Nodular Papillomatous Bromoderma
Bromides are prescribed more often than many other common drugs and are also ingredients of many proprietary preparations. However, nodular, papillomatous, fungoid bromoderma is relatively uncommon. This type of bromide eruption occurs most often in women. The lesions usually appear after weeks or months of continuous bromide ingestion. There is no correlation between the amount of drug ingested, duration of medication, and onset of the eruption. The nervous and psychic manifestations of brominism may be present but are often absent. Likewise, constitutional manifestations of brominism may occur without an associated papillomatous bromoderma. A history of ingestion of bromide or sedatives is an important aid in the differential diagnosis. It should be pointed out, however, that a habitué of proprietary sedatives is often reluctant to admit ingestion of drugs.
If the practitioner is unfamiliar with this lesion, he is most apt to consider it a carbuncle or some unusual pyogenic infection and may subject the patient to a needless operation. The most striking feature of this type of bromoderma is the high incidence of severe pain and tenderness of the lesions. The patient frequently walks with a limp and may come to the physician's office on crutches. The pressure of bandages and clothing causes discomfort, although occasionally pain is not a prominent symptom.
A painful, nodular, papillomatous, pustular lesion not surrounded by acute cellulitis should indicate the necessity for considering bromo-derma in the differential diagnosis. The initial lesion is a small, light red to yellowish red papule or group of painful. . .