Chemical Burn From Povidone-Iodine: Case and Review
April 2011 | Volume 10 | Issue 4 | Case Report | 414 | Copyright © 2011
Adam Rees MD, Quyn Sherrod MD, Lorraine Young MD
Chemical burn is a rare complication of topical polyvinylpyrrolidone-iodine (PVP-I), commonly called povidone-iodine (trade name Betadine, Purdue, Stamford, NJ). This adverse reaction occurred on the buttocks of an eight-year-old male after undergoing a laparoscopic appendectomy involving antiseptic skin preparation using a 10% PVP-I solution. This case is consistent with previous reports in which a chemical burn develops when PVP-I does not adequately dry, pools beneath a dependent body part during surgery, or is placed under an occlusive device. Symptoms develop immediately to one day after surgery. The proposed mechanism is irritation from iodine coupled with maceration, pressure and friction. While patients typically heal without significant scarring, the burn subjects the patient to unnecessary pain, prolongs hospitalization and increases the risk for infection. Physicians should be aware of this complication and therefore take preventative measures. These include allowing PVP-I to completely dry, preventing dripping and pooling and avoiding occlusion.
J Drugs Dermatol. 2011;10(4):414-417.
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Povidone-iodine (trade name Betadine, Purdue, Stamford, NJ) is a widely used antiseptic regarded for its broad antimicrobial spectrum, fast onset of action and favorable safety profile. It consists of polyvinylpyrrolidone (PVP) complexed to iodine. Its antiseptic mechanism of action is due to the iodination and oxidation by free iodine of various microbial chemical structures.1 While rare, chemical burn is a recognized complication of povidone-iodine use.3,5-12
An eight-year-old male was admitted to our institution for a two-day history of abdominal pain, vomiting and fever. An abdominal CT confirmed the diagnosis of acute appendicitis. The patient was taken to the operating room for a laparoscopic appendectomy. Antibiotic prophylaxis with intravenous cefoxitin (1 gram) was administered preoperatively. The patient was placed in a supine position, the abdominal and suprapubic skin was sterilized using a 10% povidone-iodine (PVP-I) solution and the patient was draped with a sterile and nonabsorbent fabric. The procedure lasted two hours. Immediately after surgery, the patient complained of burning pain on his buttocks. The nursing staff noted a brown stain consistent with PVP-I in the area of discomfort. Noted on exam were well-demarcated patches of dusky and blanching erythema on the bilateral buttocks, inguinal region and scrotum with superimposed vesicles and bullae (Figure 1). The patient had neither significant personal or family history of dermatologic diseases nor prior history of exposure or sensitization to PVP-I. Wound cultures were negative for bacteria and viruses. The diagnosis of partial thickness burn secondary to irritant contact dermatitis from povidone-iodine was made on the basis of the rapid appearance of the lesions following surgery, the distinct geographic pattern of involvement and the history of PVP-I staining in the affected areas. The patient received topical supportive treatment with silver sulfadiazine and AQUACEL hydrocolloid dressing (ConvaTec, Skillman, NJ). During his five-day hospitalization, the patient remained afebrile without progression of the lesions or involvement of mucosal membranes. The patient was discharged with a supportive home care regimen of Xeroform petrolatum impregnated gauze (Kendall Healthcare, Mansfield, MA) for the burn, as well as acetaminophen for pain. The patient subsequently failed to show for follow up.
Polyvinylpyrrolidone-iodine (PVP-I)-commonly called povidone- iodine (trade name Betadine)-is a widely used antiseptic regarded for its broad antimicrobial spectrum and rapid onset of action. It comes in several commercial preparations of which the most commonly used are a 10% solution and a 7.5% scrub. PVP-I consists of iodine (I2) complexed to polyvinylpyrrolidione (PVP) and iodide (I-). A 10% PVP-I solution contains 90% water, 8.5% PVP, 1% iodine and 0.5% iodide. PVP is a hydrophilic polymer that lacks intrinsic antimicrobial properties but rather acts as a carrier for the iodine.1 The true microbicidal action of the PVP-I solution comes from the free (i.e., not complexed to PVP) iodine in the solution. In aqueous solutions, free iodine is present as seven different species, including elemental iodine