TY - CHAP M1 - Book, Section TI - Special Considerations A1 - Nelson, Lewis S. A2 - Hoffman, Robert S. A2 - Howland, Mary Ann A2 - Lewin, Neal A. A2 - Nelson, Lewis S. A2 - Goldfrank, Lewis R. Y1 - 2015 N1 - T2 - Goldfrank's Toxicologic Emergencies, 10e AB - Applying a xenobiotic to the skin to treat a systemic medical condition is not new. Ointments and other salves have been applied topically for thousands of years for the treatment of local and systemic diseases. During World War I, dynamite workers used nitroglycerin applied to their hatbands to prevent angina when they were away from work and no longer exposed to organic nitrates.31 Mustard seed plaster for chest congestion, releasing allyl isothiocyanate, and topical elemental mercurials for syphilis are other examples from the early 20th century.24 Over the past 30 years, an increasing number of medications have been formulated in transdermal delivery systems or patches to allow for systemic delivery of a xenobiotic. The first commercially available patch delivered scopolamine for motion sickness (1979), which was followed by nitroglycerin for chronic angina (1981) and then fentanyl for chronic pain management (1990). In the United States, the nicotine patch remains the most widely used transdermal delivery system both because of the high need for smoking cessation and its nonprescription availability. Certain medicinal xenobiotics, such as testosterone, can be administered topically without a patch as a spray or gel.18 Furthermore, nonmedicinals can be absorbed transdermally, as occurs with nicotine after direct exposure to moist tobacco leaf in patient with "green tobacco sickness" or with organic phosphorus pesticides.3 SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/19 UR - accessemergencymedicine.mhmedical.com/content.aspx?aid=1108438718 ER -