Bromoderma mimicking pyoderma gangrenosum caused by commercial sedatives

Area of Science:

• Dermatology
• Toxicology
• Internal Medicine

Background:

• Bromoderma is a rare skin disorder linked to bromide intake, presenting with nodules, plaques, or pustular ulcers.
• Its clinical presentation can resemble pyoderma gangrenosum, leading to diagnostic challenges.
• Bromide-containing sedatives are still available over-the-counter (OTC) in some countries, posing a risk for chronic intoxication.

Purpose of the Study:

• To report a case of bromoderma misdiagnosed as pyoderma gangrenosum.
• To investigate the link between long-term OTC sedative use and bromide intoxication.
• To highlight diagnostic markers for chronic bromide intoxication.

Main Methods:

• Case report of a 41-year-old Japanese woman with a history of recurrent skin lesions and neurological symptoms.
• Laboratory analysis including serum bromide and chloride levels.
• Clinical observation following cessation of bromide-containing sedative intake.

Main Results:

• The patient presented with symptoms mimicking pyoderma gangrenosum, despite 11 years of treatment.
• Elevated serum bromide levels confirmed bromide intoxication.
• Discontinuation of bromide-containing sedatives led to the resolution of skin lesions without further treatment.

Conclusions:

• The case was diagnosed as bromoderma secondary to commercial sedative-induced bromide intoxication.
• Long-term use of OTC bromvalerylurea can lead to bromoderma.
• Measuring serum chloride concentration is recommended for diagnosing chronic bromide intoxication when neurological or psychiatric symptoms coexist with pyoderma.