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[Chronic percutaneous salicylic acid poisoning]
Summary
Uncontrolled, long-term use of 10% salicylic acid ointment caused chronic percutaneous salicylism in a psoriatic patient. Despite record-high salicylic acid levels, clinical symptoms were mild, highlighting potential risks of topical salicylic acid abuse.
Area of Science:
- Dermatology
- Toxicology
- Pharmacology
Background:
- Psoriasis treatment often involves topical agents.
- Salicylic acid is a common keratolytic agent used in dermatological preparations.
- Percutaneous absorption of topical medications can lead to systemic toxicity.
Observation:
- A 62-year-old female with psoriasis used a 10% salicylic acid ointment extensively for 18 months.
- Widespread application covered nearly 75% of her total body surface area.
- This led to chronic percutaneous salicylism.
Findings:
- Salicylic acid levels in serum (223 mg%) and urine (200 mg%) were the highest recorded for this type of intoxication.
- Clinical presentation of salicylism was notably discrete, contrasting with the high systemic levels.
- The study highlights a discrepancy between biochemical intoxication markers and overt clinical signs.
Implications:
- Warns against the uncontrolled, long-term application of topical salicylic acid preparations.
- Underscores the importance of monitoring systemic absorption even when clinical signs are minimal.
- Suggests potential for significant systemic toxicity from high-concentration topical salicylic acid, even in chronic, low-symptom cases.