Bromoderma

BROMODERMA (bromoderma papulo-tuberculosum s. tuberosum vegetans, bromoderma nodosum fungosum, papilloma area elev. Beigel'ii), a rare and highly pathognomonic disease observed in specially predisposed subjects from the use of bromine. It is localized mainly on the face, especially on the nose, on the lower extremities, and on other areas of the skin. It appears in the form of closely crowded nodules which, by merging, form large plaques and larger tumors, mostly covered with dried black-brown crusts and papillomatous growths. Extremely soft and sharply demarcated plaques with a flat surface, of brown-red and violet-red color, growing rapidly, create the impression of moist velvet upon inspection and palpation. The initial characteristic sign for diagnosis is a follicular pustule the size of a pinhead, bordered by a bright red, inflammatory-edematous rim. Upon removal of the crusts, an uneven, ulcerated, tuberous surface is exposed. The bottom of the ulcer can serve as a starting point for the formation of wart-papillary growths. Nodular infiltrates without a tendency to ulcerative breakdown are also encountered. After healing, pigmentation and often thick scars remain, which may undergo keloid degeneration. Vegetating bromoderma shows an extraordinary resemblance to iododerma, differing from the latter by softer elements, a less suppurative process, and more sharply expressed fungous formations. Frequently, bromoderma gives cause for confusion with papillomatous or fungous tuberculosis of the skin, with vegetating syphilids, and with vegetating pemphigus. The cause is the prolonged use of bromine in large doses, especially potassium bromide. Bromoderma may also appear considerably later after the last intake of the drug. In America, it is encountered more often in view of the widespread use of patented bromine preparations. Despite the fact that bromine is excreted by the sebaceous glands, histological studies show that the latter are involved in the inflammatory process secondarily. The infiltrate is concentrated mainly around the follicles, causing their destruction. The presence of bromine in the pustules testifies to its circulation in the tissue juices of the organism. According to Pasini, bromide eruptions arise as a result of reduced acidity of the gastric juice (purochlorhydria), which causes improper splitting and excretion of bromine. Luchetti believes that the immediate cause of the appearance of bromoderma is irritation or traumatic damage to the skin by analogy with gummatous syphilis, in which the infiltrate can also be deposited at the site of irritation. The cessation of bromine intake returns the affected skin to normal. Therapeutically, intravenous infusions of 50-100-200 cubic centimeters of normal or ¹/₁₀ normal sodium chloride solution are recommended (Bechet, Stevenson). To eliminate papillary growths and sluggish chronic ulcers, curettage with a sharp spoon is used. Mercurial plaster and grey mercurial ointment are appropriate. It is necessary to avoid skin irritation.