Halogenoderma Workup

Updated: Mar 26, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Workup

Laboratory Studies

Serum or urine bromide and iodide levels should be measured.

Serum immunoelectrophoresis should be performed. Monoclonal gammopathy has been reported in some patients with iododerma and bromoderma. [28] Therefore, serum immunoelectrophoresis should be considered.

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Histologic Findings

Cutaneous halogenoderma produces a suggestive pattern of epidermal and dermal changes. Papillomatosis may be observed, sometimes to the level of pseudoepitheliomatous hyperplasia or acanthosis. Often, intraepidermal abscesses form with neutrophils, eosinophils, and, at times, necrotic or even acantholytic keratinocytes within them. [29] These epidermal changes tend to be more pronounced in bromoderma than in iododerma, in which case the epidermis may be more likely to become eroded or ulcerated. Iododerma may be viewed as a rare neutrophilic dermatosis. [2]

The epidermal and dermal alterations in fluoroderma tend to be milder than those of the other two eruptions.

In the dermis, a dense infiltrate of mainly neutrophils and some leukocytoclasia may be initially observed around areas of dermal necrosis. True vasculitis may be present. Eosinophils may also be evident; at times, these may be numerous. Later, the infiltrate becomes more chronic, with a predominance of histocytes that have abundant cytoplasm and large nuclei.

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