Phenol Toxicity Following Cutaneous Exposure to Creolin®: A Case Report.

INTRODUCTION: Phenol is a caustic that may cause cutaneous or gastrointestinal burns depending on the route of exposure. Significant absorption may result in systemic toxicity. We present a case of topical phenol exposure resulting in cutaneous burns and systemic phenol toxicity. CASE REPORT: A 9-year-old girl was exposed to Creolin(®), a general-purpose disinfectant containing phenol, when her mother applied this product to her head and upper torso. The patient required endotracheal intubation due to depressed mental status; she had cutaneous erythema in the distribution of contact with the cleanser. An initial EKG revealed sinus tachycardia with brief runs of monomorphic ventricular tachycardia. On hospital day (HD) 1, the area of erythema extended to both upper extremities and hyperpigmentation developed over the affected areas, which continued to darken during the hospital course. The patient was extubated late on HD 1. On HD 2, the patient's urine was noted to be a dark green color that resolved later that day. On HD 3, areas of desquamation and decreased sensation developed in skin areas of maximal contact with the cleanser. The patient developed a mild transaminitis with peak AST and ALT levels of 84 units/l and 99 units/l, respectively. The patient was discharged to home on HD 4. DISCUSSION: Our patient presented with signs of cutaneous and systemic phenol toxicity characterized by dermal burns, depressed mental status, cardiac dysrhythmias, and elevated hepatic transaminases. Phenol exposure may cause systemic toxicity following limited dermal exposure.

CYP1A1 gene polymorphisms: modulator of genetic damage in coal-tar workers.

AIM: It is well known that polycyclic aromatic hydrocarbons (PAHs) such as benzo (a) pyrene have carcinogenic properties and may cause many types of cancers in human populations. Genetic susceptibility might be due to variation in genes encoding for carcinogen metabolizing enzymes, such as cytochrome P-450 (CYP450). Our study aimed to investigate the effect of genetic polymorphisms of CYP1A1 (m1 and m2) on genetic damage in 115 coal-tar workers exposed to PAHs in their work place. METHODS: Genetic polymorphisms of CYP1A1 were determined by the PCR-RFLP method. Comet and buccal micronucleus assays were used to evaluate genetic damage among 115 coal tar workers and 105 control subjects. RESULTS: Both CYP1A1 m1 and CYP1A1 m2 heterozygous and homozygous (wt/mt+mt/mt) variants individually as well as synergistically showed significant association (P<0.05) with genetic damage as measured by tail moment (TM) and buccal micronuclei (BMN) frequencies in control and exposed subjects. CONCLUSION: In our study we found significant association of CYP1A1 m1 and m2 heterozygous (wt/mt) +homozygous (mt/mt) variants with genetic damage suggesting that these polymorphisms may modulate the effects of PAH exposure in occupational settings.

The occupational exposure of dermatology nurses to polycyclic aromatic hydrocarbons - evaluating the effectiveness of better skin protection.

OBJECTIVES: We studied the uptake of polycyclic aromatic hydrocarbons (PAH) in nurses who apply ointments containing coal tar to patients and investigated the effectiveness of skin protection methods. METHODS: We determined gas-phase PAH on XAD-2 and particle-associated PAH on filters. We also used pads to determine PAH on the skin. Pyrene and benzo(a)pyrene were analyzed by gas chromatography/mass spectrometry and gas chromatography/tandem mass spectrometry; their respective urinary metabolites 1-hydroxypyrene and 3-hydroxybenzo(a)pyrene were analyzed using high performance liquid chromatography with fluorescence detection. RESULTS: We ruled out the inhalation of airborne pyrene and benzo(a)pyrene as the sources of PAH exposure. However, substantial amounts of pyrene and benzo(a)pyrene were observed on the hands of the nurses (median 33.0 and 16.4 ng/cm (2), respectively). Excretion of urinary 1-hydroxypyrene indicated an increased uptake of pyrene in 8 out of 12 nurses. We asked 35 nurses to perform a treatment with gloves followed by a second treatment without gloves. The use of gloves changed the excretion of 1-hydroxypyrene by -0.58 mumol (range -5.1-1.0 mumol), corresponding to a median reduction of 51.5% (P<0.001). Based on this finding, a new protocol was adopted, involving the permanent use of vinyl gloves and Tyvek sleeves. The effectiveness of this protocol was tested against pre-existing work practices and showed a 97% reduction in skin contamination with pyrene and benzo(a)pyrene, and a lowering in urinary excretion of 1-hydroxypyrene of 57%. CONCLUSION: Protecting the skin more stringently reduced pyrene and benzo(a)pyrene contamination of the hands, and lowered urinary excretion of 1-hydroxypyrene.

[The possible nephrotoxicity of a bituminous coal dermatologic agent]. / Untersuchungen zur möglichen Nephrotoxizität eines steinkohlenteerhaltigen Dermatikums.

Nephrotoxic effects are discussed as a possible risk of dermatological coal tar preparations. Therefore, we have performed a renal tolerance study with a modern coal tar preparation for the scalp, Berniter. 15 healthy volunteers, randomly subjected to 3 different modes of application, applied the preparation: twice weekly (mode I) or daily (mode II) for a period of 8 weeks. In both modes, application time was 15 min. In mode III, the preparation was used under occlusion for 30 min every second day for a period of 4 weeks. Before, during and after treatment, renal functions and urinary phenol levels were assayed. No pathological change or impairment of renal functions was detected. A relationship between urinary phenol content and the coal tar treatment was not observed, either. We conclude that the coal tar preparation investigated here has no nephrotoxic properties.

Mortality among workers exposed to coal tar pitch volatiles and welding emissions: an exercise in epidemiologic triage.

The United Automobile Workers International Union has established a system of epidemiologic triage to evaluate patterns of mortality among groups of union members. In response to worker concerns, the Union examined mortality at a metal stamping plant, using a method which linked pension records with the State of Michigan computerized death registry. The observed proportion of malignant neoplasms was nearly twice that expected (95% Confidence Limits 1.36, 2.62). Two- to five-fold excess proportional mortality from cancer of the digestive organs, lung cancer, and leukemia accounted for most of the overall excess. Strong associations were found between lung and digestive organ cancer and employment as maintenance welders or millwrights in the plant (odds ratios greater than 10). High levels of six polycyclic aromatic hydrocarbons with mutagenic and carcinogenic properties were found during hot coal tar application to wood block floors, work conducted by the high-risk groups. These levels were substantially reduced following the purchase of new tar pots. The example demonstrates that epidemiologic tools can play a valuable role in occupational health decision making, but care must be taken to avoid mechanical reliance on quantitative testing and to acknowledge the important role of social and political value judgments in the establishment of responsible public policy.