Talcosis is a rare pulmonary disease caused by intake of high levels of talcum powder. It is closely related to other silicosis variants and can lead to pulmonary hypertension with cor pulmonale in fatal manifestations. It develops as a consequence of talcum inhalation or because of drug use. Radiographic scans help in diagnosis. Corticosteroid and oxygen therapies may ease symptoms and provide long-term recovery perspectives.
Talcosis is a rare pulmonary ailment caused by the inhalation or the intravenous administration of talcum. Inhalation accumulates talcum powder in the lungs leading to either acute or chronic disease. It was first described in the late 19th century  as an occupational disease in miners and millers. Workers in the ceramic, paper, plastics, rubber, paint, construction and cosmetic industries are at an increased risk of developing this disorder . Talcum is also often deployed as an adulterant for marijuana and heroin, so patients with a history of drug abuse may also develop talcosis .
The symptoms range from very mild, often missed signs of a cough, dyspnoea, chest tightness, wheezing, hypoxemia, in rare cases scleroderma or rheumatoid arthritis and in most severe cases pulmonary hypertension with cor pulmonale. The presentation can be easily confounded with typical chain smoker symptoms and can progress after exposure. The patients have an increased risk of developing tuberculosis and carcinomas, if talcum has been ingested in association with asbestos and/or pure silica  . Talcum is hydrated magnesium silicate. Its inhalation typically occurs in conjunction with pure silica dust. Chemically neat talcum is usually ingested in patients with drug abuse history. In acute manifestations, the condition additionally shows severe alveolitis and alveolar fillings  .
The inhalation process leads to inorganic deposits in the lungs, which cause a granulomatous inflammatory reaction and the formation of granulomas encasing the ingested talcum and macrophages. These granulomas can develop in intra- and perivascular areas as well as in the interstitium. Macrophages will harvest deposited talcum and migrate to proximal lymph nodes or bronchioles or remain in the granuloma until the become apoptotic. Released part of the compound will then be phagocytosed by new macrophages. The migration of these cells is more often observed during lung infection or edema episodes .
The diagnosis requires a detailed analysis of the patient's occupational exposure. If the history reveals (past) professional activities with increased risk for this disorder or exaggerated private use of talcum powder can be confirmed, the next step is a pulmonary function test. A smoking habit may cause further worsening of symptoms .
Radiographic and computed tomography (CT) examinations are gold standard methods to confirm the diagnosis. CT scans have recently become more popular since they are more suitable to reveal parenchymal abnormalities than radiographs. Typical CT findings are small centrilobular nodules associated with heterogeneous conglomerate masses, sometimes including lower lobe emphysema. Interstitial thickening may also be observed .
Acute manifestations are always progressive and result in respiratory failure. The chronic state can be treated with a combination of oxygen and corticosteroid therapies  .