PovidoneIodine Induced Skin Burn: Case Report and Literature Review PeiChin Lin1,2, PiLai Tseng1,Yaw - PowerPoint PPT Presentation

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PovidoneIodine Induced Skin Burn: Case Report and Literature Review PeiChin Lin1,2, PiLai Tseng1,Yaw

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In these patients, PI (solution or tincture) was in contact with the skin for at ... Fig 1 Case 2. Burn after prolonged contact with PI tincture ... – PowerPoint PPT presentation

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Title: PovidoneIodine Induced Skin Burn: Case Report and Literature Review PeiChin Lin1,2, PiLai Tseng1,Yaw


1
Povidone-Iodine Induced Skin Burn
Case Report and Literature Review Pei-Chin
Lin1,2, Pi-Lai Tseng1,Yaw-Bin Huang3 1
Department of Pharmacy, Veterans General Hospital
in Kaohsiung, Kaohsiung, Taiwan2 Graduate
Institute of Pharmaceutical Sciences, College of
Pharmacy, Kaohsiung Medical University,
Kaohsiung, Taiwan3 Graduate Institute of
Clinical Pharmacy, College of Pharmacy, Kaohsiung
Medical University, Kaohsiung, Taiwan
Background
Discussion
Review of the literature, burns can be rare but
potentially serious complications of PI use.
There are some case reports about this adverse
reaction in the literature. Figure 2 show the
characteristics of cases of PI-associated burns.
In these patients, PI (solution or tincture) was
in contact with the skin for at least 1 to 8
hours or longer. The area of burn usually seen
under a gauze swab soaked in PI antiseptic
solution, in contact with a surgical sheet
immersed with PI, or under a tourniquet cuff
where the PI had been absorbed by the padding.
The clinical presentation of the affected skin is
burn with/without vesciles or blister. The onset
of symptom noted is the day or the next day after
procedure.
Povidone (Polyvinylpyrrolidone)-iodine has been
used widely as a topical antiseptics for would
cleaning or operation site disinfection from
1956. The preparations of commercially available
povidone-iodine (PI) are PI solution, scrub,
ointment, tincture or foam of these, the
solution is the most commonly used. Iodine is
complexed with povidone in this water-soluble
compound. The antiseptic action of PI is due to
the available iodine present in the complex and
generally has a favorable adverse-effect profile.
However, PI has been rarely associated with
chemical burn. In this study, we report 2 cases
who developed skin burn and blister formation
after using of povidone-iodine tincture.
Case Report
Case 1 is a 34years old female who was admitted
to receive Electrophysiologic study(EPS). Case 2
is a 74years old male and Implantable
Cardioverter Defibrillator (ICD) Implantation was
suggested due to the positive result of EPS. At
the first of procedure, after application of the
topical 10 PI tincture (70 alcohol) over the
operation site, both of them felt some liquid
flowed beneath the thigh or flowed to the left
upper back through the neck individually. Then,
in the case 1, patient felt irritation and pain
beneath the thigh in case 2, the same sensation
was described in the area of lower back and left
upper back. The sensation of irritation and pain
persisted till procedure ended. Burned skin and
desquamation were observed several days later in
case 1. The patient did no receive any treatment
and the affected area healed automatically. In
the other one, erythematous change happened
immediately after the procedure and then 3 x 3
cm2 area of burn was measured 5 hrs later after
the patients was sent to the intensive care unit.
10 x 10 cm2 area of burn with several blisters
formation were seen in the day after procedure
(Fig 1). Betamethasone cream was topically
applied and acetaminophen 500mg every six hours
were used to relief the pain. The blisters were
exposed by nurses 4days
Fig 2 The description of povidone-iodine-associate
d burns
This adverse reaction of PI application typically
occurs when it has not been allowed to dry or has
been trapped under the body of a patient in a
pooled dependent position. The probable mechanism
is a chemical burn due to irritation coupled with
maceration, friction, and pressure. The epidermal
lipid barrier acting to the skin may be decreased
by another washing using alcohol, which
deesterifies the skin. Alcohol may also cause
hypersensitivity. Reviewing the cases in our
study, these 2 patients were all macerated in the
pool of PI tincture, and in case 2, the clinical
appearances resembled chemical burns, showing
clearly marginated infiltrative erythema
accompanied by blister. The adverse reaction
induced by PI could not e excluded. Fortunately,
both of them were resolved automatically or under
he conservative treatment.
nurses four days later and no secondary infection
observed. There was no abnormal in the operation
site but burn only developed in the area that
contact with the sheet. Besides, there were no PI
allergy history in these 2 cases.
Conclusion
Given the widespread use of povidone-iodine and
the potential for development of infection after
a burn, the most important factor for preventing
the adverse drug reaction is the awareness of the
clinicians and the preventive measures.
Fig 1 Case 2. Burn after prolonged contact with
PI tincture
Abstract code TOX-W-017 Session Toxicology and
Safety Sciences 3rd Pharmaceutical Sciences World
Congress in Amsterdan, the Netherlands. 22-25
April 2007
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