Chloracne | |
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Chloracne in this herbicide production worker involved almost every follicular orifice on his face and neck with comedones, papules and cystlike lesions. | |
Specialty | Dermatology |
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.
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.
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 cases—particularly in events of massive exposure—the symptoms may appear within days. [3] [4]
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).
Agent Orange is a chemical herbicide and defoliant, one of the tactical use Rainbow Herbicides. It was used by the U.S. military as part of its herbicidal warfare program, Operation Ranch Hand, during the Vietnam War from 1961 to 1971. The U.S. was strongly influenced by the British who used Agent Orange during the Malayan Emergency. It is a mixture of equal parts of two herbicides, 2,4,5-T and 2,4-D. In addition to its damaging environmental effects, traces of dioxin found in the mixture have caused major health problems and deformities for many individuals who were exposed, and their children.
Polychlorinated biphenyls (PCBs) are organochlorine compounds with the formula C12H10−xClx; they were once widely used in the manufacture of carbonless copy paper, as heat transfer fluids, and as dielectric and coolant fluids for electrical equipment. They are highly toxic and carcinogenic chemical compounds, formerly used in industrial and consumer electronic products, whose production was banned 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.
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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.
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:
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.
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.
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.
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.
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