Prolonged absorption with development of tolerance to toxic effects after cutaneous exposure to nicotine

This report describes a patient who developed nicotine poisoning after cutaneous application of nicotine sulfate. Measurement of nicotine and metabolite levels in the blood demonstrated prolonged absorption of nicotine despite vigorous skin decontamination. This suggests that the skin may be a reservoir for slow release of nicotine into the circulation. Despite extraordinarily high levels of nicotine, the patient had full resolution of signs and symptoms of intoxication, indicating rapid and profound development of tolerance.