Chemistry

• Talc = Magnesium Silicate

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Epidemiology

• Industrial Uses of Talc
  • Ceramic Industry
  • Paper Industry
  • Plastics Industry
  • Rubber Industry
  • Paint Industry
  • Cosmetic Industry

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Clinical Manifestations

Pulmonary Manifestations

Talc Granulomatosis (Foreign Body Granulomatosis) (see Foreign Body Granulomatosis, [[Foreign Body Granulomatosis]])

• Etiology: intravenous injection of talc, which is commonly used as a filler for drugs of abuse
  • Orally-Formulated Drugs of Abuse: talc or starch fillers are commonly used in the intravenous injection of orally-formulated drugs
    • Meperidine (Demerol) (see Meperidine, [[Meperidine]])
    • Methlyphenidate (Ritalin) (see Methylphenidate, [[Methylphenidate]])
    • Methadone (see Methadone, [[Methadone]])
    • Hydromorphone (Dilaudid) (see Hydromorphone, [[Hydromorphone]])
    • Pentazocine (Talwin) (see Pentazocine, [[Pentazocine]])
    • Propoxyphene (see Propoxyphene, [[Propoxyphene]])
    • Amphetamine (see Amphetamine, [[Amphetamine]])
    • Tripelennamine (see Tripelennamine, [[Tripelennamine]])
  • Crack Cocaine (see Cocaine, [[Cocaine]]): talc is also commonly used to “cut” injectable crack cocaine
  • Heroin (see Heroin, [[Heroin]]): interestingly, foreign body granulomatosis occurs less commonly with heroin abuse, as heroin is typically mixed in soluble fillers (such as quinine, lactose, or maltose)
• Physiologic Consequences of Injected Talc
  • Pulmonary Fibrosis and Advanced Emphysema: due to injected talc usually is taken up by interstitium in lungs
  • Pulmonary Vascular Inflammation and Secondary Thrombosis: due to embolized talc
• Clinical Presentations
  • Progressive Massive Fibrosis-Like Conglomerate Lung Masses (see Lung Nodule or Mass, [[Lung Nodule or Mass]])
  • Granulomatous Interstitial Lung Disease/Fibrosis (see Interstitial Lung Disease-Etiology, [[Interstitial Lung Disease-Etiology]])
  • Hilar Lymphadenopathy (see Mediastinal Mass, [[Mediastinal Mass]])
  • Advanced Emphysema-Like Picture (see Obstructive Lung Disease, [[Obstructive Lung Disease]])
  • Granulomatous Pulmonary Arterial Occlusion with Pulmonary Hypertension (see Pulmonary Hypertension, [[Pulmonary Hypertension]])

Talcum Powder Aspiration

• Epidemiology: typically occurs in infants
• Physiology: within hours of aspiration, can cause severe and potentially fatal pneumonitis
  • Note: other non-talcum powders can also case pulmonary toxicity by similar mechanisms
• Clinical
  • Pneumonia (see Pneumonia, [[Pneumonia]])
  • Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS, [[Acute Lung Injury-ARDS]])
• Prevention: avoid use of talcum powder (particularly with infants)

Talc Pneumoconiosis (“Talcosis”)

• Epidemiology
• Clinical: xxx
• Diagnosis: xxx
• Treatment: xxx

Talcosilicosis

• Epidemiology
• Clinical: xxx
• Diagnosis: xxx
• Treatment: xxx

Talcoasbestosis

• Epidemiology
• Clinical: xxx
• Diagnosis: xxx
• Treatment: xxx

Ocular Manifestations

• Talc Retinopathy
  • Epidemiology: may occur in intravenous drug abusers in association with foreign body granulomatosis
  • Clinical: talc emboli near macula within small vessels

Other Manifestations

• xxxx

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References

• Talc Pneumoconiosis. JAMA. 1952;148(16):1418-1419. doi:10.1001/jama.1952.62930160006011b
• Talc pneumoconiosis: a pathologic and mineralogic study. Hum Pathol. 1992 Dec;23(12):1344-54 [MEDLINE]
• Pulmonary talcosis: imaging findings. Lung. 2010 Apr;188(2):165-71. doi: 10.1007/s00408-010-9230-y. Epub 2010 Feb 13 [MEDLINE]
• Intravascular Talcosis due to Intravenous Drug Use Is an Underrecognized Cause of Pulmonary Hypertension. Pulm Med. 2012; 2012: 617531. doi: 10.1155/2012/617531 [MEDLINE]