Chemical burn from povidone-iodine: case and review

Chemical burn is a rare complication of topical polyvinylpyrrolidone-iodine (PVP-I), commonly called povidone-iodine (trade name Betadine, Purdue, Stamford, NJ). This adverse reaction occurred on the buttocks of an eight-year-old male after undergoing a laparoscopic appendectomy involving antiseptic skin preparation using a 10% PVP-I solution. This case is consistent with previous reports in which a chemical burn develops when PVP-I does not adequately dry, pools beneath a dependent body part during surgery, or is placed under an occlusive device. Symptoms develop immediately to one day after surgery. The proposed mechanism is irritation from iodine coupled with maceration, pressure and friction. While patients typically heal without significant scarring, the burn subjects the patient to unnecessary pain, prolongs hospitalization and increases the risk for infection. Physicians should be aware of this complication and therefore take preventative measures. These include allowing PVP-I to completely dry, preventing dripping and pooling and avoiding occlusion.