to pyoderma gangrenosum was made. A cutaneous drug reaction was suspected, potassium bromide was suspended, and after 6 weeks the ulcerative lesions were completely healed. The present report describes a case of an ulcerative neutrophilic dermatitis presumed to be associated with administration of potassium bromide that resembled human bromoderma.

Disseminated vegetating infantile bromoderma: A dramatic response to systemic steroids

Bromoderma is a rare hypersensitivity reaction caused by bromide intake. It was relatively frequent in the early years of the previous century because of the common use of bromide-containing solutions in pediatrics due to their antispasmodic, expectorant, sedative, and anticonvulsant effects. Although recently prohibited in many countries, bromides are still used as an adjuvant anticonvulsant drug and still present in some over the counter antispasmodics and analgesics. Bromoderma usually present with pustular and vegetating lesions that may represent a diagnostic challenge for dermatologists. We describe a severe case of vegetating bromoderma that showed an excellent response to the withdrawal of the bromide-containing medication associated with systemic steroid administration.

A "seasonal bromoderma" in a farmer

Bromoderma is a rare skin disease caused by the ingestion, inhalation, or contact with products containing bromides. We report a case of bromoderma in a 36-year-old farmer, characterized by remission during the spring and exacerbation during the winter. The recognition of the use of products containing bromides during the winter helped us to understand the cause of the clinical condition.

Bromoderma in an infant

Bromoderma is a cutaneous eruption caused by the absorption of bromide. Clinical manifestations include acneiform and vegetative lesions. We report the case of an infant with bromoderma caused by the use of syrup for abdominal colic containing calcium bromide. The lesions regressed after discontinuation of the drug.

A systematic review of the safety of potassium bromide in dogs

OBJECTIVE

To critically evaluate and summarize available information on the safety of potassium bromide in dogs.

DESIGN

Systematic review.

SAMPLE

111 references reporting safety information relevant to potassium bromide published between 1938 and 2011.

PROCEDURES

PubMed searches without date limitations were conducted with the terms "potassium bromide" and "sodium bromide" in December 2009 and October 2011. Additional articles were identified through examination of article reference lists and book chapters on seizures in dogs and pharmacology.

RESULTS

Reversible neurologic signs were the most consistently reported toxicoses and were generally associated with adjunctive potassium bromide treatment or high serum bromide concentrations. Dermatologic and respiratory abnormalities were rare in dogs. Insufficient information was available to assess the effects of potassium bromide on behavior or to determine the incidence of vomiting, weight gain, polyphagia, pancreatitis, polyuria, polydipsia, or reproductive abnormalities associated with potassium bromide administration. Evidence suggested that administration of potassium bromide with food may alleviate gastrointestinal irritation and that monitoring for polyphagia, thyroid hormone abnormalities, and high serum bromide concentrations may be beneficial.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that potassium bromide is not an appropriate choice for treatment of every dog with seizures and that practitioners should tailor therapeutic regimens and clinical monitoring to each dog. Abrupt dietary changes or fluid therapy may compromise seizure control or increase the likelihood of adverse events. Availability of an appropriately labeled, approved potassium bromide product could provide better assurance for veterinarians and their clients of the quality, safety, and effectiveness of the product for veterinary use.

Drug-induced acneiform eruption

Drug-induced acne is a specific subset of acne that usually has some specific features, namely a monomorphic pattern, an unusual location of the lesions beyond the seborrheic areas, an unusual age of onset, a resistance to conventional acne therapy and, of course, the notion of a recent drug introduction. Many drugs can be responsible for such a clinical pattern. Corticosteroids, neuropsychotherapeutic drugs, antituberculosis drugs, and immunomodulating molecules are the more classical drugs associated with induced acne. Recently, new drugs, mainly targeted therapy in the field of oncology, such as epidermal growth factor receptor inhibitors, have been associated with an increased frequency of this adverse effect. Disruption of the culprit drug is rarely mandatory in cases of drug-induced acne. Close cooperation between the dermatologist and medical staff in charge of the patient is an important challenge to achieve optimal management of the initial disease.

Pseudoepitheliomatous hyperplasia: a review

Pseudoepitheliomatous hyperplasia (PEH) is a benign condition, characterized by hyperplasia of the epidermis and adnexal epithelium, closely simulating squamous cell carcinoma. PEH may be present in a number of conditions characterized by prolonged inflammation and/or chronic infection, as well as in association with many cutaneous neoplasms. Herein, we review different inflammatory, infectious, and neoplastic skin diseases, in which florid epidermal hyperplasia is a prominent histopathologic feature, and introduce a systematic approach in the interpretation of PEH.