Bromoderma – a kind of the medicinal dermatosis caused by accumulation of bromine in fabrics and hypersensibility to its connections. Symptoms of a disease have some variability. Allocate several clinical forms, in general skin manifestations come down to development of rash, or plaques. Diagnostics of a bromoderma is made on the basis of drawing up the anamnesis and the patient's poll (identification of a source of bromine in an organism), definitions of concentration of this element in fabrics. Treatment of a bromoderma includes refusal of use of bromsoderzhashchy medicines, desensibilizirushchy therapy, prevention of secondary infections of skin.
Bromoderma – the toksikodermiya caused by long administration of drugs of bromine – such, as sodium or potassium bromide. A number of researchers believes that an important role in development of pathology is played also by existence of hypersensitivity to bromine and its connections. For the first time this disease was described by the German dermatologist Pini in 1895 which managed to connect heavy rash of the patient with reception of bromsoderzhashchy substances and called this state bromodermy. Now the given pathology meets rather seldom, especially so-called tuberozny form of a disease. Most often precedes development of a bromoderma or long-term treatment by compounds of bromine (especially potassium bromide) or their single reception in a high dose.
Bromoderma is caused by a kumulyation of bromsoderzhashchy connections in an organism, in particular in skin. At the same time if the person has a hypersensitivity to this element, then there is an allergic reaction which is the reason of development of symptoms of a disease. Participation of allergic processes in development of a bromoderma proves the fact that not at each person the real disease even develops at reception of high doses of bromine. Only in an organism with sensitization signs to this element this skin violation can be shown. The pathogenesis of a bromoderma is studied insufficiently, the reasons of development of this or that clinical form of a disease are also not quite clear. Presumably, besides a sensitization in development of a bromoderma an important role is played by reactivity of an organism, level of work of immune system and other factors.
Bromoderma is characterized by emergence on a surface of integuments (most often it is face skin, knees, shins, buttocks, sometimes all body) rashes, various on the morphology. They can have papular, eritematozny, urtikarny or vezikulezny character, warty and papillomatozny rash meets less often. At most of patients of bromodermy the combination from various types of rashes of various structure is observed. Nevertheless, in dermatology conditionally allocate three main clinical forms of a bromoderma which are characterized by various simptomokompleks: generalized rash, bromic eels, tuberozny bromoderma.
Generalized rash – such form of a bromoderma is the easiest, most often children suffer from it. Soon after single reception of a high dose of compounds of bromine on a considerable part of a body there is eritematozny rash in the form of small red specks. In rare instances on the surface of skin bubbles can appear. Rashes at this form of a bromoderma quite often quickly and spontaneously disappear, and in the absence of further intake of bromine in an organism there is an absolute recovery.
Bromic eels – a clinical form of a bromoderma with more expressed symptoms which main manifestation is education follicular with a diameter of 1-4 millimeters and nodular elements. Generally rashes affect area of the person, back, buttocks and lower extremities. Pustula and small knots at this form of a bromoderma quite often have inflammatory character and are surrounded with a red border. At their permission to surfaces of integuments there can be hems of various size with characteristic cyanotic-crimson coloring. Bromic eels are the most common form of a bromoderma.
The Tuberozny bromoderma which is often called by vegetiruyushchy – the most rare and most severe form of this toksikodermiya. It is always preceded by long administration of drugs of bromine in considerable doses, most of patients – young people (up to 30 years) women. The beginning of development of a tuberozny bromoderma is characterized by emergence on skin of the lower extremities (sometimes – hands and a face) plaques with a diameter of 0,5-3 centimeters. They tower over the surrounding not changed integuments on 0,5-1 centimeter. The surface of plaques is covered with dense crusts at which office the ulcer surface is bared, pressing on education leads to the pus expiration, however morbidity is expressed slightly. Over time plaques at a tuberozny bromoderma merge among themselves, forming the continuous center of defeat with a diameter up to 10-12 centimeters. After healing of this education on skin there are hems and sites of an atrophy.
It is remarkable that at the same patient on different parts of the body various types of rash characteristic of different clinical forms of a bromoderma can come to light. In that case definition like disease is made on the rashes which are the most expressed and affected a part of skin, big on the area. Bromic eels and a tuberozny bromoderma can often be complicated by secondary infections of skin that demands application of anti-septic tanks, and in certain cases – antibiotics.
Diagnostics of a bromoderma
Diagnostics of a bromoderma is made on the basis of survey of integuments of the patient, studying of its anamnesis, and also measurement of concentration of ions of bromine in blood serum. At survey reveal rashes, characteristic of a disease (depending on a form – rash, bubbles, plaques). But much more the large role in diagnostics of a bromoderma is played by studying of the anamnesis of the patient – what medicines it accepted in recent days, weeks and months and in what dosage. Among them it is necessary to reveal the medicines containing in the structure of compound of bromine. As an additional method of diagnostics of a bromoderma serves definition of serumal concentration of ions of bromine which will be increased. Differential diagnostics is carried out with a small tortoiseshell, tubercular and syphilitic damages of skin, some dermatomikoza and a gangrenous piodermiya.
Treatment of a bromoderma
Indispensable condition of an initiation of treatment of a bromoderma is full cancellation of reception of bromsoderzhashchy medicines which became the reason of such state. In certain cases (for example, at generalized eritematozny rash) there will be enough these measures for bystry disappearance of symptoms of a disease. In case of more expressed clinical forms of a bromoderma the desensibilizing therapy is necessary – appoint calcium chloride solution, antihistamines (, ). For acceleration of process of recovery it is necessary to force a conclusion of compounds of bromine from an organism – appoint droppers with physiological solution, diuretics (furosemide), inside accept table salt.
For prevention of infectious complications of a bromoderma, especially at a vegetiruyushchy form of a disease, outwardly apply antiseptics (, hydroxymethylquinoxalinedioxide) in the form of solutions and ointments. Also apply also physiotherapy – mainly, radiation by ultraviolet rays (Ural federal district) of affected areas of skin. At a heavy current of a bromoderma kortikosteroidny medicines can be used, in case of existence of the expressed secondary infection antibiotics of a broad spectrum of activity are appointed.
Forecast and prevention of a bromoderma
In dermatology of a bromoderm does not treat heavy and difficult curable toksikodermiya – cancellation of reception of bromsoderzhashchy medicines and other therapeutic actions most often promote bystry recovery. However the forecast concerning consequences of this disease is not identical at its various clinical forms – if generalized rash disappears completely, then eels and tuberozny plaques can leave behind noticeable scars. Prevention of a bromoderma consists in moderate use of medicines with the maintenance of this element, when performing long therapy it is necessary to provide the periods between reception courses. Also simultaneous reception together with medicines of bromine also nicotinic acid can reduce probability of development of a toksikodermiya.