Topical absorption and systemic toxicity.

Dermal absorption of some chemicals and drugs can cause systemic toxicity. We evaluated several case reports from the past decade, which discuss the dermal absorption of a specific chemical and potential local and systemic effects. We focused on herbicide and pesticide exposure along with exposure to cutaneous medication, occupational contact, and cosmeceutical exposure. Although causality cannot be established in most cases, it is critical to be aware of the possible effects of topical absorption that may not be immediately apparent. We recommended further studies on specific chemicals to ascertain causality and determine the highest exposure level with no observed adverse affect level (NOAEL) and the reference dose (RfD). Post-marketing epidemiology data in most geographical areas are markedly limited. A weak link in public health resides in the inadequate reporting and workup of alleged chemically related adverse effects. This arena mandates a re-thinking of how to increase this reporting, and workup, as a backup to our preclinical and clinical studies. Public awareness and funding will be rewarded by increased evidence to backup pre-approval pre-marketing studies.