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Poster 17 Title, Successful treatment of a recalcitrant neutrophilic dermatosis with Authors and Potassium Iodide Institutions: N Mansoor, K Nugent, N Mulligan, F J Moloney Mater Misericordiae University Hospital, Dublin. Abstract: The neutrophilic dermatoses are a group of disorders characterized (Your abstract by skin lesions for which histologic examination reveals intense must use epidermal, dermal, or hypodermal infiltrates composed primarily of Normal style neutrophils with no evidence of infection or true vasculitis. Classification and must fit in of the neutrophilic dermatoses is based upon the recognition of clinical this space) and pathologic features, as well as the identification of associated diseases (1). The pathogenesis of neutrophilic dermatoses is not clearly known. First line treatment options include steroids, dapsone and colchicine. Case reports have previously suggested that Potassium Iodide (a salt composed of 76% of iodine and 23% of potassium) may have a role. It has been demonstrated that iodine has the ability to suppress the production of toxic oxygen intermediates by polymorphonuclear cells and thus exert its anti-inflammatory effect (2) A 61 year old male presented with an eight year history of relapsing and remitting tender inflammatory nodules showing pseudo-vesiculation at the margins developing on his anterior shins, dorsum of hands and forearms. These eruptions flared on average every one-to-two months and resulted in blistering and erosions which healed with scarring. There was no associated fever. Representive skin biopsies during different flares consistenly showed heavy neutrophilic infiltration of the dermis with spongiotic dermatitis without vasculitic features consistent with an acute neutrophilic dermatosis. Skin culture for bacteria, fungus and atypical mycobacterium were negative as was his DIF. He underwent thorough investigations for underlying GI, haematological, rheumatological, malignant and inflammatory trigger on multiple occasions over eight years. Laboratory, radiological and invasive tests were essentially normal/negative. Treatment with repeated courses of high dose oral steroids, hydroxychloroquine, oral dapsone, and colchicine had minimal or no impact on the frequency or severity of flares. He was therefore commenced on Potassium Iodide 65mg TDS initially and up titrated to 300mg TDS over months. His skin improved and he has remained in continued remission since for a minimum of 18 months during which he is monitored with regular monitoring including thyroid function tests. Recently the patient developed biochemical hypothyroidism and is being reviewed by the endocrinology department. Remission of neutrophilic dermatosis can be achieved with the use of Potassium Iodide, proven to be a well-tolerated second line of treatment.

1.Neutrophilic dermatoses. Callen JP, Dermatol Clin. 2002 Jul;20(3):409-19. 2. Potassium iodide in dermatology: a 19th century drug for the 21st century-uses, pharmacology, adverse effects, and contraindications. Sterling JB1, Heymann WR. J Am Acad Dermatol. 2000 Oct;43(4):691- 7.

Please return to [email protected] closing date 26th August 2015