What should dermatologists tell their patients about pesticide exposure risks?
Clinical Applications
Dr. Schwarzenberger is the former physician editor of DermWorld. She interviews the author of a recent study each month.
By Kathryn Schwarzenberger, MD, FAAD, February 1, 2022
In this month’s Clinical Applications column, Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with Alicia Leytem, MS, and Amy Cross, MS, about their American Journal of Public Health paper, "Pesticides misused for bed bug control: Comparing professional and nonprofessional applications reported to the National Pesticide Information Center, 2013–2017."
DermWorld: Your recent study in the AJPH compared the outcomes of professional versus nonprofessional pesticide applications. Why did you choose to study this topic?
We also heard from people who hired a professional to treat their home and were sometimes dealing with cleanup or health concerns after apparent misapplication of the chemicals. Professional pesticide applicators require ongoing training and licensing, and we wanted to dig into our call data to see if there was a significant difference between who applied the pesticides (professional vs. nonprofessional) and whether it led to a misapplication or an adverse health effect.
DermWorld: You and your co-authors utilized data on bed bugs and pesticide applications from the National Pesticide Information Center from 2013 to 2017, and you looked at types of applicators, misapplications, and human pesticide exposures. Tell us about your findings.
DermWorld: In your study, you mention that “policy interventions” could reduce adverse pesticide incidents related to bed bug control. What would these policy interventions entail?
Leytem and Cross: That’s a very good question. We want to be clear that none of the authors have any connections to policy writing, regulation, or enforcement.
We are familiar with pesticide-related policies at the federal level, and some states have more stringent policies to reduce risks to consumers. First, having explicit campaigns to encourage users to read and follow label directions could be beneficial to reduce adverse events. Another policy that could be helpful for general users could be requiring training or instruction for retail workers at establishments that sell pesticides. It is surprisingly common for callers to tell us they chose and applied a product according to directions from retail workers, rather than following language on the product label. Sometimes, these verbal instructions directly contradict label directions or warnings. It is entirely the responsibility of the pesticide user (including everyday citizens) to apply products according to the label. However, we hear from several people that they trust the advice of retail workers, even though they may have little to no knowledge on proper use or health risks.
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DermWorld: What should dermatologists, who sometimes see patients with cutaneous allergic reactions to bed bugs, tell our patients about the risk of exposure to pesticides? Should we advise that they seek professional services, although this can be cost-prohibitive for some families?
Leytem and Cross: With bed bugs, as is true for most pests, there are many things you can do to help control their population and reduce the chances of being bitten without applying pesticides. The first step is to learn about their behavior and ways to control them that don’t require the use of chemicals. This is often referred to as an Integrated Pest Management approach, and it’s a great way to use all the tools available to you. There are several resources available to guide patients through this process, but the National Pesticide Information Center is a great place to start. If a patient is still considering pesticides, one of the most important things for them to know is the importance of reading the entire label and following the directions closely. These labels are evaluated by the Environmental Protection Agency for user risks, and generally include ways to reduce chemical exposure, specifics on how often and where to apply, and what to do if there is an unexpected exposure. The decision to seek or not seek professional services is situation-specific and cost may absolutely be a barrier for some families.
DermWorld: In your findings, you noted only 95 cases (out of 769) submitted requests for financial assistance to pay for bed bug control. Why do you think this was so low, and what can be done to make this more affordable and/or safe?
Leytem and Cross: Financial assistance is not a service provided by NPIC, nor is it a topic raised by NPIC specialists when speaking with callers. Requests for financial assistance are unprompted. These cases were noted anecdotally after an unexpected trend was identified in the data. We included this information to highlight how cost-prohibitive professional applications can be for many people around the country, and the lack of financial assistance programs available to help in these situations. Bed bugs are experts at hiding in areas that make it difficult to locate them, which also can make it very difficult to control them. This is true for residents and professionals alike. Hiring a professional to control bed bugs often requires multiple visits, and possibly applying multiple types of products or formulations to fully control the population. These treatments may cost more than other pest control services, making it more prohibitive for many to access.
Alicia Leytem, MS, is an instructor at Oregon State University.
Amy Cross, MS, is a project coordinator at the National Pesticide Information Center. They have no relevant financial or commercial conflicts of interest to disclose. Their paper appeared in the American Journal of Public Health.
Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.
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