Skip to main content
×
×
Home
  • Print publication year: 2011
  • Online publication date: September 2011

Chap. 33 - SKIN SIGNS OF POISONING

Summary

CUTANEOUS POISONING syndromes produce a myriad of signs and symptoms. Poisoning may be acquired either accidentally or deliberately through inhalation, ingestion, or percutaneous contact of the toxic substances. It can affect all age groups, but children have an increased risk for adverse effects of these toxic agents.

Early diagnosis and therapeutic support may not always be achieved due to poor recognition of signs and symptoms. This realization emphasizes the importance of recognizing the signs of cutaneous poisoning syndromes and initiating adequate systemic therapy when indicated. The initial approach to poisoning entails a thorough clinical history, detailed physical examination, and institution of basic supportive measures. Primary and secondary prevention by way of public education and vigilant observation are essen-tial.

One of the challenges in managing these patients is to identify the “needle in the haystack,” the small percentage that may develop potentially serious clinical effects and require specific management without subjecting them to unnecessary procedures.

The focus of this review is on four major cutaneous poisoning syndromes, namely metallic poisoning (arsenic, mercury); excessive β-carotene (carotenoderma), which may present with diagnostic and therapeutic difficulties; carbon monoxide (CO) poisoning; and dioxin poisoning.

ARSENIC POISONING

Arsenic is a well-recognized poisonous metal due to its inexpensive cost, lack of odor, and tasteless quality. Arsenic can be contacted during the smelting of copper, gold, lead, and other metals. In smelting operations and in the manufacture of pesticides and herbicides, considerable contamination of the environment can be present, requiring extensive preventive measures.

Recommend this book

Email your librarian or administrator to recommend adding this book to your organisation's collection.

Emergency Dermatology
  • Online ISBN: 9780511778339
  • Book DOI: https://doi.org/10.1017/CBO9780511778339
Please enter your name
Please enter a valid email address
Who would you like to send this to *
×
References
Cabrera, HN, Gomez, ML. Skin cancer induced by arsenic in the water. J Cutan Med Surg. 2003; 7:106–11.
Mazumder, DN. Effect of drinking arsenic contaminated water in children. Indian Pediatr. 2007; 44:925–7.
Uede, K, Furukawa, F. Skin manifestations in acute arsenic poisoning from the Wakayama curry-poisoning incident. Br J Dermatol. 2003; 149:757–62.
Blejer, HP, Wagner, W. Inorganic arsenic–ambient level approach to the control of occupational cancerigenic exposures. Ann NY Acad Sci. 1976; 271:179–86.
,NRC (National Research Council). Arsenic in drinking water. Washington, DC: National Academy Press; 1999. pp. 83–149.
Schwartz, RA. Arsenic and the skin. Int J Dermatol. 1997; 36:241–50.
Graeme, KA, Pollack, CV. Heavy metal toxicity, Part I: arsenic and mercury. J Emerg Med. 1998; 16:45–56.
Madorsky, D.Arsenic in dermatology. J Assoc Military Dermatol. 1977; 3:19–22.
Duker, AA, Carranza, EJ, Hale, M. Arsenic geochemistry and health. Environ Int. 2005; 31:631–41.
Ozuah, PO. Mercury poisoning. Curr Probl Pediatr. 2000; 30:91–9.
Dinehart, SM, Dillard, R, Raimer, SS, et al. Cutaneous manifestations of acrodynia (pink disease). Arch Dermatol. 1988; 124:107–9.
Foulds, DM, Copeland, KC, Franks, RC. Mercury poisoning and acrodynia. Am J Dis Child. 1987; 141:124–5.
Nakayama, H, Niki, F, Shono, M, Hada, S. Mercury exanthem. Contact Dermatitis. 1983; 9:411–17.
Grandjean, P, White, RF, Weihe, P, Jorgensen, PJ. Neurotoxic risk caused by stable and variable exposure to methylmercury from seafood. Ambul Pediatr. 2003; 3:18–23.
Harada, M, Akagi, H, Tsuda, T, et al. Methylmercury level in umbilical cords from patients with congenital Minamata disease. Sci Total Environ. 1999; 234:59–62.
Amin-Zaki, L, Elhassani, S, Majeed, MA, et al. Perinatal methylmercury poisoning in Iraq. Am J Dis Child. 1976; 130:1070–6.
Bernard, S, Enayati, A, Redwood, L, et al. Autism: a novel form of mercury poisoning. Med Hypotheses. 2001; 56:462–71.
Boyd, AS, Seger, D, Vannucci, S, et al. . Mercury exposure and cutaneous disease. J Am Acad Dermatol, 2000; 43:81–90.
Zahir, F, Rizwi, SJ, Haq, SK, Khan, RH. Low dose mercury toxicity and human health. Env Toxical Pharmacol 2005; 20:351–60.
Counter, SA, Buchanan, LH. Mercury exposure in children: a review. Toxicol Appl Pharmacol. 2004; 198:209–30.
Lamar, LM, Bliss, BO. Localized pigmentation of the skin due to topical mercury. Arch Dermatol. 1966; 93:450–3.
Prigent, F, Cohen, J, Civatte, J. Pigmentation des paupieres probablement secondaire l'application prolongée d'une pomade ophtalmologique contenant du mercure. Ann Dermatol Vénéréol. 1986; 113:357–8.
Aberer, W.Topical mercury should be banned - dangerous, outmoded but still popular. J Am Acad Dermatol. 1991; 24:150–1.
Burge, KM, Winkelmann, RK. Mercury pigmentation. An electron microscopic study. Arch Dermatol. 1970; 102:51–61.
Dantzig, PI. A new cutaneous sign of mercury poisoning?J Am Acad Dermatol. 2003; 49:1109–11.
Lerch, M, Bircher, AJ. Systemically induced allergic exanthem from mercury. Contact Dermatitis. 2004; 50:349–53.
Roujeau, JC, Bioulac-Sage, P, Bourseau, C, et al. Acute generalized exanthematous pustulosis. Analysis of 63 cases. Arch Dermatol. 1991; 127:1333–8.
Andersen, KE, Hjorth, N, Menne, T. The baboon syndrome: systemically-induced allergic contact dermatitis. Contact Dermatitis. 1984; 10:97–100.
Barrazza, V, Meunier, P, Escande, JP. Acute contact dermatitis and exanthematous pustulosis due to mercury. Contact Dermatitis. 1998; 38:361.
Geier, DA, Geier, MR. An assessment of the impact of thimerosal on childhood neurodevelopmental disorders. Pediatr Rehabil. 2003; 6:97–102.
James, SJ, Slikker, W, Melnyk, S, et al. Thimerosal neurotoxicity is associated with glutathione depletion: protection with glutathione precursors. Neurotoxicology. 2005; 26:1–8.
Pichichero, ME, Cernichiari, E, Lopreiato, J, Treanor, J. Mercury concentrations and metabolism in infants receiving vaccines containing thiomersal:a descriptive study. Lancet. 2002; 360:1737–41.
Goldman, LR, Shannon, MW. American Academy of Pediatrics: Committee on Environmental Health Technical report. Mercury in the environment: implications for pediatricians. Pediatrics. 2001; 108:197–205.
Halsey, NA.Limiting infant exposure to thimerosal in vaccines and other sources of mercury. JAMA. 1999; 282:1763–6.
Katz, SA, Katz, RB. Use of hair analysis for evaluating mercury intoxication of the human body: a review. J Appl Toxicol. 1992; 12:79–84.
Risher, JF, Amler, SN. Mercury exposure: evaluation and intervention the inappropriate use of chelating agents in the diagnosis and treatment of putative mercury poisoning. Neurotoxicology. 2005; 26:691–9.
Leumann, EP, Brandenberger, H. Hemodialysis in a patient with acute mercuric cyanide intoxication. Concentrations of mercury in blood, dialysate, urine, vomitus, and feces. Clin Toxicol. 1977; 11:301–8.
Noorden, C. Die Zukerkrankheit und ihre Behandlung. 4th ed. 1907. p. 149.
Moro, E. Karottensuppe bei Ernahringsstorungen Saulinge. Munch Med Wschr. 1908; 55:1637–40.
Hess, AF, Meyers, VC. Carotinemia: a new clinical picture. JAMA. 1919; 73:1743–5.
Almond, S, Logan, RFL. Carotenaemia. BMJ. 1942; 2:239–41.
Roe, DA. Assessment of risk factors for carotenodermia and cutaneous signs of hypervitaminosis A in college-aged populations. Semin Dermatol. 1991; 10:303–8.
Person, JR. Red palm and orange palms. Arch Dermatol. 1981; 117:757.
Palleschi, GM, Knoepfel, BR, Lotti, T. Carotenoderma: a possible pit-fall in the immunopathologic diagnosis of pemphigus vulgaris. Int J Dermatol. 1992; 31:50–1.
Parker, PS. Absorption, metabolism, and transport of carotenoids. FASEB J. 1996; 10:542–51.
Niizu, P, Rodriguez-Abaya, D. New data on the carotenoid composition of raw salad vegetables. J Food Comp Analysis. 2005; 18:739–49.
Lascari, AD. Carotenemia. A review. Clin Pediatr. 1981; 20:25–9.
Stack, KM, Churchwell, MA, Skinner, RB. Xanthoderma: case report and differential diagnosis. Cutis. 1988; 41:100–2.
Goodman, DS, Huang, HS. Biosynthesis of vitamin A with rat intestinal enzymes. Science. 1965; 149:879–80.
Vaughan Jones, SA, Black, MM. Metabolic carotenaemia. Br J Dermatol. 1994; 131:145.
Wouterson, RA, Wolterbeed, APM, Appel, MJ, et al. Safety evaluation of synthetic beta carotene. Crit Rev Toxicol. 1999; 29:515–42.
Leung, AK. Carotenemia. Adv Pediatr. 1987; 34:223–48.
Het Hof, KH, West, CE, Weststrate, JAHautvast, JG. Dietary factors that affect the bioavailability of carotenoids. J Nutr. 2000; 130:503–6.
Leung, AK. Carotenemia. Adv Pediatr. 1987; 34:223–48.
Tang, G, Serfaty-Lacrosniere, C, Camilo, ME, Russell, RM. Gastric acidity influences the blood response to a beta-carotene dose in humans. Am J Clin Nutr. 1996; 64:622–6.
Dimitrov, NV, Meyer, C, Ullrey, , et al. Bioavailability of beta-carotene in humans. Am J Clin Nutr. 1988; 48:298–304.
Paiva, SA, Russel, RM. Beta-carotene and other carotenoids as antioxidants. Am J Clin Nutr. 1999; 18:426–33.
Wouterson, RA, Wolterbeed, APM, Appel, MJ, et al. Safety evaluation of synthetic beta carotene. Crit Rev Toxicol. 1999; 29:515–42.
Monk, BE. Metabolic carotenaemia. Br J Dermatol. 1982; 106:485–7.
Greene, CH, Blackford, LM. Carotenemia. Med Clin North Am. 1926; 10:733–44.
Svensson, A, Vahlquist, A. Metabolic carotenemia and carotenoderma in a child. Acta Dermatol Venereol. 1995; 75:70–1.
Hoerer, E, Dreyfuss, F, Herzberg, M. Carotenemic, skin colour and diabetes mellitus. Acta Diabetol Lat. 1975; 12:202–7.
Schwabe, AD.Hypercarotenaemia in anorexia nervosa. JAMA. 1968; 205:533–4.
Gupta, MA, Gupta, AK, Haberman, HF. Dermatologic signs in anorexia nervosa and bulimia nervosa. Arch Dermatol. 1987; 123:1386–90.
Singh, S, Mulley, GP, Losowsky, MS. Carotenaemia in Alzheimer's disease. BMJ. 1988; 297:458–9.
Joseph, WL.Carotenemia vs jaundice. JAMA. 1976; 236:2603.
Shoenfeld, Y, Shaklai, M, Ben-Baruch Net al. Neutropenia induced by carotenaemia. Lancet. 1982; 1:1245.
Kemmann, E, Pasquale, SA, Skaf, R. Amenorrhea associated with carotenemia. JAMA. 1983; 249:926–9.
Mathews-Roth, MM.Plasma concentrations of carotenoids after large doses of beta-carotene. Am J Clin Nutr. 1990; 52:500–1.
Bernard, C. Lecons sur les effects des subtances toxiques et medicamenteuses. Bailliere, Paris, 1857.
Haldane, J.The relation of the action of carbonic oxide to oxygen tension. J Physiol. 1895; 18:201–17.
Ehrich, WE, Bellet, S, Lewey, FH. Cardiac changes from CO poisoning. Am J Med Sci. 1944; 208:1–23.
Corya, BC, Black, MJ, McHenry, PL. Echocardiographic findings after acute carbon monoxide poisoning. Br Heart J. 1976; 38:712–17.
Shafer, N, Smilay, MG, MacMillan, FP. Primary myocardial disease in man resulting from acute carbon monoxide poisoning. Am J Med. 1965; 38:316–20.
Penny, DG, Stryker, AE, Baylerian, MS. Persistent cardiomegaly induced by carbon monoxide and associated tachycardia. J Appl Physiol. 1984; 56:1045–52.
Choi, SA, Choi, IS. Clinical manifestations and complications in carbon monoxide intoxication. J Korean Neurol Assoc. 1998; 16:500–5.
Long, PI. Dermal changes associated with carbon monoxide intoxication. JAMA. 1968; 205:50–1.
Leavell, UW, Farley, CH, McIntyre, JS. Cutaneous changes in a patient with carbon monoxide poisoning. Arch Dermatol. 1969; 99:429–33.
Nagy, R, Greer, KE, Harman, . Cutaneous manifestations of acute carbon monoxide poisoning. Cutis. 1979; 24:381–3.
Lee, JB, Chang, KH, Choi, IS. Cutaneous manifestations of carbon monoxide poisoning. Korean J Dermatol. 1983; 21:279–83.
Achten, G, Ledoux-Corbusier, M, Thys, JP. Intoxication a l'oxyde de carbone et lesions cutanées. Ann Dermatol Syphiligr. 1971; 98:421–8.
Long, PI.Dermal changes associated with carbon monoxide poisoning. JAMA. 1968; 205:120.
Leavell, UW, Farley, CH, McIntyre, JS. Cutaneous changes in a patient with carbon monoxide poisoning. Arch Dermatol. 1969; 99:429–33.
Mandy, S, Ackerman, AB. Characteristic traumatic skin lesions in drug-induced coma. JAMA. 1970; 213:253–6.
Sterling, JB, Hanke, CW. Dioxin toxicity and chloracne in the Ukraine. J Drugs Dermatol. 2005; 4:148–50.
Yamamoto, O, Tokura, Y. Photocontact dermatitis and chloracne: two major occupational and environmental skin diseases induced by different actions of halogenated chemicals. J Dermatol Sci. 2003; 32:85–94.
Pastor, MA, Carrasco, L, Izquierdo, MJ, et al. Chloracne: histopathologic findings in one case. J Cutan Pathol. 2002; 29:193–9.
Baccarelli, A, Pesatori, AC, Consonni, D, et al. Health status and plasma dioxin levels in chloracne cases 20 years after the Seveso, Italy accident. Br J Dermatol. 2005; 152:459–65.
Mocarelli, P, Marocchi, A, Brambilla, P, et al. Clinical laboratory manifestations of exposure to dioxin in children. A six-year study of the effects of an environmental disaster near Seveso, Italy. JAMA. 1986; 256:2687–95.
Geusau, A, Tschachler, E, Meixner, M, et al. Olestra increases fecal excretion of 2,3,7,8-tetrachlorodibenzo-p-dioxin. Lancet. 1999; 354:1266–7.