Transcript Skin - Pesticide Health Effects Medical Education Database

Acute Effects of Pesticides on
the Integumentary System
Pesticide Health Effects Medical Education Database (PHEMED) 2010
General Issues
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Skin: Primary
exposure route of
pesticides
Most common effect is
contact dermatitis
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Allergic
Irritant
15-25% pesticide
illness reports
Multiple Irritants in
Agricultural Workplace
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Plant materials
Solvents
Fuels
Rubber
Cleansers
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Creams
Moisture
Cold temperatures
Physical abrasions
Common Culprits by
Chemical Family of Pesticides
Fungicide induced irritant or allergic
dermatitis
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Maneb (MANEX, PENTATHLON)
Mancozeb (DITHANE)
Thiram (ROOTONE, PROSPER)
Zineb (NR)
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from a
mixture of
zineb,
sulfur and
malithion
Dithiocarbamates
Sulfur
Photo credit: M.A. O’Malley
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Source: M.A. O’Malley, Skin reactions to pesticides, Occup Med State Art Rev 12 ([1997]2): 327–45.
Common Culprits by
Chemical Family of Pesticides
Insecticides
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Miticide: propargite*
Organophosphates: skin sensitizers
Intermittent dermatitis reports in Wa and Ca
Malathion and Chlorpyrifos
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Carbamates: Reported cases in WA with carbaryl
Pyrethroids – Topical (skin surface) irritation and paresthesias
* O’Malley M. Irritant chemical dermatitis among grape workers in Fresno County, August 1995. Sacramento, 1998
California Department of Pesticide Regulation Worker Health and Safety Branch HS-1741
Photo: O’Malley
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Common Culprits by
Chemical Family of Pesticides
Soil fumigants can cause irritant
dermatitis and chemical burns
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methyl bromide (TRI-CON)
metam sodium (VAPAM)
Herbicides - induced irritant or
allergic dermatitis
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Photo : M.A. O’Malley
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paraquat – diquat – highly irritating
– 53% paraquat applicators had a
rash or burn in one study*
* Source: Castro-Gutierrez N, McConnell R, Andersson K, Pacheco-Anton F, Hogstedt,C. Respiratory symptoms,
spirometry and chronic occupational paraquat exposure. Scand J Work Environ Health 1997;23:421–427.
Severe Contact Dermatitis
Cartap + [Fenobucarb, Dimethoate and Methyl Parathion x 20 yrs]
Photo: CEDAC Centre d’Etude et de Developement Agricole Cambodgien
Pesticide Related Presentations
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Irritation, blistering,
erosions
Contact dermatitis
Flushing
Dermal sensitization
Red beefy palms/soles
Urticaria
Bullae
Pallor
Cyanosis
Yellow stain
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Keratoses, brown
discolorations
Ecchymoses
Jaundice
Excessive hair growth
Loss of hair
Loss of finger nails
Brittle nails, white
striations
Sweating - diaphoresis
Irritation, Blistering, Erosions
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Heavy metal compounds:
copper, organotin, cadmium
Metam sodium
Paraquat
Diquat
Sodium chlorate
Phosphorus
Sulfur
Glyphosate
Propargite
Sodium hypochlorite
Quaternary ammonia
Thiram
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Chlordimeform
Cationic detergents
Hexachlorphene
Ethylene oxide
Formaldehyde
Acrolein
Methyl bromide
Ethylene dibromide
Dibromochloropropane
Dichloropropane
Endothall
Aliphatic acids
Other Presentations
Dermal sensitization
Propachlor
Propargite
Ethylene oxide
Beefy red palms, soles
Borate
Urticaria
Chlorhexidine
PCP
DEET
Bullae
Liquid fumigants
Flushing
Cyanamide
Nitrophenols
Pallor
Organochlorines
Fumigants
Sodium fluoride
Creosote
Products That Can Generate
Contact Dermatitis
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Pentachlorophenol (PCP) – wood preservative
Paraquat
DEET
Chlorhexidine
Creosote
Hexachlorophine
Pyrethrins
Chlorothalonil (F)
Thiram (R)
Thiophthalmides: captan, captofol, folpet (F)
Cyanosis
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Sodium chlorate - hemolysis (H)
Paraquat- pulmonary fibrisos (H)
Cadmium dusts – pneumonitis (F)
Nicotine – respiratory paralysis (I)
Organochlorines – seizures, metabolic acidosis (I)
Convulsant Rodenticides
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Sodium fluoroacetate
Strychnine
Crimidine
Other Color Changes
Jaundice
Yellow stain
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Nitrophenols
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Keratoses
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Inorganic arsenicals
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Ecchymoses –
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Coumarins
Indandiones
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Photo: H Murphy – Andra Pradesh India
Carbon tetrachloride
Chloroform
Phosphorus
Phosphides
Phosphine
Paraquat
Sodium chlorate
Changes to Skin and Hair
Hair loss
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Thallium
Inorganic arsenicals
Excessive hair growth
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Hexachlorobenzene
Loss of fingernails
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Paraquat
Inorganic arsenicals
Brittle nails, white striations
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Inorganic arsenicals
Thallium
Photo : M.A. O’Malley
Pentachlorophenol (PCP)
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Use primarily as a wood preservative: now only
on telephone poles, railroad ties and wharf
pilings
In the past as an herbicide, algacide, defoliant,
germicide, fungicide and molluscide
Trade names: Santophen, Pentachlorol,
Chlorophen, Chlon, Dowicide 7, Pentacon*,
Penwar, Sinituho and Penta*
Common cause of dermatitis among workers
Cases of chloracne also reported
* Still registered and in use
Sweating - Diaphoresis
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Cholinesterase inhibiting insecticides
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Organophosphates
Carbamates
Nicotine
Pentachlorophenol
Naphthalene
Aminopyridine
Photo: EPA Farmworker Pesticide Safety Program
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Paraquat
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Paraquat is a potent herbicide – defoliant
Prolonged contact: erythema, chemical burns
with blistering, ulceration, abrasions and
fingernail changes.
Absorption through intact skin is slow
Effectively absorbed when skin is abraded or
eroded
Current use in the US is on cotton, almonds,
alfalfa, table and raisin grapes, and wine grapes
Brand names: Gramoxone, Surefire, Cyclone.
DEET
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Tingling, mild irritation and desquamination can
follow repeated application
Cases of contact dermatitis
Exacerbation of pre- existing skin disorders
Blisters and erosions when applied to occluded
parts of the skin (antecubital)
Use low concentration on children (<6%)
Chlorhexidine Disinfectant
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Handwash: Hibiclens and Hibistat
Mouthwash: Peridex in .12% solution
Can follow repeated applications
Rare in HC workers
Incidence 2.5 to 5.4% in atopic patients, likely
underreported*
Esophageal burns in one case with large
ingestion of a 20% solution
*Lim KS, Kam PC. Chlorhexidine--pharmacology and clinical applications.
Anaesth Intensive Care. 2008 Jul;36(4):502-12.
Creosote
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Distillation of the tar formed by anaerobic heating
wood or coal
Uses: wood preservative, animal dip, disinfectant
Workers in contact with technical grade or with
treated timber
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vesicular papular leisions
dermal pigmentation
rare gangrene and skin cancer
Residents of a community situated on a former
creosote wood treatment facility higher prevalence
of skin rashes (RR 5.7 CI 3-10.9)*
* Brender JD, Pichette JL, Suarez L, Hendricks KA, Holt M. Health risks of residential exposure to
polycyclic aromatic hydrocarbons. Arch Environ Health. 2003 Feb;58(2):111-8.
Hexachlorophine
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Disinfectant
Erythemateous desquamative rash at
exposure site
Contact dermatitis with prolonged
exposure
Potent neurotoxin when absorbed through
skin: wounds, abrasions, neonate’s
delicate skin
Copper Compounds
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Used as a agriculture
fungicide, aqautic
algaecide, molluscicide
Dusts or powders are
skin, respiratory eye
irritants
Soluble salts corrosive
Use – citrus, grapes,
nuts, aquatic, wood
treatment
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Inorganic Copper Compounds
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copper acetate
copper ammonium carbonate
copper carbonate, basic
copper hydroxide
copper lime dust
copper oxychloride
copper potassium sulfide
copper silicate
copper sulfate
cupric oxide
cuprous oxide
tribasic
Bordeaux Mixture
Organic Copper Compounds
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copper linoleate
copper naphthenate
copper oleate
copper phenyl salicylate
copper quinolinolate
copper resinate
Organotin
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Fungicide
Commercial Products
Control blights on
• fentin hydroxide
field crops and
o Super Tin
o Suzu-H
orchards
o Tubotin
Anti-fouling agents
• triphenyltin
on ships
Irritants to skin, eyes,
and respiratory
systems