Chloracne

Last updated
Chloracne
Chloracne-in-herbicide-worker.png
Chloracne in this herbicide production worker involved almost every follicular orifice on his face and neck with comedones, papules and cystlike lesions.
Specialty Dermatology   OOjs UI icon edit-ltr-progressive.svg

Chloracne is an acneiform eruption of blackheads, cysts, and pustules associated with exposure to certain halogenated aromatic compounds, such as chlorinated dioxins and dibenzofurans. [1] The lesions are most frequently found on the cheeks, behind the ears, in the armpits and groin region.

Contents

The condition was first described in German industrial workers in 1897 by Siegfried Bettmann, [2] and was initially believed to be caused by exposure to chlorine (hence the name "chloracne"). It was only in the mid-1950s that chloracne was associated with aromatic hydrocarbons. [3] The substances that may cause chloracne are now collectively known as chloracnegens.

Chloracne is particularly linked to toxic exposure to dioxins (byproducts of many chemical processes, including the manufacture of herbicides such as Agent Orange)so much so that it is considered a clinical sign of dioxin exposure. The severity and onset of chloracne may follow a typical asymptotic dose-response relationship curve.

Cause

Chloracne normally results from direct skin contact with chloracnegens, although ingestion and inhalation are also possible causative routes.

Chloracnegens are fat-soluble, meaning they persist in the body fat for a very long period following exposure. Chloracne is a chronic inflammatory condition that results from this persistence, in combination with the toxin's chemical properties. It is believed, at least from rodent models, that the toxin activates a series of receptors promoting macrophage proliferation, inducing neutrophilia and leading to a generalised inflammatory response in the skin. This process may also be augmented by induction of excess tumor necrosis factor in the blood serum.

The inflammatory processes lead to the formation of keratinous plugs in skin pores, forming yellowish cysts and dark pustules. The associated pus is usually a color of green approximating that of a tennis ball. The skin lesions occur mainly in the face, but in more severe cases they involve the shoulders and chest, the back, and the abdomen. In advanced cases, the lesions appear also on the arms, neck, thighs, legs, hands and feet.

In some instances, chloracne may not appear for three to four weeks after toxic exposure; however, in other casesparticularly in events of massive exposurethe symptoms may appear within days. [3] [4]

Treatment

Once chloracne has been identified, the primary action is to remove the patient and all other individuals from the source of contamination. Further treatment is symptomatic.

Secondary infections on severe or persistent lesions may need to be treated with oral antibiotics or isotretinoin. However, chloracne itself can be highly resistant to any treatment.

The course of the disease is highly variable. In some cases the lesions may disappear within two years or so; however, in other cases the lesions may be effectively permanent (mean duration of lesions in one 1984 study was 26 years, with some workers remaining disfigured over three decades after exposure). [5]

Chloracne is very often seen in combination with hyperhidrosis (clammy, sweaty skin) and porphyria cutanea tarda (a skin condition of increased pigmentation, hair coarsening and blistering).

Notable cases

Viktor Yushchenko at the University of Amsterdam, with chloracne from TCDD dioxin poisoning (2006) Viktor Yuschenko.jpg
Viktor Yushchenko at the University of Amsterdam, with chloracne from TCDD dioxin poisoning (2006)

Related Research Articles

<span class="mw-page-title-main">Agent Orange</span> Herbicide used by the US in the Vietnam War

Agent Orange is a chemical herbicide and defoliant, one of the tactical use Rainbow Herbicides.

<span class="mw-page-title-main">Polychlorinated biphenyl</span> Chemical compound

Polychlorinated biphenyls (PCBs) are highly carcinogenic chemical compounds, formerly used in industrial and consumer products, whose production was banned in the United States by the Toxic Substances Control Act in 1976 and internationally by the Stockholm Convention on Persistent Organic Pollutants in 2001.

Polychlorinated dibenzodioxins (PCDDs), or simply dioxins, are a group of long-lived polyhalogenated organic compounds that are primarily anthropogenic, and contribute toxic, persistent organic pollution in the environment.

<span class="mw-page-title-main">Seveso disaster</span> Toxic chemical leak in Italy in 1976

The Seveso disaster was an industrial accident that occurred around 12:37 pm on 10 July 1976, in a small chemical manufacturing plant approximately 20 kilometres (12 mi) north of Milan in the Lombardy region of Italy. It resulted in the highest known exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in residential populations, which gave rise to numerous scientific studies and standardized industrial safety regulations, including the European Union's Seveso III Directive. This accident was ranked eighth in a list of the worst man-made environmental disasters by Time magazine in 2010.

<span class="mw-page-title-main">Rosacea</span> Skin condition resulting in redness, pimples and swelling, usually on the face

Rosacea is a long-term skin condition that typically affects the face. It results in redness, pimples, swelling, and small and superficial dilated blood vessels. Often, the nose, cheeks, forehead, and chin are most involved. A red, enlarged nose may occur in severe disease, a condition known as rhinophyma.

<span class="mw-page-title-main">2,4,5-Trichlorophenoxyacetic acid</span> Chemical compound

2,4,5-Trichlorophenoxyacetic acid, a synthetic auxin, is a chlorophenoxy acetic acid herbicide used to defoliate broad-leafed plants. It was developed in the late 1940s, synthesized by reaction of 2,4,5-Trichlorophenol and chloroacetic acid. It was widely used in the agricultural industry until being phased out, starting in the late 1970s due to toxicity concerns. Agent Orange, a defoliant used by the British in the Malayan Emergency and the U.S. in the Vietnam War, was equal parts 2,4,5-T and 2,4-D. 2,4,5-T itself is toxic with a NOAEL of 3 mg/kg/day and a LOAEL of 10 mg/kg/day. Agent Pink contained 100% 2,4,5-T. Additionally, the manufacturing process for 2,4,5-T contaminates this chemical with trace amounts of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). TCDD is a carcinogenic persistent organic pollutant with long-term effects on the environment. With proper temperature control during production of 2,4,5-T, TCDD levels can be held to about .005 ppm. Before the TCDD risk was well understood, early production facilities lacked proper temperature controls and individual batches tested later were found to have as much as 60 ppm of TCDD.

Acne is acneiform eruptions. It is usually used as a synonym for acne vulgaris, but may also refer to:

A toxic tort claim is a specific type of personal injury lawsuit in which the plaintiff claims that exposure to a chemical or dangerous substance caused the plaintiff's injury or disease.

<span class="mw-page-title-main">Yushō disease</span> Mass poisoning in Japan

Yushō disease was a mass poisoning by polychlorinated biphenyls (PCBs) which occurred in northern Kyūshū, Japan, in 1968. In January 1968, rice bran oil produced by Kanemi Company in Kyushu was contaminated with PCBs and polychlorinated dibenzofurans (PCDFs) during production. For deodorization, the oil was heated using PCB as the heating medium, circulating through pipes. Due to holes in the pipes the PCB leaked into the rice bran oil. The contaminated rice bran oil was then sold to poultry farmers for use as a feed supplement and to consumers for use in cooking. In February to March 1968, farmers started reporting that their poultry were dying due to apparent difficulty in breathing; altogether 400,000 birds died. About 14,000 people who had consumed the contaminated rice oil were affected in Japan. More than 500 died. Common symptoms included dermal and ocular lesions, and a lowered immune response. Other symptoms included fatigue, headache, cough, and unusual skin sores. Additionally, in children, there were reports of poor cognitive development.

<span class="mw-page-title-main">1,4-Dioxin</span> Chemical compound

1,4-Dioxin (also referred as dioxin or p-dioxin) is a heterocyclic, organic, non-aromatic compound with the chemical formula C4H4O2. There is an isomeric form of 1,4-dioxin, 1,2-dioxin (or o-dioxin). 1,2-Dioxin is very unstable due to its peroxide-like characteristics.

<span class="mw-page-title-main">Polychlorinated dibenzofurans</span> Family of organic compounds

Polychlorinated dibenzofurans (PCDFs) are a family of organic compounds with one or several of the hydrogens in the dibenzofuran structure replaced by chlorines. For example, 2,3,7,8-tetrachlorodibenzofuran (TCDF) has chlorine atoms substituted for each of the hydrogens on the number 2, 3, 7, and 8 carbons. Polychlorinated dibenzofurans with chlorines at least in positions 2,3,7 and 8 are much more toxic than the parent compound dibenzofurane, with properties and chemical structures similar to polychlorinated dibenzodioxins. These groups together are often inaccurately called dioxins. They are known developmental toxicants, and suspected human carcinogens. PCDFs tend to co-occur with polychlorinated dibenzodioxins (PCDDs). PCDFs can be formed by pyrolysis or incineration at temperatures below 1200 °C of chlorine containing products, such as PVC, PCBs, and other organochlorides, or of non-chlorine containing products in the presence of chlorine donors. Dibenzofurans are known persistent organic pollutants (POP), classified among the dirty dozen in the Stockholm Convention on Persistent Organic Pollutants.

<span class="mw-page-title-main">Acneiform eruption</span> Medical condition

Acneiform eruptions, or acne mimicking eruptions, are a group of skin conditions characterized by small bumps resembling acne. Typically, these bumps are mostly of similar size. Some bumps may be bigger or contain fluid. Generally, blackheads and whiteheads are absent. It tends to appear suddenly, with the chest and back most frequently affected.

<span class="mw-page-title-main">Dioxins and dioxin-like compounds</span> Class of chemical compounds

Dioxins and dioxin-like compounds (DLCs) are a group of chemical compounds that are persistent organic pollutants (POPs) in the environment. They are mostly by-products of burning or various industrial processes or, in the case of dioxin-like PCBs and PBBs, unwanted minor components of intentionally produced mixtures.


Acne necrotica presents with a primary lesion that is a pruritic or painful erythematous follicular-based papule that develops central necrosis and crusting and heals with a varioliform scar.

<span class="mw-page-title-main">2,3,7,8-Tetrachlorodibenzodioxin</span> Polychlorinated dibenzo-p-dioxin, chemical compound

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is a polychlorinated dibenzo-p-dioxin (sometimes shortened, though inaccurately, to simply 'dioxin') with the chemical formula C12H4Cl4O2. Pure TCDD is a colorless solid with no distinguishable odor at room temperature. It is usually formed as an unwanted product in burning processes of organic materials or as a side product in organic synthesis.

<span class="mw-page-title-main">Holmesburg Prison</span> Former detention center in Pennsylvania, United States

Holmesburg Prison, given the nickname "The Terrordome," was a prison operated by the city of Philadelphia, Pennsylvania and the Pennsylvania Department of Prisons (PDP) from 1896 to 1995. The facility is located at 8215 Torresdale Ave in the Holmesburg section of Philadelphia. It was decommissioned in 1995 when it closed. As of today, the structure still stands and is occasionally used for prisoner overflow and work programs.

Toxic equivalency factor (TEF) expresses the toxicity of dioxins, furans and PCBs in terms of the most toxic form of dioxin, 2,3,7,8-TCDD. The toxicity of the individual congeners may vary by orders of magnitude.

<i>Inochi no Chikyuu: Dioxin no Natsu</i> 2001 film by Satoshi Dezaki

The Life on the Earth - The Summer of Dioxin, also known as Tracing the Gray Summer, is a 2001 Japanese anime drama film by Satoshi Dezaki, a joint production between the Magic Bus and the GoGo Visual Planning which recounts the true story of the Seveso disaster, a chemical incident occurred over the Italian town of Seveso in 1976, which is still considered one of the worst ecological disasters in history.

Heptachlorodibenzo-<i>p</i>-dioxin Chemical compound

1,2,3,4,6,7,8-Heptachlorodibenzo-para-dioxin (often referred to as 1,2,3,4,6,7,8-HpCDD) is a polychlorinated derivative of dibenzo-p-dioxin and can therefore be categorized as polychlorinated dibenzo-p-dioxin (PCDD), a subclass of dioxins which includes 75 congeners. HpCDD is the dibenzo-p-dioxin which is chlorinated at positions 1, 2, 3, 4, 6, 7, and 8. It is a polycyclic heterocyclic organic compound, since HpCDD contains multiple cyclic structures (two benzene rings connected by a 1,4-dioxin ring) in which two different elements (carbon and oxygen) are members of its rings. HpCDD has molecular formula C12HCl7O2 and is an off-white powder, which is insoluble in water.

<span class="mw-page-title-main">2,2',3,3',4,4'-Hexachlorobiphenyl</span> Chemical compound

2,2',3,3',4,4'-Hexachlorobiphenyl is an organic chemical and belongs to a group of compounds called polychlorinated biphenyls. This group of organic compounds was used in transformers as dielectric fluids, until production was banned in 1979. While only being a part of this mixture, it is sometimes referred to as Aroclor 1260.

References

  1. Plewig, Gerd; Melnik, Bodo; Chen, WenChieh (2019). "9.4.3 Acne mimicking diseases". Plewig and Kligman ́s Acne and Rosacea. Switzerland: Springer. p. 306-307. ISBN   978-3-319-49273-5.
  2. Siegfried Bettmann (1869–1939), University of Heidelberg
  3. 1 2 Williams DE, Wolfe WH, Lustik MB, et al. (1995). "An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides". p. 427. A313403. Archived from the original on 2012-02-10. Retrieved 2008-08-20.
  4. De Marchia B, Ravetzb JR (1999). "Risk management and governance: a post-normal science approach". Futures. 31 (7): 743–57. doi:10.1016/S0016-3287(99)00030-0.
  5. Moses M, Lilis R, Crow KD, et al. (1984). "Health status of workers with past exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin in the manufacture of 2,4,5-trichlorophenoxyacetic acid: comparison of findings with and without chloracne". Am. J. Ind. Med. 5 (3): 161–82. doi:10.1002/ajim.4700050303. PMID   6142642.
  6. Robbins, William; Times, Special To the New York (1983-07-17). "DIOXIN TESTS CONDUCTED IN 60'S ON 70 PHILADELPHIA INMATES, NOW UNKNOWN". The New York Times. ISSN   0362-4331 . Retrieved 2023-05-31.
  7. Barlett DL, Steele JB (2008). "Monsanto's Harvest Of Fear". Vanity Fair. No. May.
  8. Bertazzi, P. A. (1991-07-01). "Long-term effects of chemical disasters. Lessons and results from Seveso". The Science of the Total Environment. 106 (1–2): 5–20. Bibcode:1991ScTEn.106....5B. doi:10.1016/0048-9697(91)90016-8. ISSN   0048-9697. PMID   1835132.
  9. "Corporate Giant Monsanto Hid Decades Of Pollution". Commondreams.org. 2002-01-01. Archived from the original on 2020-11-08. Retrieved 2013-09-08.
  10. "Monsanto creek contaminated". CatastropheMap, Ltd. Archived from the original on 23 March 2009. Retrieved 10 April 2014.
  11. Aoki Y (2001). "Polychlorinated biphenyls, polychlorinated dibenzo-p-dioxins, and polychlorinated dibenzofurans as endocrine disrupters--what we have learned from Yusho disease". Environ. Res. 86 (1): 2–11. Bibcode:2001ER.....86....2A. doi:10.1006/enrs.2001.4244. PMID   11386736.
  12. "BBC NEWS - Health - Yushchenko and the poison theory". bbc.co.uk. 11 December 2004. Retrieved 2014-12-08.
  13. "陳裕匡". www.facebook.com. Archived from the original on 2022-02-26. Retrieved 2019-11-30.
  14. "Hong Kong reporter diagnosed with chloracne after tear gas exposure, prompting public health concerns". Hong Kong Free Press. 2019-11-14. Retrieved 2019-11-14.

Commons-logo.svg Media related to Chloracne at Wikimedia Commons