Dermatologic toxicology in children.

Abstract

Historical Perspective ~ s early as 1886, the toxic effects of percutaneously absorbed agents on neonates was described by Dr Rayner, a medical officer in London, after he was asked to examine several curiously blue infants. Prominent dye stamps from a freshly labeled diaper on the buttocks and perineum of one of the newborns were his clue to the discovery of aniline toxicity. Despite this fact, aniline labeled diapers continued to be used and resulted in at least six infant deaths. 1 Acrodynia, the systemic and cutaneous manifestations of chronic mercury exposure, was first reported as Pink Disease in Australia in 1890. Several decades passed before the dangers of mercury exposure in newborns became widely recognized as mercury rinsed diapers and mercury containing teething powders were linked to commonly reported cases of neonatal acrodynia. The morality rate was as high as 10% and more than 500 children died from mercury poisoning in the 1930s and 40s. 2 Phenolic compounds are a historically infamous cause of neonatal toxicity. In the late 1960s in a small birthing hospital for unwed mothers in St. Louis, Missouri, infant bed linens and diapers laundered in pentachlorophenol were responsible for at least 20 cases of percutaneous toxicity and two deaths. The infants experienced profuse sweating, tachycardia, tachypnea, hepatomegaly and metabolic acidosis. 3 Hexachlorophene, a phenolic compound well known for its anti-staphylcoccal properties, is marketed in 3% concentration in pHisoHex@ (Sterling Winthrop Inc). pHisoHex® is an antiseptic cleanser popularized for bathing infants until its neurotoxic properties were recognized in the early 1970s. Percutaneous absorption resulted in an acute encephalopathy, seizures, and death. 4