- Chloracne
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Chloracne Classification and external resources ICD-10 L70.8 DiseasesDB 31706 eMedicine topic/620
(Acneiform Eruptions)MeSH D054506 Chloracne is an acne-like eruption of blackheads, cysts, and pustules associated with over-exposure to certain halogenated aromatic compounds, such as chlorinated dioxins and dibenzofurans. 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 von Bettman, and was initially believed to be caused by exposure to toxic chlorine (hence the name "chloracne"). It was only in the mid-1950s that chloracne was associated with aromatic hydrocarbons.[1] 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.
Contents
Etiology and progression
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 greenish in color. 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, 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.[1][2]
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.
Severe or persistent lesions may be treated with oral antibiotics or isotretinoin. However, chloracne may be highly resistant to any treatment.
The course of the disease is highly variable. In some cases the lesions may resolve 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).[3]
Recent research by groups at University of Cincinnati School of Medicine in Ohio and the University of Western Australia indicated that PCB poisoning, including chloracne symptoms, can be treated with fat substitute olestra.[4]
Related conditions
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
- In 1949, 226 workers became ill after a container of herbicide exploded at a Monsanto Company plant in Nitro, West Virginia.[5] Many were diagnosed with chloracne; a medical report at the time described "systemic intoxication in the workers involving most major organ systems." In the 1960s, the same plant manufactured Agent Orange.
- 193 cases of chloracne occurred in Seveso, Italy in 1976 following an industrial accident in which up to a few kilograms of TCDD were released into the atmosphere.
- Almost 2,000 individuals suffered chloracne, among other symptoms, after chronic exposure to cooking oils contaminated with PCBs and PCDFs in northern Kyūshū, Japan in 1968. The syndrome came to be called Yusho or "Rice Oil" disease.
- Eleven years later, a similar case of mass contamination of cooking oil was reported in central Taiwan. Over 2,000 individuals were affected by what came to be called Yu-Cheng in 1979.[6]
- Ukrainian President Viktor Yushchenko suffered from extremely prominent facial chloracne after being diagnosed with possible dioxin poisoning in late 2004 according to prominent toxicologist John Henry, though he never personally examined Yushchenko.
References
- ^ a b Williams DE, Wolfe WH, Lustik MB, et al. (1995). "An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides". pp. 427. A313403. http://www.stormingmedia.us/31/3134/A313403.html.
- ^ 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.
- ^ 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.
- ^ Redgrave TG, Wallace P, Jandacek RJ, Tso P (2005). "Treatment with a dietary fat substitute decreased Arochlor 1254 contamination in an obese diabetic male". J. Nutr. Biochem. 16 (6): 383–4. doi:10.1016/j.jnutbio.2004.12.014. PMID 15936651.
- ^ Barlett DL, Steele JB (2008). "Monsanto's Harvest Of Fear". Vanity Fair (May). http://www.vanityfair.com/politics/features/2008/05/monsanto200805?currentPage=4.
- ^ 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. doi:10.1006/enrs.2001.4244. PMID 11386736.
External links
Disorders of skin appendages (L60–L75, 703–706) Nail ungrouped: Paronychia (Acute paronychia, Chronic paronychia ) · Chevron nail · Congenital onychodysplasia of the index fingers · Green nails · Half and half nails · Hangnail · Hapalonychia · Hook nail · Lichen planus of the nails · Longitudinal erythronychia · Malalignment of the nail plate · Median nail dystrophy · Mees' lines · Melanonychia · Muehrcke's lines · Nail–patella syndrome · Onychoatrophy · Onychocryptosis · Onycholysis · Onychomadesis · Onychomatricoma · Onychomycosis · Onychophosis · Onychoptosis defluvium · Onychorrhexis · Onychoschizia · Platonychia · Pincer nails · Plummer's nail · Psoriatic nails · Pterygium inversum unguis · Pterygium unguis · Purpura of the nail bed · Racquet nail · Red lunulae · Shell nail syndrome · Splinter hemorrhage · Spotted lunulae · Staining of the nail plate · Stippled nails · Subungual hematoma · Terry's nails · Twenty-nail dystrophyHair noncicatricial alopecia: Alopecia/Alopecia areata (Alopecia totalis, Alopecia universalis, Ophiasis)
Androgenic alopecia (male-pattern baldness) · Hypotrichosis · Telogen effluvium · Traction alopecia · Lichen planopilaris · Trichorrhexis nodosa · Alopecia neoplastica · Anagen effluvium · Alopecia mucinosacicatricial alopecia: Pseudopelade of Brocq · Central centrifugal cicatricial alopecia · Pressure alopecia · Traumatic alopecia · Tumor alopecia · Hot comb alopecia · Perifolliculitis capitis abscedens et suffodiens · Graham-Little syndrome · Folliculitis decalvansHirsutism · Acquired generalized hypertrichosis · Generalized congenital hypertrichosis · Localized acquired hypertrichosis · Localized congenital hypertrichosis · Patterned acquired hypertrichosis · Prepubertal hypertrichosis · X-linked hypertrichosisAcneAcne vulgaris · Acne conglobata · Acne miliaris necrotica · Tropical acne · Infantile acne/Neonatal acne · Excoriated acne · Acne fulminans · Acne medicamentosa (e.g., steroid acne) · Halogen acne (Iododerma, Bromoderma, Chloracne) · Oil acne · Tar acne · Acne cosmetica · Occupational acne · Acne aestivalis · Acne keloidalis nuchae · Acne mechanica · Acne with facial edema · Pomade acne · Acne necrotica · Blackhead · Lupus miliaris disseminatus facieiPerioral dermatitis (Granulomatous perioral dermatitis) · Phymatous rosacea (Rhinophyma, Blepharophyma, Gnathophyma, Metophyma, Otophyma) · Papulopustular rosacea · Lupoid rosacea · Erythrotelangiectatic rosacea · Glandular rosacea · Gram-negative rosacea · Steroid rosacea · Ocular rosacea · Persistent edema of rosacea · Rosacea conglobata · variants (Periorificial dermatitis, Pyoderma faciale)UngroupedGranulomatous facial dermatitis · Idiopathic facial aseptic granuloma · Periorbital dermatitis · SAPHO syndromeFollicular cystsFolliculitis (Folliculitis nares perforans, Tufted folliculitis) · Pseudofolliculitis barbae
Hidradenitis (Hidradenitis suppurativa, Recurrent palmoplantar hidradenitis, Neutrophilic eccrine hidradenitis)UngroupedAcrokeratosis paraneoplastica of Bazex · Acroosteolysis · Bubble hair deformity · Disseminate and recurrent infundibulofolliculitis · Erosive pustular dermatitis of the scalp · Erythromelanosis follicularis faciei et colli · Hair casts · Hair follicle nevus · Intermittent hair–follicle dystrophy · Keratosis pilaris atropicans · Kinking hair · Koenen's tumor · Lichen planopilaris · Lichen spinulosus · Loose anagen syndrome · Menkes kinky hair syndrome · Monilethrix · Parakeratosis pustulosa · Pili (Pili annulati · Pili bifurcati · Pili multigemini · Pili pseudoannulati · Pili torti) · Pityriasis amiantacea · Plica neuropathica · Poliosis · Rubinstein–Taybi syndrome · Setleis syndrome · Traumatic anserine folliculosis · Trichomegaly · Trichomycosis axillaris · Trichorrhexis (Trichorrhexis invaginata · Trichorrhexis nodosa) · Trichostasis spinulosa · Uncombable hair syndrome · Wooly hair · Wooly hair nevusSweat glands Miliaria (Colloid milium • Miliaria crystalline • Miliaria profunda • Miliaria pustulosa • Miliaria rubra • Occlusion miliaria • Postmiliarial hypohidrosis), Granulosis rubra nasi, Ross’ syndrome, Anhidrosis, Hyperhidrosis (Generalized, Gustatory, Palmoplantar)Categories:- Acneiform eruptions
- Toxicology
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