Minimising risk of harm from potassium permanganate soaks.

Overview of: British Association of Dermatologists. Guidance on minimising risk of harm from potassium permanganate soaks. April 2022.

Manganese oxidation state as a cause of irritant patch test reactions.

BACKGROUND: Manganese chloride (MnCl2) 2.5% is included in the extended metals patch test series to evaluate patients for contact hypersensitivity to this metal salt. OBJECTIVES: The objective of this study was to prospectively determine the rate of allergic and irritant patch test reactions to MnCl2 (Mn(II)), Mn2O3 (Mn(III)), and KMnO4 (Mn(VII)) in a cohort of patients undergoing patch testing. METHODS: Fifty-eight patients were patch tested with MnCl2, Mn2O3, and KMnO4, each at 2.5% in petrolatum. Patch readings were taken at 48, and 72 or 96 hours, and scored using standard methods. Cultured monolayers of keratinocytes (KCs) were exposed to MnCl2, Mn2O3, and KMnO4 in aqueous culture medium, and cell survival and cytokine release were studied. CONCLUSIONS: MnCl2 caused irritant patch test reactions in 41% of the cohort, whereas Mn2O3 and KMnO4 caused a significantly lower rate of irritant reactions (both 3%). No allergic morphologies were observed. Similarly, in cultured KC monolayers, only MnCl2 was cytotoxic to KC and induced tumor necrosis factor α release.The oxidation state of manganese used for patch testing affects the irritancy of this metal salt, as Mn(II) caused an unacceptably high rate of irritant reactions in a cohort of patients. In vitro studies confirmed these clinical data, as only Mn(II) was cytotoxic to cultured monolayers of KC.

Chronic manganese toxicity due to substance abuse in Turkish patients.

BACKGROUND: Manganese toxicity may lead to a levodopa-resistant akinetic-rigid syndrome. Pathological changes occur mostly in the pallidium and stratium. MATERIALS AND METHODS: We report seven patients with a new form of chronic manganese toxicity due to long-term intravenous use of a solution consisting of ephedrine, acetylsalicylic acid and potassium permanganate as a psycho-stimulant, popularly known as "Russian Cocktail". RESULTS: The age of the patients ranged between 19 and 31 years, and the duration of substance abuse was between nine and 106 months. The onset of symptoms from first use ranged seven to 35 months. The initial symptom was impaired speech followed by gait disturbance and bradykinesia. In addition to these symptoms, choreic movements, ataxia presenting as backward falls and dystonia were also seen. Serum and urine samples revealed high levels of manganese. Hyperintense lesions on T1-weighted magnetic resonance imaging were seen in bilateral basal ganglia and brainstem, dentate nuclei, features consistent with manganese intoxication. CONCLUSION: Manganese toxicity, which may cause a distinctive irreversible neurodegenerative disorder, can be seen frequently with "Russian Cocktail" abuse, a substance which can be accessed very easily and at a low cost.

Patients' perceptions of the impact of treatments and products on their experience of leg ulcer pain.

OBJECTIVE: Very little research has explored patients' experience of pain with different cleansing agents and dressings. We therefore undertook a longitudinal study of their impact on leg ulcer pain. METHOD: Patients with leg ulcers referred to community nurses were eligible to participate. They were followed up for six months, completing questionnaires about the impact on pain of each wound treatment used. A treatment episode was defined as the use of a wound cleansing agent, primary dressing and bandages. When one aspect of treatment changed, a new treatment episode began. RESULTS: There were 210 treatment episodes for 96 leg ulcer patients. In 206 episodes cleansing agents were used. Cleansing caused pain in 22% of episodes and relieved pain in 27%. Of the five most commonly used dressing types, low-adherent dressings were the least likely to cause pain. Only 56% of patients were able to tolerate full compression bandaging and pain was the most common reason for non-compliance. CONCLUSION: A substantial proportion of patients felt that leg ulcer treatments caused pain. A greater emphasis on the impact of treatment on pain and healing is warranted both clinically and in research.

[Pharyngeal scars stenosis in children]. / Rybtsovye stenozy glotki u detei.

The treatment and follow-up data are available for 18 children (12 boys and 6 girls) with persistent scarry pharyngostenosis. The disease was first diagnosed at the age of 1 year 8 months to 12 years. Pharyngostenosis has resulted from burn induced by KMnO4 crystals. After treatment (laser destruction in 13 patients and bourginage in 4 patients) 15 patients resumed free breathing. 2 patients continue the treatment.

[Chemical burns of the oral cavity and esophagus in infants]. / Khimicheskii ozhog polosti rta i pishchevoda u detei rannego vozrasta.

The author has analyzed 482 sick children younger than 2 years of age. The burn degree was established with the help of narcotized esophagoscopy and by parameters of homeostasis. The washing out of the chemical substance was performed by oral introduction of 6-9 liters of water and the following probe-elimination from the stomach within the first 12-24 hours. Correction of disturbed homeostasis was fulfilled if necessary. The independent nutrition was started on the 2nd-3rd day. The method allowed treatment of the burned esophagus without bougieurage provided the patient was admitted to the hospital during the 1st day. Nineteen patients died (3.9%). Long-term results were favorable.

Potassium permanganate induced oesophageal stricture.

A case of oesophageal stenosis following ingestion of potassium permanganate as an abortifacient is described.

PIP: A case is reported of a 20-year-old married female who developed esophageal stricture following consumption of potassium permanganate as an abortifacient. The woman was admitted in May 1985 with progressive dysphagia of 4 weeks duration. A week before the onset of symptoms, she was given, by a "village quack", a powder to be taken with sugar for inducing abortion in the 1st trimester of pregnancy. Immediately after consuming about 25 g of this powder, the patient experienced intense pain in the retrosternal area. She vomited repeatedly the whole day and aborted 12 hours later. Soon thereafter, she began to have difficulty in swallowing, which increased progressively over the next month before she came to the hospital for advice. Examination revealed mild dehydration. The oral cavity did not show any ulceration. A barium swallow showed a long, narrow stricture of the esophagus. Endoscopy revealed a mild esophagitis from 20-24 cm, beyond which a long, narrow stricture could be seen. A feeding tube was put in, and 2 weeks later endoscopic dilatation with Eder-Puestow dilators was begun. She underwent 6 sittings of dilatation which led to complete recovery of her symptoms. A followup barium study was not done since the patient had conceived again. A sample of the "powder" which she had consumed was chemically analyzed and found to be potassium permanganate. This case illustrates that potassium permanganate (KMn04) can cause severe chemical burns to the esophagus, which on healing may reult in fibrosis leading to stricture formation.

Oral ingestion of potassium permanganate or aluminum acetate in two patients.

Accidental ingestion of medication intended for topical use occurred in two patients. A patient hospitalized for psoriasis mistakenly swallowed potassium permanganate tablets intended for use in her bathwater. Another patient ingested tablets intended to prepare Burow's solution for topical treatment of his wound infection. These types of accidental ingestion of medicine intended for topical use are, fortunately, uncommon and do not usually lead to complications. However, the current trend to unit dosing, especially in tablet form, may result in the more frequent occurrence of such accidents.