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Potassium Iodide for Cutaneous Inflammatory Disorders: a Monocentric, Retrospective Study

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Potassium Iodide for Cutaneous Inflammatory Disorders: a Monocentric, Retrospective Study Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2019 Potassium Iodide for Cutaneous Inflammatory Disorders: A Monocentric, Retrospective Study Anzengruber, Florian ; Mergenthaler, Caroline ; Murer, Carla ; Dummer, Reinhard Abstract: OBJECTIVES: Potassium iodide (KI) is a medication that has been used for decades in dermatology and it is mentioned as a treatment option in all major dermatology textbooks. Yet, there is little recent information on its efficacy. In our study, we wanted to retrospectively evaluate the therapy response to KI in our patients. METHODS: The hospital information system was searched for patients treated with KI at the Department of Dermatology (University Hospital Zurich) in the last 20 years (January 1, 1998 to December 31, 2017). A total of 52 patients were found and, subsequently, 35 patients were included in our study. RESULTS: KI was prescribed for the following skin conditions: erythema nodosum, disseminated granuloma anulare, necrobiosis lipoidica, nodular vasculitis, cutaneous sarcoidosis, and granulomatous perioral dermatitis/ rosacea. The median duration of KI intake was 5 ± 7.7 weeks (range 1-26). The global assessment of efficacy by the treating physician showed an improvement of disease in about a third of all patients. No response was seen in 14 patients and 9 even had a progression of disease. An adverse event was documented in 16 cases. CONCLUSIONS: Our findings show that an improvement was reached in only about a third of all cases. High responserates with only mild side effects (in 16 out of 35 patients) were observed. DOI: https://doi.org/10.1159/000494614 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-160590 Journal Article Published Version Originally published at: Anzengruber, Florian; Mergenthaler, Caroline; Murer, Carla; Dummer, Reinhard (2019). Potassium Iodide for Cutaneous Inflammatory Disorders: A Monocentric, Retrospective Study. Dermatology, 235(2):137-143. DOI: https://doi.org/10.1159/000494614 Research Article Dermatology Received: August 6, 2018 DOI: 10.1159/000494614 Accepted after revision: October 16, 2018 Published online: November 21, 2018 Potassium Iodide for Cutaneous Inflammatory Disorders: A Monocentric, Retrospective Study a, b a, b a, b Florian Anzengruber Caroline Mergenthaler Carla Murer a, b Reinhard Dummer a b Department of Dermatology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland Keywords ment of disease in about a third of all patients. No response Potassium iodide · Inflammatory dermatosis · Erythema was seen in 14 patients and 9 even had a progression of nodosum · Necrobiosis lipoidica · Nodular vasculitis · disease. An adverse event was documented in 16 cases. Granuloma anulare Conclusions: Our findings show that an improvement was reached in only about a third of all cases. High response rates with only mild side effects (in 16 out of 35 patients) Abstract were observed. © 2018 S. Karger AG, Basel Objectives: Potassium iodide (KI) is a medication that has been used for decades in dermatology and it is mentioned as a treatment option in all major dermatology textbooks. Yet, there is little recent information on its efficacy. In our Introduction study, we wanted to retrospectively evaluate the therapy re- sponse to KI in our patients. Methods: The hospital informa- Potassium iodide (KI) is a medication that has been tion system was searched for patients treated with KI at the used for decades in dermatology [1]. Kl is a photosensi- Department of Dermatology (University Hospital Zurich) in tive crystal composed of salt (76%) and potassium (23%) the last 20 years (January 1, 1998 to December 31, 2017). A [2]. It was originally used to treat thyroid disorders and total of 52 patients were found and, subsequently, 35 pa- was then obtained from seaweed in ancient times. Its des- tients were included in our study. Results: KI was prescribed ignated use encompassed diseases like psoriasis, eczema, for the following skin conditions: erythema nodosum, dis- tuberculosis, and syphilis [2, 3]. seminated granuloma anulare, necrobiosis lipoidica, nodu- Nowadays, KI represents a treatment option in inflam- lar vasculitis, cutaneous sarcoidosis, and granulomatous matory, granulomatous, and infectious diseases, like ery- perioral dermatitis/ rosacea. The median duration of KI in- thema nodosum [4], nodular vasculitis [4], subacute mi- take was 5 ± 7.7 weeks (range 1–26). The global assessment gratory panniculitis [5], granuloma anulare [6, 7], pyoder- of efficacy by the treating physician showed an improve- ma gangrenosum [8], granulomatosis with polyangiitis, © 2018 S. Karger AG, Basel Florian Anzengruber Department of Dermatology, University Hospital Zurich Gloriastrasse 31 E-Mail [email protected] CH–8091 Zurich (Switzerland) www.karger.com/drm E-Mail Florian.anzengruber @ usz.ch Downloaded by: Universität Zürich, E-Medien 144.200.17.42 - 1/3/2019 10:26:14 AM Search in the hospital information system for patients being treated with potassium iodide from 1998 to 2017 (n = 52) Participants with one or more Excluded as no follow-up follow-up visits (n = 38) data available (n = 14) Oral use of potassium iodide Topical use of potassium (n = 35) iodide (n = 3) Fig. 1. Flowchart of Materials and Meth- ods. Participant inclusion and exclusion. Behçet’s disease, Sweet’s syndrome [1, 9], cryptococcosis Table 1. Overview of patients’ characteristics [10], and zygomycosis [11]. Most studies have been per- formed on sporotrichosis [12–18]. KI has a fast effect on Patients, n 35 dermatosis. It is reported that remission occurs within Male 11 Female 24 days or weeks [19]. For inflammatory dermatosis, the rec- Age, years 50±18 (18–79) ommended dosage is 300 mg three times daily [20]. Nondermatological indications include emphysema, Data for age are presented as mean ± SD (range). cystic fibrosis, and cataract [2, 21–23]. It is controversial whether KI can be administered to patients with thyroid disease [1, 2, 19, 24, 25]. However, in case of a nuclear emergency, KI is used as a thyroid blocker [26]. Observed Materials and Methods side effects include nausea, vomiting, and skin changes For further details, see the online supplementary material (see such as eczema and acneiform rashes [4]. An excess of www.karger.com/doi/10.1159/000494614 for all online suppl. ma- iodine can cause thyrotoxicosis (Jod-Basedow effect) terial) (Fig. 1). [20]. The absorption of iodine through the skin is poor, which makes it a commonly used topical disinfectant. When orally applied, KI is concentrated in the thyroid Results gland and excreted in urine, as well as feces. It has been proven to be teratogenic and should thus not be applied A total of 35 patients were included in our study (Table in pregnant women [2]. 1): 11 patients were diagnosed with disseminated granu- The precise mechanism of action has not been revealed loma anulare, 9 with erythema nodosum, 7 suffered from [2]. However, it is assumed that its anti-inflammatory ef- necrobiosis lipoidica, and 3 patients had a cutaneous fects are partly exerted by the suppression of toxic oxy- manifestation of sarcoidosis. The remaining patients suf- gen, inhibition of chemotaxis, as well as by halogenation fered from granulomatous perioral dermatitis or granu- reactions from myeloperoxidases [27–29]. There is no di- lomatous rosacea (n = 3) and 2 were diagnosed with nod- rect antibacterial or antifungal activity [30]. ular vasculitis (Fig. 2; Table 2). In our cohort, there was Data on its efficacy are scarce, as only little interest ex- no complete clearing: 12 out of 35 showed an improve- ists from scientific centers and pharmaceutical compa- ment as judged by the physician, no response was seen in nies. In fact, no randomized, placebo-controlled, or dou- 14 patients, and 9 even had a progression of disease ble-blind studies on its efficacy have been conducted [2]. (Fig. 3a). From the 9 patients with erythema nodosum, 5 Nonetheless, for more than a century clinical researchers showed an improvement, and the remaining 4 did not have described its efficacy in multiple diseases. In our benefit from this treatment (Fig. 3b; Table 2). On the con- study, we wanted to retrospectively evaluate the efficacy trary, all 3 patients with granulomatous perioral derma- of KI in our patients. titis or rosacea worsened during treatment. Similar re- 2 Dermatology Anzengruber/Mergenthaler/Murer/ DOI: 10.1159/000494614 Dummer Downloaded by: Universität Zürich, E-Medien 144.200.17.42 - 1/3/2019 10:26:14 AM Table 2. Patients’ response to treatment according to disease Erythema nodosum Total Re- Im- No re- Progres- 9 mis- prove- sponse sion of Granulomatous sion ment disease perioral dermatitis/ 3 Disseminated rosacea 11 granuloma anulare Erythema nodosum 9 0 5 3 1 Disseminated granuloma Sarcoidosis 3 anulare 11 0 4 5 2 2 Necrobiosis lipoidica 7 0 2 5 0 Nodular vasculitis 7 Nodular vasculitis 2 0 1 0 1 Necrobiosis Cutaneous sarcoidosis 3 0 0 1 2 lipoidica Granulomatous perioral dermatitis/rosacea 3 0 0 0 3 Fig. 2. Diseases treated with potassium iodide. Data are presented as number of patients. 15 Disseminated granuloma Erythema nodosum n 10 Necrobiosis lipoidica Sarcoidosis Patients, Patients, 5 Nodular vasculitis ■ No treatment response Granulomatous perioral dermatitis/rosacea ■ Treatment response 0 0 5 10 15 a b Patients, n of disease Progression Full remission Improvement No remission Fig. 3. a Treatment response to potassium iodide. b Treatment response stratified according to disease. sults were seen in cutaneous sarcoidosis. Disseminated was used as a sixth-line treatment in 1 case. In almost all granuloma anulare showed an improvement in 4/11, nec- cases topical steroids were used as first-line treatments. robiosis lipoidica in 2/7, and nodular vasculitis in 1/2. An Topical calcineurin inhibitors or systemic, immunomod- adverse event was documented in 16 cases, namely hypo- ulating antibiotics, such as dapsone or tetracyclines, were thyreosis, stomachache, palpitations, metallic sensation also used (Table 3).
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