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[Life threatening salicylate poisoning caused by percutaneous absorption in severe ichthyosis vulgaris]
R Germann1, I Schindera, M Kuch
1Hautarztpraxis, Völklingen.
Insights
Salicylate intoxication occurred in a child treated for ichthyosis vulgaris with topical salicylic acid ointment. Safer treatment options for ichthyosis vulgaris are needed.
Area of Science:
- Dermatology
- Toxicology
- Pediatrics
Background:
- Ichthyosis vulgaris is a common skin condition.
- Topical salicylic acid is used to treat ichthyosis vulgaris.
Observation:
- A 7-year-old boy developed salicylate intoxication after 4 weeks of topical 10% salicylic acid ointment.
- Symptoms included somnolence, hyperventilation, vomiting, tinnitus, and vertigo.
Findings:
- The patient presented with metabolic acidosis and a serum salicylate level of 985 micrograms/ml.
- Treatment with forced diuresis and alkalization resolved the intoxication without hemodialysis.
- Neurological deficits persisted for weeks, with full recovery taking 6 months.
Implications:
- This case highlights the risk of salicylate toxicity from topical application in children.
- It underscores the need for safer therapeutic alternatives for ichthyosis vulgaris in pediatric patients.
Abstract:
In a 7-year-old boy, ichthyosis vulgaris was treated with a 10% ointment for application over a large area of the body surface. In this way, the child received 400 g salicylic acid (0.6 g/kg body weight per day) percutaneously over a period of 4 weeks. The patient was referred to hospital by the family doctor: he was in a deep somnolent state, apparently caused by hyperventilation following wheezing, vomiting, tinnitus and vertigo. Salicylate intoxication was suspected because of metabolic acidosis, an anion gap and respiratory overcompensation. The diagnosis was confirmed by a serum salicylate level of 985 micrograms/ml (therapeutic level 150-300 micrograms/ml). Following forced diuresis and alkalization with sodium bicarbonate, haemodialysis was unnecessary. As the salicylate level declined to values within the therapeutic range, the patient started to recover consciousness, waking on the 4th day. By day 6 there were still obvious neurological deficiencies. Fecal incontinence, bilateral ptosis and intermittent diverging strabismus on the right persisted for some weeks. It was 6 months before complete neurological resolution was achieved. The pathogenesis of salicylate toxicity and the need for safer therapies for ichthyosis vulgaris are discussed.