Selected clinical presentations of irritant chemicals

Extremely cytotoxic agent (risk of severe tissue damage
Able to penetrate intact skin due to its limited dissociation constant
Painful penetration may persist for days after exposure
Onset of symptoms may be delayed for up to a day with low concentrations
Intense pain is due to the capacity of fluoride ions to bind tissue calcium which affects nerve conduction
Toxicity is influenced by hypomagnesemia and a fluoride-mediated increase in pulmonary vascular resistance

Acute ulcerative damage due to the high alkalinity of wet cement which releases calcium hydroxide
Necrotic skin changes are seen 8–12 hours after exposure
Chronic irritant cement dermatitis develops with continued exposure over months to years; may be accompanied by allergic contact dermatitis to chromium
Common locations: lower limbs (kneeling, contaminated footwear), hands (glove contamination)

Gives a green-black color to hair, skin, and teeth if continuous exposure to dust forms
Inhalation of copper oxides may cause metal fume fever (transient influenza-like illness often associated with welding)

Blue linear pigmentation of the tongue and gums (potential marker for systemic mercury poisoning)

Both irritant and allergic contact dermatitis have restricted its use as a skin disinfectant
Positive patch tests to mercury are seen in patients with oral lichenoid reactions to dental materials

Cutaneous irritation
Systemic effects include liver and kidney damage, central nervous system depression, and carcinogenesis
Methylene chloride can hydrolyze to form hydrochloric acid causing significant cutaneous irritation
“Degreaser’s flush”: sudden onset of erythema of the face, neck, and shoulders; caused by alcohol ingestion before or during inhalation of trichloroethylene

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