Bromism is a syndrome that results from bromide intoxication. It is difficult to diagnose since it mimics a myriad of psychiatric and dermatological disturbances. Historically, the most common sources have been drug ingestion or contaminated drinks. This work aims to thoroughly review all the state-of-the-art aspects of bromism and bromoderma, including its pathophysiology, diagnosis, treatment, and other relevant clinical and forensic features. In this context, a comprehensive search was conducted in PubMed (U.S. National Library of Medicine) without time restrictions. Bromism may occur in individuals of any age or gender, but it is more frequent in women. In children, it usually occurs under therapy for resistant epilepsy or is breastfed by mothers who ingested bromide and may manifest as bromoderma. In adults, bromism manifests with psychiatric and neurological signs such as hallucinations, delusions, or ataxia. Pseudohyperchloremia with a negative anion gap is highly suggestive of the diagnosis. Treatment requires the removal of bromide, which is achieved by per os or intravenous saline administration or even hemodialysis. Although bromism is not usually observed in clinical and forensic practice, it is still related to the administration of controlled or immediate-release formulations, mainly analgesics or antiepileptic drugs, as well as internet-purchased supplements.

Bromoderma is caused by exposure to bromine-containing agents, presenting as exudative plaques, enlarging nodules, necrotic ulcers, and acne-like skin rash. Pseudohyperchloremia, a key finding in some bromoderma patients, is a phenomenon in which the ionic membrane is affected by halogens such as bromine ions (Br[-]) and iodine ions when serum chloride ion (Cl[-]) is measured by the ion-selective membrane electrode (ISE) method. This results in a high value of serum Cl[-] even though the actual level is normal. Here, we report a case of bromoderma that did not show pseudohyperchloremia in a previous hospital. A 43-year-old man came to our hospital with verrucous nodules and erythema on both shins. He had had epilepsy since the age of 3 months and had been treated with potassium bromide. A skin biopsy showed pseudocarcinomatous hyperplasia and dermal infiltration of lymphocytes and neutrophils. His serum Cl[-] level measured in our hospital exceeded the upper threshold. Due to his medication history, clinical and histological appearances, and pseudohyperchloremia, the case was diagnosed with bromoderma. Potassium bromide was discontinued the day after the patient's visit to our hospital. All verrucous nodules disappeared 25 weeks after the first visit. It has been reported that there is no clear correlation between serum levels of Cl[-] and Br[-] and that the degree of pseudohyperchloremia is dependent on the ion exchange membrane used. Therefore, we have to be aware that bromoderma cannot be ruled out even if pseudohyperchloremia is not seen. Clearance of skin rashes after discontinuation of bromine is essential if elevation of serum Br[-] levels is not confirmed. In retrospect, in our case, the serum Cl[-] level was measured by electrochemiluminescence immunoassay in the previous hospital, but was measured by the ISE method in our hospital. It is important to check serum Cl[-] levels and the method of measurement when seeing patients with suspected bromoderma.

Halogenoderma (HD) is an uncommon dermatosis that develops following exposure to halogens such as iodide and bromide, referred to as iododerma and bromoderma, respectively. Here, we report the case of a 40-year-old male who presented with a three-week history of slightly itchy progressive skin lesions associated with low-grade fever and malaise. The patient had a history of using food supplements containing iodide and bromide for four months prior to the appearance of skin rashes. Skin examination revealed multiple crusted papules and nodules scattered on his face, neck, and trunk. A skin biopsy was taken from the lesions. The epidermis showed crustation, exocytosis of neutrophils, and multiple intraepidermal abscesses. The dermis showed heavy cellular infiltrates composed mainly of neutrophils. The skin lesions disappeared completely after the cessation of food supplements, along with the use of topical corticosteroids for a few weeks.

A dog was referred because of the presence of painful ulcers with violaceous borders and multiple dermal and subcutaneous haemorrhagic nodules on the bridge of the nose, on the dorsal aspect of the front paws, and on all four legs. Lesions had not responded to antibacterial and immunomodulatory therapy. Nine months earlier, the dog had been diagnosed with idiopathic epilepsy and treated with potassium bromide ever since. Histopathological examination of lesions revealed an interstitial neutrophilic dermatitis multifocally extending to the subcutaneous tissue. All special stains were negative for infectious agents, and due to the lack of tropism for follicular structures as well as negative bacterial and fungal cultures, a diagnosis of a sterile neutrophilic process similar to pyoderma gangrenosum was made. A cutaneous drug reaction was suspected, potassium bromide was suspended, and after 6 weeks the ulcerative lesions were completely healed. The present report describes a case of an ulcerative neutrophilic dermatitis presumed to be associated with administration of potassium bromide that resembled human bromoderma.

Bromoderma is a rare hypersensitivity reaction caused by bromide intake. It was relatively frequent in the early years of the previous century because of the common use of bromide-containing solutions in pediatrics due to their antispasmodic, expectorant, sedative, and anticonvulsant effects. Although recently prohibited in many countries, bromides are still used as an adjuvant anticonvulsant drug and still present in some over the counter antispasmodics and analgesics. Bromoderma usually present with pustular and vegetating lesions that may represent a diagnostic challenge for dermatologists. We describe a severe case of vegetating bromoderma that showed an excellent response to the withdrawal of the bromide-containing medication associated with systemic steroid administration.

Bromoderma is a rare skin disease caused by the ingestion, inhalation, or contact with products containing bromides. We report a case of bromoderma in a 36-year-old farmer, characterized by remission during the spring and exacerbation during the winter. The recognition of the use of products containing bromides during the winter helped us to understand the cause of the clinical condition.

Bromoderma is a cutaneous eruption caused by the absorption of bromide. Clinical manifestations include acneiform and vegetative lesions. We report the case of an infant with bromoderma caused by the use of syrup for abdominal colic containing calcium bromide. The lesions regressed after discontinuation of the drug.

Bromoderma is a rare skin disorder caused by bromide intake. It presents as single or multiple papillomatous nodules or plaques, and ulcers studded with small pustules on the face or limbs. The clinical features of bromoderma are similar to those of pyoderma gangrenosum. A 41-year-old Japanese woman was diagnosed with pyoderma gangrenosum 11 years prior to presentation. Pyoderma had repeatedly appeared over her entire body despite treatment. She also frequently complained of syncopal episodes. She was admitted to our hospital after loss of consciousness and an episode of generalized convulsion. Laboratory tests revealed a negative serum anion gap and hyperchloremia. Her serum bromide level was significantly elevated, suggesting bromide intoxication. The patient had a 10-year history of high serum bromide levels. After the intake of bromide-containing sedatives was stopped, there was no recurrence of pyoderma in the absence of treatment. In conclusion, this case was diagnosed as bromoderma with commercial sedative-induced bromide intoxication. Although the US Food and Drug Administration have banned the use of bromides, over-the-counter (OTC) treatments containing bromides are still used in Japan and other countries. Long-term use of OTC medicines containing bromvalerylurea may result in the development of bromoderma. If unclarified neurological or psychiatric symptoms are associated with pyoderma, we propose measurement of the patient's serum chloride concentration. Determination of hyperchloremia is helpful for the diagnosis of chronic intoxication with bromides.