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Chap. 33 - SKIN SIGNS OF POISONING

Published online by Cambridge University Press:  07 September 2011

By
Batya B. Davidovici  and
Ronni Wolf
Edited by
Ronni Wolf ,
Batya B. Davidovici ,
Jennifer L. Parish  and
Lawrence Charles Parish
Batya B. Davidovici
Affiliation:
Kaplan Medical Center
Ronni Wolf
Affiliation:
Hebrew University–Hadassah Medical School
Ronni Wolf
Affiliation:
Kaplan Medical Center, Rehovot, Israel
Batya B. Davidovici
Affiliation:
Kaplan Medical Center, Rehovot, Israel
Jennifer L. Parish
Affiliation:
Jefferson Medical College of Thomas Jefferson University
Lawrence Charles Parish
Affiliation:
Jefferson Medical College of Thomas Jefferson University
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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.

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Emergency Dermatology , pp. 318 - 326
Publisher: Cambridge University Press
Print publication year: 2011

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