Chloracne
Encyclopedia
Chloracne is an acne
-like eruption of blackhead
s, cyst
s, and pustules associated with over-exposure to certain halogen
ated aromatic compounds, such as chlorinated dioxins and dibenzofuran
s. 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. 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 process
es, 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
.
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 keratin
ous 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.
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).
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
.
(clammy, sweaty skin) and porphyria cutanea tarda
(a skin condition of increased pigmentation, hair coarsening and blistering).
Acne vulgaris
Acne vulgaris is a common human skin disease, characterized by areas of skin with seborrhea , comedones , papules , pustules , Nodules and possibly scarring...
-like eruption of blackhead
Blackhead
A blackhead is a yellow or blackish bump or plug on the skin. A blackhead is a type of acne vulgaris. Contrary to the common belief that it is caused by poor hygiene, blackheads are caused by excess oils that have accumulated in the sebaceous gland's duct...
s, cyst
Cyst
A cyst is a closed sac, having a distinct membrane and division on the nearby tissue. It may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst could go away on its own or may have to be removed through surgery.- Locations :* Acne...
s, and pustules associated with over-exposure to certain halogen
Halogen
The halogens or halogen elements are a series of nonmetal elements from Group 17 IUPAC Style of the periodic table, comprising fluorine , chlorine , bromine , iodine , and astatine...
ated aromatic compounds, such as chlorinated dioxins and dibenzofuran
Dibenzofuran
Dibenzofuran, is a heterocyclic organic compound with the chemical structure shown at right. It is an aromatic compound that has two benzene rings fused to one furan ring in the middle. All of the numbered carbon atoms have a hydrogen atom bonded to each of them...
s. 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
Chlorine
Chlorine is the chemical element with atomic number 17 and symbol Cl. It is the second lightest halogen, found in the periodic table in group 17. The element forms diatomic molecules under standard conditions, called dichlorine...
(hence the name "chloracne"). It was only in the mid-1950s that chloracne was associated with aromatic hydrocarbons. 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 process
Chemical process
In a "scientific" sense, a chemical process is a method or means of somehow changing one or more chemicals or chemical compounds. Such a chemical process can occur by itself or be caused by somebody. Such a chemical process commonly involves a chemical reaction of some sort...
es, including the manufacture of herbicides such as Agent Orange
Agent Orange
Agent Orange is the code name for one of the herbicides and defoliants used by the U.S. military as part of its herbicidal warfare program, Operation Ranch Hand, during the Vietnam War from 1961 to 1971. Vietnam estimates 400,000 people were killed or maimed, and 500,000 children born with birth...
)—so much so that it is considered a clinical sign of dioxin exposure. The severity and onset of chloracne may follow a typical asymptotic
Asymptote
In analytic geometry, an asymptote of a curve is a line such that the distance between the curve and the line approaches zero as they tend to infinity. Some sources include the requirement that the curve may not cross the line infinitely often, but this is unusual for modern authors...
dose-response relationship
Dose-response relationship
The dose-response relationship, or exposure-response relationship, describes the change in effect on an organism caused by differing levels of exposure to a stressor after a certain exposure time...
curve
Curve
In mathematics, a curve is, generally speaking, an object similar to a line but which is not required to be straight...
.
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
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
condition that results from this persistence, in combination with the toxin's chemical properties. It is believed, at least from rodent
Rodent
Rodentia is an order of mammals also known as rodents, characterised by two continuously growing incisors in the upper and lower jaws which must be kept short by gnawing....
models, that the toxin activates a series of receptors
Receptor (biochemistry)
In biochemistry, a receptor is a molecule found on the surface of a cell, which receives specific chemical signals from neighbouring cells or the wider environment within an organism...
promoting macrophage
Macrophage
Macrophages are cells produced by the differentiation of monocytes in tissues. Human macrophages are about in diameter. Monocytes and macrophages are phagocytes. Macrophages function in both non-specific defense as well as help initiate specific defense mechanisms of vertebrate animals...
proliferation, inducing neutrophilia
Neutrophilia
Neutrophilia is a condition where a person has a high number of neutrophil granulocytes in their blood.-Causes:...
and leading to a generalised inflammatory response in the skin. This process may also be augmented by induction of excess tumor necrosis factor
Tumor necrosis factors
Tumor necrosis factors refers to a group of cytokines family that can cause cell death . The first two members of the family to be identified were:...
in the blood serum
Blood plasma
Blood plasma is the straw-colored liquid component of blood in which the blood cells in whole blood are normally suspended. It makes up about 55% of the total blood volume. It is the intravascular fluid part of extracellular fluid...
.
The inflammatory processes lead to the formation of keratin
Keratin
Keratin refers to a family of fibrous structural proteins. Keratin is the key of structural material making up the outer layer of human skin. It is also the key structural component of hair and nails...
ous plugs in skin pores, forming yellowish cysts and dark pustules. The associated pus
Pus
Pus is a viscous exudate, typically whitish-yellow, yellow, or yellow-brown, formed at the site of inflammatory during infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection of pus within or beneath the epidermis is known as a pustule or...
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.
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
Isotretinoin
Isotretinoin, INN, is a medication used mostly for cystic acne. It was first developed for brain, pancreatic and other cancers. It is used to treat harlequin-type ichthyosis, a usually lethal skin disease, and lamellar ichthyosis. Its effects are systemic and nonselective...
. 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).
Recent research by groups at University of Cincinnati
University of Cincinnati
The University of Cincinnati is a comprehensive public research university in Cincinnati, Ohio, and a part of the University System of Ohio....
School of Medicine in Ohio
Ohio
Ohio is a Midwestern state in the United States. The 34th largest state by area in the U.S.,it is the 7th‑most populous with over 11.5 million residents, containing several major American cities and seven metropolitan areas with populations of 500,000 or more.The state's capital is Columbus...
and the University of Western Australia
University of Western Australia
The University of Western Australia was established by an Act of the Western Australian Parliament in February 1911, and began teaching students for the first time in 1913. It is the oldest university in the state of Western Australia and the only university in the state to be a member of the...
indicated that PCB
Polychlorinated biphenyl
Polychlorinated biphenyls are a class of organic compounds with 2 to 10 chlorine atoms attached to biphenyl, which is a molecule composed of two benzene rings. The chemical formula for PCBs is C12H10-xClx...
poisoning, including chloracne symptoms, can be treated with fat substitute olestra
Olestra
Olestra is a fat substitute that adds no fat, calories, or cholesterol to products. It has been used in the preparation of traditionally high-fat foods such as potato chips, thereby lowering or eliminating their fat content...
.
Related conditions
Chloracne is very often seen in combination with hyperhidrosisHyperhidrosis
Hyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature.-Classification:Hyperhidrosis can either be generalized or localized to specific parts of the body...
(clammy, sweaty skin) and porphyria cutanea tarda
Porphyria cutanea tarda
Porphyria cutanea tarda is the most common subtype of porphyria. The disorder results from low levels of the enzyme responsible for the fifth step in heme production. Heme is a vital molecule for all of the body's organs...
(a skin condition of increased pigmentation, hair coarsening and blistering).
Notable cases
- In 1949, 226 workers became ill after a container of herbicideHerbicideHerbicides, also commonly known as weedkillers, are pesticides used to kill unwanted plants. Selective herbicides kill specific targets while leaving the desired crop relatively unharmed. Some of these act by interfering with the growth of the weed and are often synthetic "imitations" of plant...
exploded at a Monsanto Company plant in Nitro, West VirginiaNitro, West VirginiaNitro is a city in West Virginia, along the Kanawha River. Most of the city lies in Kanawha County, with the remainder in Putnam County. The population was 7,178 at the 2010 census.Nitro was incorporated in 1932 by Circuit Court.- City name origin :...
. 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 OrangeAgent OrangeAgent Orange is the code name for one of the herbicides and defoliants used by the U.S. military as part of its herbicidal warfare program, Operation Ranch Hand, during the Vietnam War from 1961 to 1971. Vietnam estimates 400,000 people were killed or maimed, and 500,000 children born with birth...
. - 193 cases of chloracne occurred in SevesoSevesoSeveso is a town and comune in the Province of Monza and Brianza, in the Region of Lombardy. The economy of the town has traditionally been based around the furniture industry....
, ItalyItalyItaly , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
in 1976 following an industrial accidentSeveso disasterThe Seveso disaster was an industrial accident that occurred around 12:37 pm July 10, 1976, in a small chemical manufacturing plant approximately north of Milan in the Lombardy region in Italy...
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 PCBPolychlorinated biphenylPolychlorinated biphenyls are a class of organic compounds with 2 to 10 chlorine atoms attached to biphenyl, which is a molecule composed of two benzene rings. The chemical formula for PCBs is C12H10-xClx...
s and PCDFs in northern KyūshūKyushuis the third largest island of Japan and most southwesterly of its four main islands. Its alternate ancient names include , , and . The historical regional name is referred to Kyushu and its surrounding islands....
, Japan in 1968. The syndrome came to be called YushoYusho Diseasewas a mass poisoning by PCBs which occurred in northern Kyūshū, Japan in 1968. In January 1968, rice bran oil produced by Kanemi Company in Kyushu started to become contaminated with polychlorinated biphenyls and polychlorinated dibenzofurans...
or "Rice Oil" disease. - Eleven years later, a similar case of mass contamination of cooking oil was reported in central TaiwanTaiwanTaiwan , also known, especially in the past, as Formosa , is the largest island of the same-named island group of East Asia in the western Pacific Ocean and located off the southeastern coast of mainland China. The island forms over 99% of the current territory of the Republic of China following...
. Over 2,000 individuals were affected by what came to be called Yu-Cheng in 1979. - Ukrainian President Viktor Yushchenko suffered from extremely prominent facial chloracne after being diagnosed with possible dioxin poisonPoisonIn the context of biology, poisons are substances that can cause disturbances to organisms, usually by chemical reaction or other activity on the molecular scale, when a sufficient quantity is absorbed by an organism....
ing in late 2004 according to prominent toxicologist John HenryJohn Henry (toxicologist)Professor John Anthony Henry was a professor specialising in toxicology in the Faculty of Medicine, Imperial College London, at St Mary's Hospital in Paddington...
, though he never personally examined Yushchenko.