|Year : 1990 | Volume
| Issue : 4 | Page : 317-318
An unusual side effect of castellani's paint
P Sugathan, R Najeeba, Neelakanta R Sharma
An unusual but serious side effect of methaemoglobinemia following topical application of decomposed Castellani's paint is described .
Keywords: Castellani′s paint, Methaemoglobinaemia.
|How to cite this article:|
Sugathan P, Najeeba R, Sharma NR. An unusual side effect of castellani's paint. Indian J Dermatol Venereol Leprol 1990;56:317-8
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Sugathan P, Najeeba R, Sharma NR. An unusual side effect of castellani's paint. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2013 May 24];56:317-8. Available from: http://www.ijdvl.com/text.asp?1990/56/4/317/3558
Castellani's paint is an effective antifungal preparation introduced in dermatologic therapeutics in 1928. It contains resorcinol which is fungicidal and basic fuchsin which inhibits the monilial group In tropical dermatological practice it is widely used though several other cosmetically elegant formulations are available.
It has to be stored in amber coloured bottle protected from direct light. The finished product has a bright magenta red colour and strong phenolic smell. Its shelf life is about 6 to 9 hours and hence it is not available as a ready to use pharmaceutical preparation. It has to be prepared fresh as far as possible and is effective in the treatment of various conditions like eczematised fungal infections, intertrigo of any aetiology, chronic paronychia, nummular eczema, seborrhoeic ' dermatitis, erosio interdigitale, candidal balanoposthitis and vulvovaginitis.
The only objection to its widespread use is perhaps the bright magenta red colour. Attempts have been made to manufacture this paint without basic fuchsin.
Castellani's paint is a safe, effective and economical local medication as it gives speedy recovery : both subjective and objective. A patient is therefore likely to save the left over from a previous prescription for future unauthorised use. Normally it is dispensed only in small quantities and hence long term storage and related complications are seldom seen. We came across a serious complication from the local application of decomposed castellani's paint.
| Case Report|| |
A 35 year old patient had been suffering from an intractable intertrigo of the groin since 5 years. Several topical medications applied by him gave only temporary relief. He was then prescribed castellani's paint for topical applications. The subjective improvement was rapid within a week and there upon he was advised to stop applying the paint. Impressed by the effect of the medicine, he wanted to keep some handy for possible future use and procured a sample from another city.
Nine months later he had recurrence of intertrigo of the groin. He applied the stored castellani's paint. Within minutes of the application he felt a burning sensation at the site and he became listless, irritable and soon became unconscious. He was rushed to a nearby nursing home where he was found to have central cyanosis and rapid thready pulse. His blood pressure was 150/50 mm of Hg. His venous blood was found to be chocolate brown in colour which did not change even after areation with oxygen. A clinical diagnosis of methaemoglobninaemia was made and he was treated with intravenous injections of vit.C 500 mgm every 4 hours, oxygen inhalation and later blood transfusion. His general condition gradually improved and he recovered fully on the 3rd day. However the site of local application ulcerated and required 3 weeks for healing.
The sample of castellani's paint that produced this serious complication was obtained which was already dirty brown in colour. It was used for animal experiments. Two sets of albino rats weighing 200 to 250 gms of either sex, 3 each were chose. Their anterior abdominal walls were shaved till punctate bleeding was obtained and the decomposed paint was applied over an area of 3 cm x 4 cm. Freshly prepared castellani's paint was applied on the control rats. Four hours after the application their tails were cut and 9 drops of blood was milked into citrate solution. It was then centrifuged for 15 minutes at 3000 rpm. The ABCs were then washed twice with normal saline and then resuspended in double distilled water to produce haemolysis. The haemolysate showed on spectrophotometry diagnostic absorption bands at 502 and 632 nm, while the samples from the controls did not show any abnormality.
| Comments|| |
In methaemoglobinaemia ferroprotoporphyrin is converted into ferriprotoporphyrin which can be detected easily by spectrophotometry. A grey blue cyanosis is the hall mark of methaemoglobinaemia and it becomes clinically discernible when the concentration of methaemoglobin reaches 2 gm%. In practice when cyanosis is unaccompanied by either respiratory or cardiac abnormalities the diagnosis of methaemoglobinaemia is obvious. When methaemoglobin reaches 20 to 30 gm% profound cyanosis develops. This may be fatal.
Normally also a small amount of methaemoglobin is formed but it is soon reconverted to haemoglobin by the enzyme methaemoglobin reductase present in RBCs. Several drugs like nitrobenzene, phenylbutazone, primaquine, chlorates and nitrates, aniline dyes and dapsone can induce methaemoglobinaemia.
The treatment of methaemoglobinaemia is an emergency and should be instituted without any delay once the diagnosis is made. The drug of choice is a reducing agent like Vitamin C 500 gm intravenously every 4 hours of Methylene blue 1-2. mgm/kg by weight intravenously. Supportive measures like oxygen inhalation and very rarely haemodialysis may be necessary.
It is therefore stressed that casteliani's paint decomposes on storage and becomes a contact poison. Fatal methaemoglobinaemia may result from the local application of decomposed castellani's paint. One case of fatal renal failure has been brought to our attentions. This should be explained to the patients. Prompt recognition and treatment is essential to save a life.
| References|| |
|1.||Castellani A. Carbofuchsin paints in the treatment of certain cases of epidermophytosis. Amer Med 34 : 351-356, 1928. Quoted by Riley K and Flower Jr. A.H. A comparison of the inhibitory effect of Castellani's paint and of gentiori violet solution on the vitro growth of candida albicans. J Invest Dermatol 15 : 355-361, 1950. |
|2.||Sutton RL Jr, in skin diseases, 11 th Ed. St. Louis, C.V. Mosby and Co. 1956, pp 521. |
|3.||Wilkinson DS Formulary of Topical medications in Text book of Dermatology vol.3, 4th Ed. Rook A; Wilkinson DS, Ebling FAG (Eds) Bombay, Oxford University Press, 1987, pp 2611. |
|4.||Gutman AB, Methaemoglobinaemia in Cecil-Loeb Text book of Medicine, Beeson PB and Mc Dermott W (Eds) 12th Ed (Asian Ed) Tokyo, Igakushoin Ltd., 1967 pp 1249-1250. |
|5.||Nair BKH (1989) Personal communication. |
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