LAUSR

Report of a Case | A man in his 60s presented to our dermatology clinic, reporting recurrent acnelike lesions on his nose, cheeks, and upper back (Figure) that had been present for several months and were exacerbated by consumption of seafood. The patient was undergoing treatment for non–small cell carcinoma of the lung with metastases to the brain and liver. Based on this clinical history, one might suspect that his chemotherapeutic regimen included an epidermal growth factor receptor inhibitor, but this was not the case. After pneumonectomy, chemotherapy, and radiotherapy were ineffective, the patient discontinued all conventional treatments and instead elected to pursue Hoxsey herbal therapy at the Hoxsey Bio-Medical Center in Tijuana, Mexico.1 As part of his therapy, he had been taking Hoxsey’s “brown tonic” 3 to 4 times daily for the previous 6 to 7 months. Given the morphologic features of the rash, we suspected a halogenoderma, possibly iododerma. At the time of the patient’s presentation, the ingredients of brown tonic were unknown to us. Through the Memorial Sloan Kettering Cancer Center database titled About Herbs, Botanicals & Other Products, we found that the tonic contained potassium iodide.2 Although the patient declined a skin biopsy, laboratory testing revealed that his urine iodine level was 7 455 647 μg/L (reference range, 34-523 μg/L), and his blood iodine level was 60 261 μg/L (reference range, 52-109 μg/L; to convert to nanomoles per liter, multiply by 7.88). His thyroid-stimulating hormone level was normal, and pustules on the right side of the oral commissure (Figure) were negative for herpes simplex viruses 1 and 2 by polymerase chain reaction testing. Based on our diagnosis of iododerma, clinicians at the Hoxsey Bio-Medical Center removed potassium iodine from the patient’s formulation of brown tonic, and his eruption gradually resolved over the course of several weeks.