Iodine and skin eruptions

There is a plethora of info here, my main interest is on iodine supplementation's effects on the skin.

The premise is that iodism is caused by abnormal vasoconstriction and that iodine "acne", skin eruptions, etc are caused by plasma being forced out of capillary walls.

Iodine and its preparations not only do not, as shown above, cause vasodilation either in large or small doses, but they provoke constriction of all vessels, arteries and veins, because these vessels are supplied with a muscular coat, and owing to the excessive metabolism which they incite indirectly in this, the contractile layer of these vessels. This morbid phenomenon is aggravated by another factor: the presence in the blood of sufficient iodine to irritate the intima, a feature which, in itself, tends to promote constriction in vessels supplied with vasomotor nerves. What has been mistaken for general vasodilation is dilation of the capillaries. These delicate vessels not being supplied with a muscular coat or vasomotor nerves, are not morbidly influenced as are the others, but they suffer indirectly: the arteries and veins, by contracting inordinately, drive the blood into them and cause passive dilation. So great is the pressure in some cases, that the plasma is forced out of the capillary walls in relatively large quantities—sufficient, in fact, to cause oedema of the face, larynx, pleura, lungs, etc., and even to provoke their rupture,as shown by the ecchymosis, haemorrhages, hematuria, purpura,
menorrhagia, metrorrhagia, etc., witnessed.

 

Iodism.—This condition is due to the presence of an excess of iodine in the blood over and above the aggregate of this halogen required by the body at large.  This aggregate is represented by the iodine contained in the thyroid and parathyroids, the red corpuscles (which take up their thyroidase) and what reserve the body fluids and the different organs can accommodate.

Although, on the whole, large quantities of iodine or its salts, whether given in one dose or in many small doses, are more likely to cause iodism than small quantities, the question of dose is subsidiary to the condition of the patient. A very small quantity may thus produce iodism merely because the patient's asset in iodine is up to its maximum limit—his supposed "iodiosyncrasy." This is particularly the case in subjects whose thyroid apparatuses only able, owing to local disorders (goiter, for example) or deficient development, to take up a small proportion of this halogen. Any condition which inhibits more or less its excretion also predisposes the patient to iodism, by causing his asset to remain high...

... Cutaneous eruptions of various kinds, papular, vesicular, eczematous, erysipelatous, pustular, etc., may appear during the administration of iodine or its salts, especially of the potassium iodide. The presence of several of these eruptions coincides with that of other symptoms of iodism and with abnormal vasoconstriction; they are due to the fact that the latter condition, by causing retention of the drug in the capillaries of the skin, promotes therein disorders similar to those produced by external applications of iodine. The multiplicity of cutaneous disorders is due to the presence in these capillaries of different kinds of wastes: alloxuric bases, hypocatabolized cellular debris, various acids, etc., each of which affects the cutaneous elements in its own way. The underlying cause of all these eruptions, therefore, is the same as in all phenomena witnessed in iodism, viz., abnormal vasoconstriction.

All these phenomena, and the excessive constriction of the arteries, would not occur were iodine able to excite the thyropressor nerve.  But such is not the case. Even when taken in doses sufficient to produce acute poisoning, iodine and its preparations fail to increase the secretory activity of the thyroid. Were it, in fact, otherwise, this organ would waste its product whenever its own pabulum, iodine, would enter the blood...

...As to the quantities of iodine or its salts which produce iodism, the comprehensive research of Briquet in several hundred cases, led to the conclusion that "the greater the dose of any iodide, the greater the likelihood that iodism will appear, and that the symptoms will be severe"—contrary to the prevailing opinion. He cites, moreover, cases reported by Bresgen, Negre and Petitjean in which large doses would produce it, while smaller doses would not. According to my own interpretation of its effects, the nearer the patient's condition approximates normal health, the greater are the chances of his developing iodism. I have not only observed this fact clinically, hut Ricord, Jullien and Wood, according to Briquet, have observed that syphilitica appear, on the whole, to be practically immune to the morbid effects of  iodides as compared to others. There is no doubt, moreover, that very small doses can produce iodism in accord with the prevailing view. In one of my goitrous cases, less than 1 minim (0.065 c.c.) of the tincture of iodine daily produced it; Rilliet observed that even sea-air and cod-liver oil sufficed to awaken morbid phenomena in these cases. Gautier confirmed the observation as to the influence of the sea-shore. and refers to a case in which poisoning followed "the application of iodine dressing to a tooth by a dentist." The reason for this becomes self-evident if interpreted from my standpoint. While Baumann found that the amount of iodine in the thyroid was greatly reduced when this organ was diseased, Ewald observed that in advanced colloid degeneration of the gland only traces of iodine were present. The loss of the body's great storehouse for this halogen accounts for its accumulation in the blood and the readiness with which morbid phenomena are produced. This indicates how the organism resents even minute quantities when they exceed the physiological limit. Indeed, irrespective of the presence of goiter, small doses may also provoke iodism. Hynes reported a case in which 3-grain (0.2 gm.) doses brought on haemorrhagic rash; and H. C. Wood one in which 6 grains (0.4 gm.) daily brought on violent conjunctivitis with facial oedema.

The presence of iodine in the cutaneous secretions has been shown by R. W. Taylor, and other ohservers have found it in the saliva, nasal secretion, milk. etc. Its morbid influence in the production of the cutaneous disorders during elimination is generally recognized. Cushny writes: "That a similar action on the skin may he induced by iodine and iodides is shown by the application of iodine to the skin, being often followed by eruptions which are not confined to the point of application, but spread." That toxic wastes must be retained as well as the iodides in the cutaneous capillaries hardly needs to be emphasized; their influence in the pathogenesis of eruptions is also well-known.

The list of symptoms observed in iodism could be considerably lengthened—sufficiently so, in fact, to show that the three degrees of passive capillary hyperemia: the simple, exudative and hemorrhagic, can be provoked by iodine and its preparations in all organs. The fact that such an array of phenomena can be explained by this one general mechanism, affords in itself conclusive proof of its soundness as an explanation of iodism—especially in view of the fact that the physiological action of iodine has remained unknown.

source: The Internal Secretions and the Principles of Medicine 1917

Iodism and eliminative function

Another article on syphilis. Good advice, though on how to avoid "iodism".

The general hygienic management of syphilis is of fundamental importance. In many instances mercury and iodides act badly, simply because the patient's eliminative areas are not functionating with their normal activity. Injurious results from the drug specifics occur under such circumstances, and are explained by that explanation which does not explain, "idiosyncrasy." Ptyalism and iodism may both be avoided in many cases by attention to the eliminative functions. The ingestion of large quantities of water, with the concomitant increased functional activity of the skin, kidneys and bowels, is very useful in syphilis. This point is too frequently neglected. In giving iodides it is best, as is generally known, to administer them simultaneously with considerable quantities of water. It is impossible, however, without resulting stomachic disturbance, to give a sufficient quantity of water in this way to perfect elimination by the kidneys in certain cases in which the renal function is inadequate. It is in just such cases that iodism from so-called idiosyncrasy is liable to occur.

The best method of giving the iodide under such circumstances is to mix the daily dose of the drug with a given quantity of pure water, say from two quarts to a gallon, and instruct the patient to drink the entire amount, a glassful at a time, at intervals during the twenty-four hours,  have succeeded in avoiding iodism in this way in patients in whom the smallest quantity of iodide given by the ordinary method produced iodism.

Hot baths are a very useful adjuvant to the treatment of syphilis. They increase tissue metamorphosis, favor; elimination, and necessarily enhance the therapeutic action of the mercury and iodide, while limiting any possible injurious effects of the drugs. In many instances hot baths alone will prevent injurious effects from mercury and iodide. A very hot bath of short duration, taken daily and followed by a cold shower or cold tub, is perhaps the best method of administration for the average patient. The ideal method, however, where its application is practicable, is the Turkish or Russian bath. The patient should drink large quantities of hot water while in the bath. Much of the efficacy of the Hot Springs treatment of syphilis is dependent upon the free ingestion of hot water while the hot bath is being given.
Attention to the bowels is very important in the treatment of syphilis. Ptyalism not infrequently results as a consequence of constipation. Obviously, the simpler forms of laxatives are best. The saline aperients taken hot in the morning are excellent. 

Ptyalism~ an excessive flow of saliva.

  The Medical News, Volume 80, 1902

GENERAL MEDICAL TREATMENT OF SYPHILIS.

BY G. FRANK LYDSTON, M.D., 

           of Chicago; 

PROFESSOR Of GENITO-URINARY SURGERY AND SYPHILOLOGY IN THE 

   MEDICAL DEPARTMENT OF THE UNIVERSITY OF ILLINOIS; PRO- 

      FESSOR OF SURGERY IN THE CHICAGO CLINICAL SCHOOL. 

iodism schmiodism!

a snippet from an article on treating intercranial syphilis.

In giving potassium iodide I have, for many years, taught the doctrine that there is no such thing as a fixed or arbitrary dosage. When indicated, give it not with iodism as a guide, but until either the disease yields, or until very large doses—seven, eight, or nine hundred grains daily—without any modification of symptoms, satisfies you that its further employment is useless. To recur to iodism, that stumbling-block in the pathway of so many. Iodism should be a very rare obstacle to the successful treatment of nervous syphilitics. I have had to discontinue the drug in only two cases during the past six years, a success due, I believe, entirely to my method of giving the iodide, which is as follows: I always use the drug in the form of the saturated solution, for convenience and accuracy. I am careful to get a pure drug from a reputable chemist. Beginning with twenty drops (never less) after meals, the dose is increased three, five, or ten drops daily, according to the urgency or gravity of conditions. The vehicle is changed every third day, the first two days water, the next two milk, the next Vichy, then Apollinaris, then back and through the same cycle again and again, the amount of the vehicle being increased pari passu with the increase of the drug. Should iodism develop to an annoying or extreme degree, I stop for two days and then start just where I stopped, doubling the ratio of daily increase. Your patient will be thirty or forty grains daily further along before iodism recurs, employing this method. The addition of essence of pepsin in two or three-drachm doses after the iodide seems to be of decided service at times. The rennet mixture advocated by some writers is a vile mess, in my judgment, and is but rarely tolerated for more than a few days. Iodism is much more apt to occur from the continued use of a fixed dose, although a moderate one, than when giving it by the progressive method. I have seen iodism from continuous 20 gr. doses disappear at forty or fifty grains—paradoxical as this statement may appear. Following this method I have repeatedly given six hundred grains and more daily without any special inconvenience, and in one patient affected with meningomyelitis, a daily quantity of 1245 drops of the saturated solution was reached without untoward symptoms.



source: A DIAGNOSTIC SYNDROME FOR INTRACRANIAL SYPHILIS. WITH REMARKS UPON PROGNOSIS AND TREATMENT.. By WM. BROADDUS PRITCHARD., Medical Record, Volume 65, 1904


grain~  64.79891 mg, 1⁄7000 of a pound (wikipedia)


more on the myth of iodism here:


 http://iodinehistory.blogspot.com/2012/01/iodism-debunked-1922.html

"iodism" debunked, 1922

source: "Life Shortening Habits and Rejuvenation", by Arnold Lorand, 1922



"...When iodides are given in certain quantities the symptoms of intolerance may present themselves, constituting a condition we term iodism.

These symptoms are due very probably to an exaggeration of thyroid activity. Iodine being contained in the thyroid gland in larger amount than in any other gland and constituting its most important component substance, it will readily be understood that if too much of it is given it will excite an unduly pronounced activity of the gland.

 Strange to say, I have myself observed—and with me a number of others—that frequently even relatively small doses of the iodides produce such an effect, viz., iodism, yet if afterwards larger doses are given, they are well borne and bring about a feeling of well being and all the beneficial effects known to be characteristic of this drug.

I am not among those who look with alarm upon these symptoms of thyroid excitation.

I do not consider it an untoward result if an arteriosclerotic person, with symptoms of sclerosis of the brain vessels, suffers from one of the typical symptoms of iodism, viz., a running at the nose. Indeed, as I show in my book on the improvement of human intellect, such persons ought to be thankful if the circulation of the brain is relieved this way, close relations existing between the circulation of the blood-vessels of the brain and that in the vessels of the nose.

Nor can it be considered as a serious drawback if toxic substances are carried out and deposited at the periphery of the body, in the skin, giving rise to pimples.

A feeling of marked lassitude may also be present as one of these symptoms, and not infrequently also an attenuation of the sexual function.

Not by any means do I consider such a condition of iodism as an unfortunate event, for it is only a passing stage, and if larger doses are given, it may disappear altogether. Indeed, in such cases as I have noted recently, in which large doses of iodides had been given on account of previous syphilitic infection, a marked state of well being can be produced for a certain period of time, with an increase of muscular strength.

Long walks and climbing in the mountains became possible without the subsequent feeling of great fatigue. Likewise the sexual desire reappeared, sometimes even in a higher degree than before the treatment. These persons, furthermore, began to look younger than their age, and in general became decidedly more vigorous..."