Boric acid poisoning in infancy arising from the treatment of napkin rash.

Accidental poisoning is not always recognized. If there is no leading history of the ingestion or exposure to poison the signs can easily be misinterpreted. In this way boric acid poisoning of infants may remain unsuspected, especially when it occurs by absorption through the skin. Boric acid has been in clinical use as an antiseptic for 80 years. Soon after its introduction for this purpose by Lister reports of fatal poisoning began to appear (Molodenkow, 1881). Many deaths have been recorded following its ingestion, parenteral injection, irrigation or packing of wounds and body cavities, or application to damaged skin. In spite of these, the drug has continued to be regarded as bland and harmless. Its local use in ammoniacal dermatitis of infants was first advised by Cooke (1921) when he demonstrated that the rash was due to bacterial decomposition of urine. However, it is only recently that poisoning by boric acid has been attributed to its employment in this way. Fellows, Campbell and Wadsworth (1948) reported the deaths of two young infants after napkin rashes had been treated with boric acid; they considered fatal poisoning proven in one case and suspected it in the other. Single fatal cases have been discussed by Abramson (1949), Brooke and Boggs (1951) and Bumbalo (1952), while Fisher (1951) has briefly recorded eight other deaths. Whether boric acid can be absorbed through the intact skin of the healthy adult is still disputed, but dangerous amounts can unquestionably penetrate the infant's skin when it is reddened and excoriated. In the belief that poisoning by this route may be commoner than has been realized, an example is reported. It was not fatal.