Acute Effects of Pesticides on the Integumentary System

1. Acute Effects of Pesticides on the Integumentary System Pesticide Health Effects Medical Education Database (PHEMED) 2010

2. General Issues • Skin: Primary exposure route of pesticides • Most common effect is contact dermatitis • Allergic • Irritant • 15-25% pesticide illness reports

3. Plant materials Solvents Fuels Rubber Cleansers Creams Moisture Cold temperatures Physical abrasions Multiple Irritants in Agricultural Workplace

4. Common Culprits by Chemical Family of Pesticides • Fungicide induced irritant or allergic dermatitis • Dithiocarbamates • Maneb (MANEX, PENTATHLON) • Mancozeb (DITHANE) • Thiram (ROOTONE, PROSPER) • Zineb (NR) • Sulfur from a mixture of zineb, sulfur and malithion Photo credit: M.A. O’Malley Source: M.A. O’Malley, Skin reactions to pesticides, Occup Med State Art Rev 12 ([1997]2): 327–45.

5. Common Culprits by Chemical Family of Pesticides • Insecticides • Miticide: propargite* • Organophosphates: skin sensitizers • Intermittent dermatitis reports in Wa and Ca • Malathion and Chlorpyrifos • Carbamates: Reported cases in WA with carbaryl • Pyrethroids – Topical (skin surface) irritation and paresthesias Photo: O’Malley * 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

6. Common Culprits by Chemical Family of Pesticides • Soil fumigants can cause irritant dermatitis and chemical burns • methyl bromide (TRI-CON) • metam sodium (VAPAM) • Herbicides - induced irritant or allergic dermatitis • paraquat – diquat – highly irritating – 53% paraquat applicators had a rash or burn in one study* Photo : M.A. O’Malley * 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.

7. Severe Contact DermatitisCartap + [Fenobucarb, Dimethoate and Methyl Parathion x 20 yrs] Photo: CEDAC Centre d’Etude et de DevelopementAgricoleCambodgien

8. Irritation, blistering, erosions Contact dermatitis Flushing Dermal sensitization Red beefy palms/soles Urticaria Bullae Pallor Cyanosis Yellow stain Keratoses, brown discolorations Ecchymoses Jaundice Excessive hair growth Loss of hair Loss of finger nails Brittle nails, white striations Sweating - diaphoresis Pesticide Related Presentations

9. Irritation, Blistering, Erosions • Heavy metal compounds: copper, organotin, cadmium • Metam sodium • Paraquat • Diquat • Sodium chlorate • Phosphorus • Sulfur • Glyphosate • Propargite • Sodium hypochlorite • Quaternary ammonia • Thiram • Chlordimeform • Cationic detergents • Hexachlorphene • Ethylene oxide • Formaldehyde • Acrolein • Methyl bromide • Ethylene dibromide • Dibromochloropropane • Dichloropropane • Endothall • Aliphatic acids

10. Other Presentations

11. Products That Can Generate Contact Dermatitis • Pentachlorophenol (PCP) – wood preservative • Paraquat • DEET • Chlorhexidine • Creosote • Hexachlorophine • Pyrethrins • Chlorothalonil (F) • Thiram (R) • Thiophthalmides: captan, captofol, folpet (F)

12. Sodium chlorate - hemolysis (H) Paraquat- pulmonary fibrisos (H) Cadmium dusts – pneumonitis (F) Nicotine – respiratory paralysis (I) Organochlorines – seizures, metabolic acidosis (I) Convulsant Rodenticides Sodium fluoroacetate Strychnine Crimidine Cyanosis

13. Other Color Changes Yellow stain • Nitrophenols Keratoses • Inorganic arsenicals Ecchymoses – • Coumarins • Indandiones Jaundice • Carbon tetrachloride • Chloroform • Phosphorus • Phosphides • Phosphine • Paraquat • Sodium chlorate Photo: H Murphy – Andra Pradesh India

14. Changes to Skin and Hair Hair loss • Thallium • Inorganic arsenicals Excessive hair growth • Hexachlorobenzene Loss of fingernails • Paraquat • Inorganic arsenicals Brittle nails, white striations • Inorganic arsenicals • Thallium Photo : M.A. O’Malley

15. Pentachlorophenol (PCP) • 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

16. Sweating - Diaphoresis • Cholinesterase inhibiting insecticides • Organophosphates • Carbamates • Nicotine • Pentachlorophenol • Naphthalene • Aminopyridine Photo: EPA Farmworker Pesticide Safety Program

17. Paraquat • 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.

18. DEET • 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%)

19. Chlorhexidine Disinfectant • 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.

20. Creosote • 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 • 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.

21. Hexachlorophine • Disinfectant • Erythemateous desquamative rash at exposure site • Contact dermatitis with prolonged exposure • Potent neurotoxin when absorbed through skin: wounds, abrasions, neonate’s delicate skin

22. Copper Compounds • 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 • Inorganic Copper Compounds • 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 • copper linoleate • copper naphthenate • copper oleate • copper phenyl salicylate • copper quinolinolate • copper resinate

23. Organotin • Fungicide • Control blights on field crops and orchards • Anti-fouling agents on ships • Irritants to skin, eyes, and respiratory systems Commercial Products • fentin hydroxide • Super Tin • Suzu-H • Tubotin • triphenyltin