Use of topical povidone‐iodine resulting in an iododerma‐like eruption

Abstract

Iododerma is a rare skin eruption that is usually induced by the systemic use of iodide-containing radiographic contrast medium or treatment with oral potassium iodide therapy. Iododerma has also rarely been reported to occur following topical application of iodine. We herein report the case of a 42-year-old male who developed multiple pinpoint pustules on both lower extremities. Three days after the eruption began, the patient started applying topical 10% povidone-iodine solution to the lesions. During this treatment, the lesions enlarged into multiple 2-9-cm pus-filled bullae, limited to the treated areas. Lesional bacterial culture swab and Gram stain were negative. Blood cultures were also negative and the patient's white blood cell count was normal. A punch biopsy specimen revealed pseudoepitheliomatous hyperplasia and dermal-epidermal separation with epidermal necrosis and underlying abscess formation. A superficial and deep perivascular, interstitial and perifollicular infiltrate containing numerous neutrophils, with abscess formation and eosinophils was also seen. This histology was consistent with iododerma and the patient's lesions involuted following cessation of topical iodine use, leaving only post-inflammatory hyperpigmentation. In summary, our patient likely had a folliculitis that was then treated with topical povidone-iodine that led to iododerma. Although it remains possible that the reaction was an unusual contact hypersensitivity response, the ulceration, pseudoepitheliomatous hyperplasia and abscess formation do support an iododerma-like eruption.

Sweet syndrome with pseudocarcinomatous hyperplasia: A case report and review of the literature

“…Multiple reports have described PEH as part of a hypersensitivity reaction to tattoos; the observation of keratoacanthoma arising within red tattoos may represent a related phenomeon . Halogenodermas, cutaneous papulonodular reactions to topical or ingested fluoride or bromide‐containing products, commonly display PEH with neutrophilic microabscesses . Other conditions with rarely‐reported PEH include tophaceous gout and insect bites …”

Acute Ioderma: an Uncommon Serious Adverse Event Associated with Saturated Solution of Potassium Iodide Treatment

“…Although extremely rare, physicians should consider the potential for ioderma development as a dangerous but treatable side effect of SSKI therapy (20).…”

Role of Antiseptics in the Prevention of Surgical Site Infections

“…2,13,51,56 These are nonirritating to the eyes and mucous membranes, provide visibility to areas covered, and do not readily remove surgical markings. 58,59 Anaphylaxis has occurred in patients with a systemic povidone-iodine allergy after topical use; therefore, topical PVP-I is not recommended in those with a history of systemic allergy. 3,15,51 PVP-I has been documented to cause an iododerma-like reaction and chemical burns.…”