Bromoderma mimicking pyoderma gangrenosum caused by commercial sedatives

Postsurgical Pyoderma Gangrenosum Requiring Plastic Surgical Intervention: A Practical Review

Pyoderma gangrenosum is a neutrophilic dermatosis characterized by immune dysfunction and pathergy. Thus, it is frequently seen in patients with underlying systemic illnesses or postoperatively. For the performance of the debridement or closure of the resultant defect, plastic surgeons are often involved in the care of pyoderma patients. However, both procedures may exacerbate the injury. Therefore, plastic surgeons must be familiar with the presentation of postsurgical pyoderma to avoid further damage and safely repair related soft tissue defects. A systematic search of the PubMed/Medline database was performed using the following keywords: "pyoderma gangrenosum" and "surgery." This online database search has identified 656 studies published between 1958 and 2022. Only reconstructed cases of postsurgical pyoderma gangrenosum were selected. Twenty-eight patients who developed pyoderma after dermatologic, plastic, orthopedic, cardiovascular, general, or obstetric surgery were included in this study. The average time to the PG presentation and diagnosis was 5.5 and 17 days, respectively. Diagnostic scoring tools were not used, and the diagnosis was primarily based on histopathology after repeated treatment failures. The patients received split- or full-thickness skin grafts, local, pedicled, and free flaps. An estimated 82.1% underwent skin grafting, whereas 42.9% underwent flap reconstruction. In addition, 21.4% got both the graft and flap. Accurate diagnosis of PSPG, prevention of further surgical injury, and timely medical management are vital for improving patient outcomes. Reconstruction can be performed, if required. However, despite the availability of different reconstructive techniques, there is no standard approach to the management of the PSPG.

Halogenoderma: A Case Report and Review of the Literature

Halogenoderma (HD) is an uncommon dermatosis that develops following exposure to halogens such as iodide and bromide, referred to as iododerma and bromoderma, respectively. Here, we report the case of a 40-year-old male who presented with a three-week history of slightly itchy progressive skin lesions associated with low-grade fever and malaise. The patient had a history of using food supplements containing iodide and bromide for four months prior to the appearance of skin rashes. Skin examination revealed multiple crusted papules and nodules scattered on his face, neck, and trunk. A skin biopsy was taken from the lesions. The epidermis showed crustation, exocytosis of neutrophils, and multiple intraepidermal abscesses. The dermis showed heavy cellular infiltrates composed mainly of neutrophils. The skin lesions disappeared completely after the cessation of food supplements, along with the use of topical corticosteroids for a few weeks.

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.

Pyoderma Gangrenosum: An Update on Pathophysiology, Diagnosis and Treatment

Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic disorder with prototypical clinical presentations. Its pathophysiology is complex and not fully explained. Recent information regarding the genetic basis of PG and the role of auto-inflammation provides a better understanding of the disease and new therapeutic targets. PG equally affects patients of both sexes and of any age. Uncontrolled cutaneous neutrophilic inflammation is the cornerstone in a genetically predisposed individual. Multimodality management is often required to reduce inflammation, optimize wound healing, and treat underlying disease. A gold standard for the management of PG does not exist and high-level evidence is limited. Multiple factors must be taken into account when deciding on the optimum treatment for individual patients: location, number and size of lesion/ulceration(s), extracutaneous involvement, presence of associated disease, cost, and side effects of treatment, as well as patient comorbidities and preferences. Refractory and rapidly progressive cases require early initiation of systemic therapy. Newer targeted therapies represent a promising pathway for the management of PG, and the main focus of this review is the management and evidence supporting the role of new targeted therapies in PG.