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See also Physical contraceptives—spermicides
General information
Phenol is a benzyl alcohol and a major oxidized metabolite of benzene that was introduced into medicine as an antiseptic [ ]. Although it can be prepared in an aqueous solution or in glycerine, it appears to be more effective when mixed in aqueous compounds. At a concentration of 0.2% it is bacteriostatic and at over 1% bactericidal [ ]. In addition to its uses as an antiseptic and disinfectant, phenol is also used as a sclerosant, as a local anesthetic on the skin, and as an analgesic, by injection into nerves or spinally, but its use was limited by severe adverse effects. Current medical uses include cosmetic face peeling, nerve injections, and topical anesthesia. It is also an ingredient of various topical formulations, and is used as an environmental disinfectant.
The phenol derivatives paratertiary butylphenol and amylphenol are used in proprietary germicides, as is dinitrophenol, which has been used as a colorant and in weight reduction.
Dinitrophenol
Dinitrophenol is an antiseptic and pesticide that was used during the 19 th century as a food coloring and during the First World War in manufacturing explosives. In the 1930s it was introduced as a weight reducing agent. It has often caused deaths in overdose (see below).
Nonoxynols
Nonoxynols are ethoxylated alkyl phenols that are synthesized from alkylbenzene nonoxynol by reacting it with ethylene oxide to produce ethylene oxide polymers of various lengths. Each nonoxynol is followed by a number that indicates the approximate number of ethylene oxide groups it contains. In cosmetic products, nonoxynols are used as emulsifying, wetting, foaming, and solubilizing agents. They are used in hair and skin products, and in bath, shaving, and fragrance formulations [ ]. The non-ionic surfactant properties of nonoxynols allow them to be used in a wide variety of industrial, household, agricultural, and pharmaceutical products. Nonoxynol-9 and nonoxynol-10 are surface-active agents used in antiseptic formulations, such as Hibitane solution, Betadine solution, Hexomedine transcutanée, and Hexomedine ointment. They are the most commonly used spermicidal contraceptives and have been recommended in the prevention of sexually transmitted diseases and in human immunodeficiency virus prophylaxis [ ].
Octoxynols
Octoxynols are ethoxylated alkylphenols, similar to nonoxynols, in which the size of the molecule is related to the number of moles of ethylene oxide used in synthesis. They are surfactants and octoxynols of various sizes and their salts and organic acids are used in cosmetics as emulsifying agents, cleansing agents, solubilizers, or hydrotropes at concentrations ranging from 0.0008% to 25%, with most less than 5.0%. Their toxicity has been reviewed [ ]. Pregnancies that occurred despite the use of octoxynol-9 as a spermicide were not associated with an increase in the risk of fetal malformations. In skin patch tests formulations that contained 2.0% octoxynol-9 were classified as minimally or moderately, but 1.0% octoxynol-9 was non-irritant in a nine subjects who were patch tested for 4 consecutive days. Octoxynol-1 caused sensitization in 2 of 50 subjects. There was no evidence of sensitization in the following studies: 8.0% octoxynol-9 in 103 subjects, 0.5% octoxynol-9 in 102 subjects, and 0.1% octoxynol-9 in 206 subjects.
Pentachlorophenol
Pentachlorophenol is a disinfectant that is used in commercial laundries. In 1967 a hospital laundry accidentally used a product containing sodium pentachlorophenolate for a final rinse in the laundering of diapers and infants’ bed linen. Twenty newborn infants developed sweating, tachycardia, tachypnea, hepatomegaly, and metabolic acidosis. Six children with severe reactions were subjected to exchange blood transfusion and in each instance there was a dramatic improvement. Two babies died before exchange transfusion could be carried out; postmortem examination showed fatty change in the liver and hydropic and fatty degeneration in the renal tubules and myocardium. There were toxic concentrations of pentachlorophenol in the serum of one patient and autopsy tissue of another.
General adverse effects and adverse reactions
Systemic adverse reactions can occur through absorption from intact skin or wounds, by ingestion, or by absorption of vapor through the skin or via the lungs. They include central nervous stimulation followed by depression, seizures, coma, tachycardia, hypotension, dysrhythmias, pulmonary edema, metabolic acidosis, and hepatic and renal injury. Serious adverse reactions due to percutaneous absorption can occur and death has been described several times. The signs and symptoms of phenol toxicity have been reviewed [ ] and are listed in Table 1 .
Table 1
The signs and symptoms of phenol toxicity
| System | Signs and symptoms |
|---|---|
| Cardiovascular | Cyanosis, cardiac dysrhythmias, electrocardiographic abnormalities, circulatory failure, collapse |
| Respiratory | Respiratory failure |
| Nervous system | Dizziness, coma |
| Sensory systems | Darkening of the cornea |
| Hematologic | Methemoglobinemia |
| Gastrointestinal | Abdominal pain |
| Urinary tract | Hemoglobinuria |
| Skin | Darkening of the face and hands |
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