Formaldehyde
Indications: Bromidrosis; Hyperhidrosis
DESCRIPTION:
Formalyde-10 Spray (Drying Agent): Active Ingredients: Formaldehyde 10%. Inactive Ingredients: Water, SD-40 alcohol 40, polysorbate 20, fragrance.
Lazerformalyde Solution: Active Ingredients: Formaldehyde 10%. Inactive Ingredients: Water, polysorbate 20, hydroxyethyl cellulose, fragrance.
INDICATIONS AND USAGE:
Safeguards against offensive odor and dries excessive moisture of feet. Drying agent for pre and post surgical removal of warts, or for non-surgical laser treatment of warts where dryness is required.
CONTRAINDICATIONS:
Not to be used in patients known to be sensitive to any ingredients in this product.
PRECAUTIONS:
FOR EXTERNAL USE ONLY: HARMFUL IF SWALLOWED, CONTACT A LOCAL POISON CONTROL CENTER IMMEDIATELY. KEEP OUT OF THE REACH OF CHILDREN. Safety and effectiveness in pediatric patients have not been established. Avoid contact and keep away from face, eyes, nose and mucous membranes. Check skin for sensitivity to formaldehyde prior to application since it may be irritating and sensitizing to the skin of some patients. If redness or irritation persists, consult your PODIATRIST, DERMATOLOGIST or PHYSICIAN.
DOSAGE AND ADMINISTRATION:
Formalyde-10 Spray: Spray once a day to affected areas or as directed by a PODIATRIST, DERMATOLOGIST or PHYSICIAN. Keep cap closed tightly. Do not shake the bottle.
Lazerformalyde Solution: Apply with the roll-on applicator once a day to affected areas, or as directed by your PODIATRIST, DERMATOLOGIST or PHYSICIAN. Do not shake the bottle with the cap removed. When not in use, keep cap closed tightly.
Formaldehyde Exposure in Medical Students
Formaldehyde is used extensively for the purpose of
sterilization, disinfection, embalming, preservation of tis-
sues and preparation of viral vaccines. One cannot deny
the use of formaldehyde in medical profession especially
in gross anatomy laboratories and embalming rooms.
Occupational exposure may not be inescapable, but
adhering to strict precautions may restrict the harmful
adverse effects of formaldehyde. A greater knowledge of
the scientific facts by the first year medicos, may minimize
the adverse effects of such hazardous chemicals. The
present article summarizes the toxic effects of formalde
hyde and discusses the precautions needed for safe
handling of the same.
Introduction
The inchoate first year medicos spend more than
18 hours per week in gross anatomy dissection labora-
tory. Majority of the nascent medicos dissect cadavers
without wearing gloves. Hence, they are exposed to
formaldehyde everyday. The employees of renal trans-
plant units, embalming staff and morticians also face the
maximum risk of exposure. The present article summarizes
the insidious harmful effects of formaldehyde and
discusses the proper prevention methods in order to help
the individuals, mainly the first year medicos.
Chemical composition and properties
Formaldehyde (HCHO) is commercially sold as a solid
polymer, paraformaldehyde or formalin which is water
based solution of 370 g/lt (37%) in a stabilizing medium
of methanoi (100 mi/I)'. Formaldehyde is a colourless gas
and is inflammable. It has a pungent odour'.
Mechanism of action
After inhalation, formaldehyde is metabolised to
formic acid2 There is alkylation ofamino and sulphydryl
groups of proteins and ring nitrogen atoms of purine
bases"'. It reacts with cell protein DNA or RNA4.
Exposure zone
Formaldehyde is used in medical field as disinfectant.
embalming agent, fixative, preservative for anatomical
specimens, sterilizing agent to sterilize instruments. In
industries dealing with paint, cosmetic items, textiles,
dyes, inks, plastic and adhesives, one can find the maxi-
mum exposure to formaldehyde2. Formaldehyde is also
released by cars, fires and cigarette smoker It is
frequently found as a chemical which is used by the
poultry husbandry staff for fumigation of buildings
and rooms". Exposure also results from the use of
hexamethylenetetramine as a food additive".
Exposure limits
The concentration of formaldehyde is expressed as
ppm (parts per million). I ppm=l .248 mg/mzΒ·3 Exposure limit
is 2.0ppm\ The recommended exposure NIOSH standard
for formaldehyde exposure is I PPm6 The present federal
standard is 3 ppm". In United States, the permissible limit
is 3 ppm for 8 hour time weighed average breathing zone2~
Adverse effects
At concentration below 2.0 ppm, there is irritation of
eye?. Concentration above 5.0 ppm causes burning sen-
sation in eyes, nose, pharynx, respiratory distress and
production of tears'. There is excessive irritation and tear
production when exposure crosses the normal threshold.
Concentration as low as 0.24 ppm might cause irritation
to the eye". With chemical sensitivity the allergic
symptoms excerbate.
Concentrations above 20 ppm are reported to cause
pulmonary oedema and pneumonia2 However, mortality
studies in human are rare.
Respiratory system
There is irritation of mucous membrane, allergic
rhinitis, and occupational asthma. Reduction in peak
expiratory flow has been reported.
Skin
Exposure to formaldehyde causes contact dermatitis
and chemical burns'. Prolong exposure may cause
squamous cell carcinoma of the nose25.
CNS
Memory, sleep and mood disorders are reported as a
result of formaldehyde exposure". It has been labeled as
a neurotoxic agent by some research workers'".
Mutagenicity
An increase in sister chromatid exchange in medical
students and genetic damage have been reported" 'β’'.
Reproductive system
Reduced fertility in females have been noted by
research workers'3.Congenital malformations,
spontaneous abortions also occur as a result of
exposure'2
Joints
Polyarthritis has been reported in a farmer who was
exposed to fumigation in his piggery'".There are also
reports of arthralgia in two farm assistants and a
bricklayer'"*.
Formaldehyde as a potential carcinogen
Studies have shown that formaldehyde exposure in
Fisher 344 rats cause squamous cell carcinoma in nasal
cavity2. There are reports of squamous cell metaplasia in
animals like monkeys and rats following exposure to
formaldehyde"". Even OSHA had indicated that formalde-
hyde be considered as a potential carcinogen in places of
work\ Exposure to formaldehyde also increases risk for
pancreatic carcinoma.
Recommended precautions
Acute toxic effects of formaldehyde have been
reported in humans. Past research has shown the
increase in carcinogenicity in experimental animals'.
Certainly it sends a warning signal but such cases have
not been reported in human. Nevertheless, it's carcino-
genic effects cannot be ruled out. One cannot have an
insouciant attitude while handling such chemical agents.
The following precautions are recommended
1) Adequate ventilation facility in laboratories. Exhaust
fans, fume cupboards to store and mix formalin with other
embalming solutions.
2) Advising medical students and embalming staff to
wear gloves, safety spectacles and visors to avoid
unnecessary exposure.
3) Regular education programs to discuss the health
hazards.
4) Regular measurements of the concentration of formalde-
hyde in laboratories and dissection halls. This is done by
taking air samples in the breathing zone .The data can be
used to monitor future occupational exposure.
5) Treatment of acute cases of formaldehyde poisoning
should be taught to laboratory technicians, medicos and
embalming staff. In case of accidental ingestion might
supportive care is will be necessary.
6) Medical surveillance to identify at risk workers and
minimize the risk of such occupational injury.
7) To limit the exposure time to minimum, thereby reducing
the harmful effects.
References
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2. Pabst R. Exposure to formaldehyde in anatomy. An occu-
pational health hazard? Anatomical Record. 1987;
219(2):109-112.
3. Mayhall CG. Hospital Epidemiology and Infection
Control, Baltimore, Wiiliams & Wilkins, 1996;p. 925.
Block SS. Disinfection, Sterilization and Preserv
Philadelphia, Lea & Febiger, 1983;p. 52.
CollinsCH and Kennedy DA. Laboratory acquired
tions. History, incidence, causes and prevention, 0?
ButterworthHeinemann,1999;p. 176.
LastJM. Public Health and Prevention Medicine, AplSl
-Century- Crofts, New York, 1986:p. 642.
Koren H and Bisesi M. Handbook of Environm
Health and safety. Principles and Practices, Florida, C
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Kriebel D, Myers D, Cheng M, Woskie S and Cocan
Short term effects of formaldehyde on peak expire
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9. Kilbui-n K.H, Seidman BC and Warshaw R. Neurobehav
and respiratory symptoms of formaldehyde and xy
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1985;40(4):229-233.
10. Pitten FA, KramerA, Hermann K, BremmerJ and KocΒ·
Formaldehyde neurotoxicity in animal experime
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induced cytotoxic, genotoxic and mutagenic responsi
human lymphocytes and S. fyphimurium. Mutagem
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ture review. J. Environ Health. 1985:48(2)52-56.
IS.Taskinen HK., Kyyronen P, Sallmen M, Virtanen S
Liukkonen TA,Huida 0, Lindbohm ML and Antilla
Reduced fertility among female wood workers expose(
formaldehyde. Am. J. lnd. Mod. \ 999;36 ( I ):206-212.
14. Tilsted D, Hansen AM, Rasmussen K.. Formaldehyde
the occupational environment. A possible cause ofcherr
cally induced reactive arthritis. Ugeskr Laege
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15. Sellakumar AR, Snyder CA, Solomon JJ and Albert R
Carcinogenicity of formaldehyde and hydrog
chloride in rats. Toxicol Appl Pharmacol', 1985: 8
Opt. l):401-406.
16. CollinsJJ,EsmenNA,HallTA. A review and meta ana
sis of formaldehyde exposure and pancreatic cancel
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