Bromoderma after Excessive Ingestion of Ruby Red Squirt

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Abstract
We report a case of bromoderma from excessive ingestion of a soft drink. A 63-year-old man presented with a two-week history of tender, ulcerated, erythematous nodules on his hands and fingers ( Figure 1 ). There was no history of recent travel or trauma. Skin biopsy revealed epidermal hyperplasia with sheets of intraepidermal and dermal neutrophils. Tissue culture was negative for microorganisms. The patient reported that he had been drinking 8 liters of Ruby Red Squirt daily for several months. This soft drink contains brominated vegetable oil. The patient's serum bromine level was 0.96 mg per deciliter (normal level, <0.5 mg per deciliter), and a diagnosis of bromoderma was made. Review of the patient's medications and additional history did not reveal other sources of bromine exposure. Because colchicine is thought to be antineutrophilic, treatment with colchicine was started. Discontinuation of consumption of the brominated soft drink and treatment with colchicine were followed by resolution of the skin lesions within four months. There was no recurrence after discontinuation of treatment with colchicine.

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