Povidone-iodine is also efficient against fungi and viruses (including HIV and "Herpes simplex"). It is used in pleurodesis (fusion of the pleura because of incessant pleural effusions). For this purpose, povidone-iodine is equally effective and safe as talc, and may be preferred because of easy availability and low cost. There is tentative evidence that chlorhexidine and denatured alcohol used to clean skin prior to surgery is better than povidone-iodine with alcohol; however, the evidence is not strong enough as of 2015 to determine routine practice. PVP-I is contraindicated in patients with hyperthyroidism (overactive thyroid gland) and other diseases of the thyroid,
Iodine demonstrated that these animals could survive after eating a 14000 mg/kg dose). Excess iodine can be more cytotoxic in the presence of selenium deficiency. Iodine supplementation in selenium-deficient populations is, in theory, problematic, partly for this reason. The toxicity derives from its oxidizing properties, through which it denaturates proteins (including enzymes). Elemental iodine is also a skin irritant, and direct contact with skin can cause damage and solid iodine crystals should be handled with care. Solutions with high elemental iodine concentration, such as tincture of iodine and Lugol's solution, are capable of causing tissue damage if used in prolonged cleaning