Derm Dx: Blisters on the buttock after surgery - Clinical Advisor

Derm Dx: Blisters on the buttock after surgery

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  • Betadine Contact Dermatitis_0212 Derm Dx

An 8-year-old boy is admitted to the hospital with acute appendicitis. He is brought to the operating room for a laparoscopic appendectomy. During the procedure he is placed in a supine position, and his skin is prepped with povidone-iodine solution (Betadine) and draped in a sterile fashion. The procedure lasted two hours.

Immediately upon awaking from anesthesia, the patient complained of a burning sensation on his buttock. On examination, the patient was afebrile with stable vital signs. He had well-demarcated, dusky and blanching erythematous patches with overlying vesicles on his buttock. What’s your diagnosis?

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Povidone-iodine solution (Betadine) is a very commonly used antiseptic that is highly bactericidal, viricidal, fungicidal, cysticidal, and moderately protozoacidal. Irritant contact dermatitis to povidone-iodine is a well recognized, but avoidable adverse effect.  This complication develops when povidone-iodine solution pools beneath a...

Submit your diagnosis to see full explanation.

Povidone-iodine solution (Betadine) is a very commonly used antiseptic that is highly bactericidal, viricidal, fungicidal, cysticidal, and moderately protozoacidal. Irritant contact dermatitis to povidone-iodine is a well recognized, but avoidable adverse effect. 

This complication develops when povidone-iodine solution pools beneath a dependent body surface (in this case, the buttocks), is placed under an occlusive devise such as a tourniquet, or soaks into an absorbent material that is directly in contact with the skin (such as a dressing or blanket). The combination of moisture, occlusion, maceration and pressure leads to a greatly increased risk for irritant contact dermatitis.  

In practical use, povidone-iodine solution should be wiped onto skin and then allowed to adequately dry. When used in this manner, contact dermatitis is rare. 

Povidone iodine-associated contact dermatitis generally appears within 24 hours after surgery and consists of well-demarcated, erythematous patches with vesicles and bullae that occur on areas directly in contact with the solution. It usually does not occur on regions of skin where surgery was performed, because the povidone-iodine solution is usually allowed to adequately dry in these areas, the skin is not occluded and the skin is cleansed after surgery.1    

Diagnosis

Diagnosis is based on clinical appearance of well-demarcated, erythematous patches with vesicles corresponding to a skin area that was in contact with povidone-iodine cream.

Well-demarcated patches of dusky erythema are not consistent with impetigo, herpes or erythema multiforme diagnoses.1

Treatment           

Treatment is supportive and similar to treatment for a partial thickness burn. It consists of adequate analgesia, topical antibiotic prophylaxis with medications such as silver sulfadiazine, and dressing that promotes healing, such as petrolatum-impregnated gauze. 1          

Adam Rees, MD, is a graduate of the University of California Los Angeles School of Medicine and a resident in the Department of Dermatology at Baylor College of Medicine in Houston.           

References

1. Rees A et al. “Chemical burn from povidone-iodine: case and review.” J Drugs Dermatol. 2011. Apr;10(4):414-7.

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