Short-term thallium intoxication: dermatological findings correlated with thallium concentration.
BACKGROUND
The dermatological features and skin biopsy findings of short-term thallium intoxication have been described. However, the correlation between the dermatological findings and the thallium concentration, the prognosis of peripheral neuropathy, and a cutaneous nerve biopsy study are lacking.


METHODS
Two patients initially developed perioral numbness, erythematous facial rashes, and polyneuropathy after ingesting thallium-containing water. Severe diffuse alopecia was noted, and a skin biopsy specimen revealed parakeratosis and vacuolar degeneration of the basal layer. Examinations of the hair mount demonstrated a tapered appearance of the anagen root. A serial cutaneous nerve biopsy study showed a loss of epidermal nerves 7 weeks and even 1 year after the thallium intoxication. A toxicology survey disclosed a high concentration of thallium (about 3124 mg/L) in the water. The clinical dermatological features subsided completely, but polyneuropathy with severe painful feet persisted. The blood and daily urinary thallium concentrations decreased slowly in the following 3-month period.


CONCLUSIONS
The clinical dermatological features subsided completely, but painful polyneuropathy persisted. The series cutaneous nerve biopsy specimens showed persistent damage to the sensory nerve endings. The disappearance of the dermatological features and the appearance of Mees lines correlated with the decrease of blood and urinary thallium concentrations.
Lu
Ching-I
CI
Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Taiwan.
Huang
Chin-Chang
CC
Chang
Ya-Ching
YC
Tsai
Yu-Tai
YT
Kuo
Hung-Chou
HC
Chuang
Ya-Hui
YH
Shih
Tung-Sheng
TS
D000505:Alopecia / Q000139:chemically induced*; D001706:Biopsy; D019557:Dermatitis, Perioral / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009260:Nail Diseases / Q000139:chemically induced; D011115:Polyneuropathies / Q000139:chemically induced* / Q000473:pathology; D011379:Prognosis; D012867:Skin / Q000473:pathology*; D013054:Spectrophotometry, Atomic / Q000379:methods; D013793:Thallium / Q000097:blood / Q000506:poisoning* / Q000652:urine
D013793:Thallium