Pulmonary talcosis in the setting of cosmetic talcum powder use

Our plain-English summary of Pulmonary talcosis in the setting of cosmetic talcum powder use, by A. Cho, R. Amirahmadi, A. Ajmeri, et al (Respiratory Medicine Case Reports, 2021).

The study

• Authors: A. Cho, R. Amirahmadi, A. Ajmeri, J. Deepak
• Journal: Respiratory Medicine Case Reports
• Published: 2021;34:101489
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pulmonary talcosis is a rare pneumoconiosis that is difficult to diagnose and may progress to debilitating lung disease. Four types of talcosis are described in literature: talc-silicosis and talc-asbestosis secondary to inhalation in industry workers and talc-emboli in intravenous drug users that self-inject talc-containing oral tablets. Although found in common household products, talc is overlooked as a cause of pneumoconiosis. Talcosis caused by cosmetic face powder is even rarer. Here we discuss a woman in her 50s who developed talcosis from inhalation of cutaneous cosmetics two years prior, and how comprehensive history may be crucial in diagnosing this rare disease.

Published by Elsevier Ltd.

In plain English

This case report describes one non-smoking woman in her 50s who was diagnosed with pulmonary talcosis, a lung disease caused by talc. She first saw a lung specialist for shortness of breath on exertion. A chest CT scan showed diffuse ground-glass nodules in both lungs. She was presumptively diagnosed with granulomatosis with polyangiitis and treated with prednisone and cyclophosphamide. About a year later she was readmitted. A new CT scan showed nodules mainly in the upper lobes and fluid around the left lung, and her blood cultures grew candida. Lung biopsies showed talc crystals and titanium particles, findings the authors described as consistent with inhaled talc. On further questioning, she reported excessive use of talcum face powder for two years before her presentation. She improved after the fluid was drained and was discharged home. The authors concluded that a thorough exposure history may have prevented the delay in diagnosis and the unnecessary immune-suppressing treatment that led to a fungal infection and liver problems. They said the role of the titanium was unclear. The report does not discuss asbestos in this patient.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One non-smoking Caucasian woman in her 50s, seen by an outpatient pulmonologist and later admitted to hospital (authors at University of Maryland, Baltimore, USA)
• Exposure: Excessive application of talcum face powder (cosmetic talc) for two years before her presentation
• Main results:
  • At first evaluation, a chest CT showed diffuse centrilobular ground-glass nodules in both lungs
  • She was presumptively diagnosed with granulomatosis with polyangiitis (GPA) and treated with prednisone and cyclophosphamide
  • On readmission, CT showed centrilobular nodules in both lungs with upper lobe predominance and a left-sided pleural effusion
  • Blood cultures were positive for candida and she was started on antifungal therapy
  • Biopsies showed macrophages containing white crystals, which the authors identified under polarized light as talc, consistent with inhalational pulmonary talcosis
  • Titanium particles were also deposited in the lung tissue around the talc crystals
  • She improved after the pleural effusion was removed and was discharged home
• The authors' conclusion: The authors concluded that a comprehensive review of exposure history may have prevented the delay in diagnosis and the unnecessary immunosuppression that led to a fungal infection and liver dysfunction
• Limitations the authors state:
  • The authors state it is unclear how much the titanium found in the lung contributed to the disease

Topics

Medical terms in this study, explained in our Lexicon: Pneumoconiosis, Talc, Silicosis.

Related studies

• Pulmonary disease caused by the inhalation of cosmetic talcum powder — I.P. Wells, P.A. Dubbins, et al. (1979)
• Potential Airborne Asbestos Exposure and Risk Associated with the Historical Use of Cosmetic Talcum Powder Products — A.M. Burns, C.A. Barlow, et al. (2019)
• Asbestos in commercial cosmetic talcum powder as a cause of mesothelioma in women — R. Lee, D. Van Orden (2015)
• Response to RE: Gordon R, Fitzgerald S, and Millette J. Asbestos in commercial cosmetic talcum powder as a cause of mesothelioma in women. Int J Occup Environ Health. 2014;20(4):318-332 — R.E. Gordon (2015)
• Commentary on "Assessment of Health Risk From Historical Use of Cosmetic Talcum Powder" — D. Egilman, J. Steffen (2018)
• Letter concerning: Burns AM, Barlow CA, Banducci AM, Unice KM, Sahmel J. Potential Airborne Asbestos Exposure and Risk Associated with the Historical Use of Cosmetic Talcum Powder Products — M.M. Finkelstein (2019)

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