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Dermatological Findings Correlated With Thallium Concentration

Ching-I Lu, MD; Chin-Chang Huang, MD; Ya-Ching Chang, MD; Yu-Tai Tsai, MD; Hung-Chou Kuo, MD; Ya-Hui Chuang, MD; Tung-Sheng Shih, PhD

Arch Dermatol. 2007;143(1):93-98.

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.

Observations  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.

Author Affiliations: Departments of Dermatology (Drs Lu, Chang, and Chuang) and Neurology (Drs Huang, Tsai, and Kuo), Chang Gung Memorial Hospital; Department of Neurology, Chang Gung University (Dr Huang); and Institute of Occupational Safety and Health, Council of Labor Affairs, Executive Yuan (Dr Shih), Taipei, Taiwan.