BROMODERMA

From Big Medical Encyclopedia

BROMODERMA (bromoderma; lat. bromum bromine + grech, derma skin) — the rare dermatosis arising at long administration of drugs of bromine, especially potassium bromide and also at people with hypersensitivity to them. Chances of emergence of B. at babies whose mothers accept drugs of bromine. At long administration of drugs of bromine during B.'s pregnancy can arise at a fruit (inborn B.).

The clinical picture

B. is shown by rash of inflammatory and proliferative character on a face (a nose, a forehead, eyebrows), pilar head skin, the lower extremities (especially shins), generative organs.

Clinically distinguish three forms B.: generalized rashes, acneform and pustular and knotty B.

Generalized rashes are observed more often at children; have an appearance of spotty, usually quickly disappearing rashes like rubella, a small tortoiseshell or remind chicken pox, vaccinal rash or an exudative erythema.

Fig. 1. Acneform and pustular bromoderma.

The most frequent and a typiform of B. is acneform and pustular (synonym: acne bromica, bromic eels, fig. 1). It is shown in the form of follicular pustules of krasnovatosinyushny color with bent to group, merge and suppuration therefore there are extensive girlyandopodobny centers covered with purulent crusts. Further they turn into the ulcer ektimo-and the rupiopodobny centers hemming in the center and growing on the periphery.

Fig. 2. A knotty bromoderma on shins.

At knotty B. (synonym: tuberous B., knotty ulcer and vegetans B., fig. 2) arise usually not numerous limited soft nodes and tumorous plaques of violet-red color from one to several centimeters in size which are quite often becoming covered by plentiful crusts. Under crusts the ulcer, vegetans surface is found. Knotty infiltrates can resolve, without ulcerating, leaving a nevus pigmentosus or hems.

Visible mucous membranes are surprised very seldom. At a severe form of a disease in blood of patients the leukocytosis, an eosinophilia and anemia are noted.

Various forms B. are observed often at the same time at the same patient.

Patogistologiya

At acneform and pustular B. — the follicular and perifollikulyarny infiltrate leading to destruction of hair follicles. Sebaceous glands are involved in inflammatory process for the second time and often atrofichna; blood vessels in a circle of a follicle are expanded and filled with leukocytes. At knotty B. — the expressed acanthosis with formation of intra epidermal and interfollicular abscesses and inflammatory leukocyte infiltration of a derma.

The diagnosis

B. should be differentiated with yododermy, a pyoderma, a knotty erythema, much formnoy an exudative erythema, a tinea profunda, a tuberculosis cutis, syphilides, a vegetans pemphigus, a zymonematosis, fungoid mycosis, etc. At difficulty in the diagnosis make bacteriological, serological and histologic researches. The anamnesis, availability of bromine in urine (Belot's reaction), positive skin test with bromine (its specificity is disputable) help with B.'s recognition

the Forecast

the Forecast is usually favorable. Only in very hard cases, at sharp disturbance of the general condition of an organism, the lethal outcome is possible.

Treatment

Termination of administration of drugs of bromine; in 10% solution of calcium chloride, intravenous injections of isotonic solution of sodium chloride or 30% of solution of sodium thiosulphate; corticosteroid drugs (Triamcinolonum, dexamethasone) in combination with antibiotics (Tetraolenum, erythromycin) at a complication a consecutive piokokkovy infection; bathtubs with potassium permanganate, uv radiations (in a neosystem of a stage of inflammatory process); fortifying treatment (iron, phosphorus, vitamins). Locally: the ointments containing corticosteroids and antibiotics (Oxycortum, locacortenum, etc.), water aseptic dressings; obkalyvaniye of the centers of knotty B. solutions of corticosteroid drugs.


Bibliography: Zheltakov M. M. and B. A. Allergiya's Som to medicinal substances, M., 1968.

M. I. Lane.

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