Talcum has been used in pleurodesis for over eight decades. Despite a wealth of research, controversy remains over the optimal sclerosant for pneumothorax and pleural effusions. Talc's historical primacy has been challenged due to its potential for pulmonary toxicity, possible carcinogenicity, and recent concerns surrounding availability and legal liability, making an ideal time for a review.This is a systematic review of the talc literature, focused on publications after the year 2000 evaluating mechanism of action, efficacy, side-effect profile, and alternative sclerosants; included is an overview of current socioeconomic and legal controversies.The data support talc as the most effective agent for pleurodesis. There is evidence to suggest that mean particle size has a direct relationship to the side-effect profile and that significant hypoxemic events following talc administration are exceedingly rare using available graded talc preparations. Concerns regarding the development of malignancies following topical talc application remain incompletely resolved but appear related to cosmetic powder preparations that were contaminated with asbestos. Purified talc in the pleural space has not been implicated. Recent difficulties accessing commercial talc preparations have been solved. Although safe and effective talc alternatives do exist, these agents are not as well studied.Talc pleurodesis with modern, purified, graded talc preparations is safe and highly effective. Talc is an inexpensive and accessible option that remains appropriate for pleurodesis despite existing controversies.
View details for DOI 10.1016/j.athoracsur.2019.08.104
View details for PubMedID 31593652