POTASSIUM IODIDE IN

DERMATOLOGY
Presenter- Dr. Mehul Choudhary
Moderator- Dr. Amit Tiwari Sir
INTRODUCTION
• Potassium iodide was invented as early as the beginning
of the nineteenth century.

• It is used medically since at least 1820 and is Included in

the World Health Organization's List of Essential
Medicines.

• It is administered orally.
Chemical Properties of Potassium Iodide
• A molecule of potassium iodide consists of one potassium
cation and one iodide anion, which are held together by
an ionic bond.

• Potassium iodide is an odourless, non-flammable, water-

soluble chemical substance with a salty bitter taste.

• Potassium Iodide is a salt composed of 76% of iodine and

23% of potassium which presents itself as a transparent
or white hexahedral crystals.
Pharmacokinetics
• Iodide is well absorbed in the gastrointestinal tract.
• It is concentrated in several body parts: thyroid, stomach,
salivary glands, and breast milk.
• About 90% of iodide is excreted in urine, with the
remainder found in sweat, breast milk, and feces.
• The onset of action for iodide is 24-48 hours.
• Peak levels of iodide occur around day 14.
Mechanism Of Action
Potassium Iodide's Effect on Neutrophil Chemotaxis
and Inflammation:
• It inhibits neutrophil chemotaxis in peripheral blood, which
is why it's effective in neutrophilic dermatoses.
• It also inhibits the production of toxic oxygen
intermediates by polymorphonuclear cells, resulting in an
anti-inflammatory effect.
Iodine's Role in Halogenation Reactions

• Iodine participates in halogenation reactions by myeloperoxidase,

crucial for phagocyte action.
• This action explains its use in infectious disorders, including
mucormycosis.
Mechanisms Against Fungi:
• The exact mechanism of how potassium iodide (KI) works
against fungi is unclear.
• It's used for sporotrichosis, but its mode of action remains
uncertain.
• Some theories suggest direct antifungal activity in vitro
against Sporothrix schenckii.
• Another theory involves cell lysis when exposed to
increasing KI concentrations, releasing lysosomal
enzymes.
Immunomodulatory Action:
• KI may have immunomodulatory effects, but the specific
target in the immunological pathway requires further
investigation.
Prescribing Considerations
Indications for Potassium Iodide:
• It is indicated as a thyroid-blocking agent to prevent the
uptake of radioactive iodine.
• Used in situations such as nuclear accidents or before
administering radioiodinated compounds in nuclear
medicine investigations.
Off-Label Dermatological Use:
Potassium iodide (SSKI) is not officially approved for
dermatological [Link], it is frequently prescribed for
various skin disorders, including:
• Certain Fungal Infections
• Erythema nodosum (EN)
• Disseminated granuloma annulare
• Necrobiosis lipoidica
• Nodular vasculitis
• Cutaneous sarcoidosis
• Granulomatous perioral dermatitis/rosacea
Dosage and Admintration
Recommended Doses:
• For treating infectious diseases: 4 to 6 grams per day in
adults, with pediatric doses being approximately half or
one-third of the adult dose.
• For inflammatory dermatoses: Approximately 1 gram per
day for adults, divided into three doses.
Potassium iodide can be administered as either “saturated
solution of potassium iodide” (SSKI) or concentrated
solution.
Saturated Solution of Potassium Iodide (SSKI):
• To create a 100 mL solution, use 100 g of salt with 70 mL
of distilled water (or 50 g of salt with 35 mL for a 50 mL
solution).
• Each drop from this solution contains approximately 0.07
g of KI (1.42 g/mL), resulting in approximately 4 g of daily
potassium iodide intake when administering 20 drops (70
mg/drop) 3 times a day.
Concentrated Solution:
• In a concentrated solution, 1 g of potassium iodide is
present in each mL of water.
• Using a 0.05 mL drop volume (50 mg), administering 20
drops 3 times a day yields a daily dose of 3 g.
Initiating Treatment:
• Begin treatment with low doses, typically 5 drops of SSKI
(0.07 g × 5) (0.35 g) three times a day.
• Gradually increase the dose by one drop per
administration until reaching the target dosage.
Administration Guidelines:
• Dilute the solution in 8 fluid ounces of liquid before taking
it.
• Can be taken with food, milk, or an antacid to minimize
stomach upset.
• Use a straw to prevent tooth discoloration.
Solution Maintenance:
• Do not use if the solution turns brownish-yellow.
• If crystals form in the solution, dissolve them by warming
the closed container in warm water.
INDICATIONS
USES OF SSKI
Labelled Thyroid diseases
(hyperthyroidism/thyrot
oxicosis)
Nuclear accidents
Off-label Neutrophilic disorders Sweet's syndrome, Pyoderma
gangrenosum, Behcet's disease
Panniculitis Erythema nodosum
Vasculitis: Nodular vasculitis, Wegener's
granulomatosis
Deep-mycoses Sporotrichosis,
Cryptococcosis,Entomophthoramycosis,
Chromoblastomycosis, [Link]
pyoderma, Mucormycosis
Miscellaneous Erythema multiforme, granuloma
annulare, erythema annulare centrifugum
Sporotrichosis
• SSKI is considered equivalent to itraconazole and is cost-
effective for treating lymphocutaneous and fixed cutaneous
sporotrichosis.
• Dosage:
• Initiate SSKI at 5-10 drops three times a day, with juice or water.
• Gradually increase the dose by 5 drops per dose per week.
• For children under 10 years, the recommended dose is 25-40 drops once
daily.
• For individuals over 10 years, the dose is 10-50 drops three times a day.
• Treatment Duration and Response:
• Initial response seen within 2 weeks.
• Complete healing usually occurs in 4-8 weeks.
• Continue treatment for 4-8 weeks after clinical cure for mycological cure.
A case of sporotrichosis before and after treatment with
SSKI
Entomophthoromycosis
• Entomophthoromycosis is a subcutaneous fungal infection
caused by Basidiobolus and Conidiobolus species.
• SSKI (Saturated Solution of Potassium Iodide) has been
found to be useful in treating this condition (Arora et al.,
2015).
• A recent study explored a combination therapy of
itraconazole (200 mg twice daily) and SSKI for rhinofacial
conidiobolomycosis and reported positive outcomes for
most patients.
Therapeutic Success Factors: The success of potassium iodide
treatment depends on:
• The size and duration of the infection
• The intrinsic immunological status of the host

Chromoblastomycosis:
• For chromoblastomycosis, the response to itraconazole and
terbinafine may be better for infections caused by C. carrionii.
However, for infections caused by E. pedrosoi, potassium iodide
alone can be effective.
Mucormycosis:
• In selected cases of mucormycosis, potassium iodide at a dose
ranging from 5 drops three times daily (TDS) to 20 drops TDS
has been found to be useful. Recent cases have shown
effectiveness in treating rhinocerebral mucormycosis.
• Neutrophilic disorders like pyoderma gangrenosum,
Sweet's syndrome, and Behçet's disease involve
neutrophil activity in their pathophysiology.
• Potassium iodide inhibits neutrophil chemotaxis and toxic
radical production, making it suitable for these disorders.
• For pyoderma gangrenosum, potassium iodide at a dose
of 900-1,200 mg/day has been effective alone or in
combination with other treatments.
• Potassium iodide is also effective in treating panniculitis.
• Rapid improvement in fever, pain, and erythema is seen.
• Complete remission often achieved within two weeks.
• Main indications for its use include erythema nodosum
(EN), nodular vasculitis, and subacute nodular migratory
panniculitis.
Erythema Nodosum
• Potassium iodide is generally well-tolerated, effective, and
non-immunosuppressive.
• The recommended dose of SSKI is 1 to 2 drops three times
a day (tds), with gradual titration up to 5 drops tds advised.
• Topical heparin is a useful addition to the treatment. It
induces mast cells to release heparin, which suppresses
delayed hypersensitivity reactions, implicated in the
causation of erythema nodosum.
• Potassium iodide is especially beneficial in subacute
nodular migratory panniculitis (erythema nodosum
migrans).
A case of erythema nodosum migrans recalcitrant to conventional
medications with complete resolution on sski and topical heparin.
Monitoring the treatment
• Monitor pulse, blood pressure, weight and temperature.
• Check serum potassium levels.
• Thyroid function test should be checked every 6-12 months during long
term use.
Symptoms to Monitor for Hypothyroidism:
• Puffy hands, feet, periorbital swelling.
• Weight gain.
• Lethargy.
• Hair loss.
• Hirsutism.
Symptoms of Iodism to Watch for:
• Metallic taste.
• Skin lesions.
• GI upset.
Side Effects
• Common: GI upset, acne, iodism symptoms.
• Rare: Urticaria, angioedema, hypothyroidism with goiter,
cutaneous side effects, rash, urticaria, angioneurotic
edema, mucosal hemorrhage.
• Excessive iodine can cause hypothyroidism or
hyperthyroidism.
Overdose Symptoms:
• Iodism symptoms (headache, salivary gland swelling, fever, GI
upset).
• Pulmonary edema.
• Corrosive GI tract injury.
• Cardiopulmonary collapse.
• Glottis edema.
Treatment for Overdose:
• Do not perform gastric lavage due to the risk of corrosive injury.
• Activated charcoal may help if administered within 1 hour of
ingestion.
• Provide milk or starch-based food.
Conditions where KI should not be Used/Caution
Excercised
• Thyroid diseases (hypo- or hyperthyroidism, nodules, thyroid
cancer).
• Family history of thyroid disease (with consideration for anti-
thyroid antibody screening).
• Hypersensitivity to iodine/iodides.
• Pregnancy and lactation.
• Concomitant conditions (chronic renal failure, Addison's
disease, uncontrolled diabetes).
• Hyperkalemia (caution with certain medications).
• Hypocomplementemic vasculitis.
• Dermatitis herpetiformis.
• Patients with malignancy, HIV, or on immunosuppressants.
Advise to patients
• Watch for hypersensitivity reactions like rash, swollen
salivary glands, headache, wheezing, or coughing.
• Be alert to signs of an overactive thyroid: weight loss,
increased appetite, heat intolerance, excessive sweating.
• Monitor for an enlarged thyroid and myxedema (skin and
tissue thickening, especially on the face).
• Be cautious of stomach upset, nausea, metallic taste, and
report these symptoms.
• Continued use may lead to depression, nervousness,
insomnia, or impotence
THANK YOU