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ACUTE EXPOSURE INFORMATION

  1. USES: Cantharidin is a lipid soluble extract derived from the blister beetle. There are more than 200 species of blister beetle worldwide. The most commonly implicated beetle is "Spanish Fly" (Cantharis vesicatoria); however, the highest concentration of cantharidin is found in the Chinese blister beetle (Mylabris cichorii L.). It has historically been utilized for its aphrodisiac properties and is known as "Spanish Fly." Cantharidin has also been utilized in Chinese medicine to treat fungal infections, warts, and various dermatologic conditions and to induce abortions. Currently, cantharidin is occasionally used by dermatologists to remove warts and molluscum contagiosum. It has also been studied as an experimental antitumor agent.
  1. PHARMACOLOGY: Cantharidin is a powerful vesicant and potent irritant. It is a volatile double-ringed structure that is crystalline, colorless, odorless, and water insoluble. It is secreted by adult male beetles near the leg joints in hemolymph. Females do not produce cantharidin but can extrude it as a result of copulation deposition.
  1. TOXICOLOGY: The irritant contact dermatitis results in intraepidermal and subepidermal blistering, epidermal necrosis, and acantholysis. It is caused by activation of neutral proteases that destroy dense desmosomal plaques. Cantharidin is also a potent inhibitor of protein phosphatases 1 and 2A. This results in the detachment of tonofilaments from desmosomes and the appearance of intraepidermal blisters. Biopsies reveal intraepidermal vesicles with fibrin, polymorphonuclear cells, and acanthocytes. Large ingestions may produce acute renal tubular necrosis with loss of brush borders, cloudy swelling, and hydropic degeneration resulting in renal injury and hematuria. Because cantharidin is a powerful vesicant and irritant, oral and ophthalmic exposures can result in vesiculobullous lesions, mucosal edema, and keratoconjunctivitis.
  1. EPIDEMIOLOGY: Cantharidin exposure/ingestions are rare poisonings that very rarely result in serious morbidity or death.
  1. WITH THERAPEUTIC USE
    1. COMMON: The most commonly reported adverse effects include irritant dermatitis, dermal vesicles and bullae, conjunctivitis, priapism, and hematuria.
    1. RARE: Other more rare adverse effects include renal failure, liver injury, gastrointestinal hemorrhage, coagulopathy, airway obstruction, seizure, dysrhythmias, and shock.
  1. WITH POISONING/EXPOSURE
    1. MILD TO MODERATE TOXICITY: Mild inflammation of the dermis, oral or genital mucosa, and conjunctiva, fever, nausea, vomiting, wheeze, and lymphadenopathy.
    1. SEVERE TOXICITY: Severe mucosal, dermal, or conjunctival injury, renal failure, liver injury, gastrointestinal hemorrhage, coagulopathy, airway obstruction, seizure, dysrhythmias, and shock.
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