Oda F, Tohyama M, Murakami A, Kanno K, Sonobe N, Sayama K, et al.
The Journal of dermatology. Date of publication 2016 May 1;volume 43(5):564-6.
1. J Dermatol. 2016 May;43(5):564-6. doi: 10.1111/1346-8138.13162. Epub 2015 Oct 28.
Bromoderma mimicking pyoderma gangrenosum caused by commercial sedatives.
Oda F(1), Tohyama M(1), Murakami A(2), Kanno K(2), Sonobe N(3), Sayama K(1).
Author information:
(1)Department of Dermatology, Ehime University Graduate School of Medicine,
Ehime, Japan.
(2)Department of Clinical Laboratory, Ehime University Graduate School of
Medicine, Ehime, Japan.
(3)Department of Psychiatry, Ehime University Graduate School of Medicine, Ehime,
Japan.
Bromoderma is a rare skin disorder caused by bromide intake. It presents as
single or multiple papillomatous nodules or plaques, and ulcers studded with
small pustules on the face or limbs. The clinical features of bromoderma are
similar to those of pyoderma gangrenosum. A 41-year-old Japanese woman was
diagnosed with pyoderma gangrenosum 11 years prior to presentation. Pyoderma had
repeatedly appeared over her entire body despite treatment. She also frequently
complained of syncopal episodes. She was admitted to our hospital after loss of
consciousness and an episode of generalized convulsion. Laboratory tests revealed
a negative serum anion gap and hyperchloremia. Her serum bromide level was
significantly elevated, suggesting bromide intoxication. The patient had a
10-year history of high serum bromide levels. After the intake of
bromide-containing sedatives was stopped, there was no recurrence of pyoderma in
the absence of treatment. In conclusion, this case was diagnosed as bromoderma
with commercial sedative-induced bromide intoxication. Although the US Food and
Drug Administration have banned the use of bromides, over-the-counter (OTC)
treatments containing bromides are still used in Japan and other countries.
Long-term use of OTC medicines containing bromvalerylurea may result in the
development of bromoderma. If unclarified neurological or psychiatric symptoms
are associated with pyoderma, we propose measurement of the patient's serum
chloride concentration. Determination of hyperchloremia is helpful for the
diagnosis of chronic intoxication with bromides.
© 2015 Japanese Dermatological Association.
DOI: 10.1111/1346-8138.13162
PMID: 26507105 [Indexed for MEDLINE]
