Chloracne

Chloracne is a rare skin condition caused by certain toxic chemicals including the dioxins. It develops a few months after swallowing, inhaling or touching the responsible agent.

The name 'chloracne' is misleading, because it is not related to acne. Rather than overactive sebaceous glands, as occurs in acne, the glands are destroyed and replaced by epidermal cysts.

Most cases of chloracne are due to occupational exposure but it can also arise after accidental environmental poisoning. One hundred and ninety-three cases of chloracne resulted from an industrial accident in Seveso, Italy in 1976. Deliberate dioxin poisoning is blamed for Ukrainian President Victor Yushchenko's changed appearance in September 2004.

Chloracne

President Victor Yushchenko, December 2004 © TIME South Pacific, with permission

Chloracne is caused by exposure to halogenated aromatic hydrocarbons, which are most often found in:

• Fungicides
• Insecticides
• Herbicides
• Wood preservatives

Chloracne is the most common skin sign of dioxin poisoning. Responsible chemicals include:

• Chlornaphthalene
• Polychlorbiphenyls
• Polychlorinated dibenzofurone
• Chlorophenol contaminants
• Trifluoromethyls
• Pyrazole derivatives
• Chlorobenzene

The features of chloracne are:

• Open and closed comedones (whiteheads and blackheads)
• Uninflamed nodules and cysts

Blackheads and cysts

Inflammatory lesions

Chloracne blackheads

The lesions are most often seen on the cheeks, behind the ears, in the armpits and in the groins. Although they resemble acne, the skin is not usually oily; in fact the oil glands are often smaller than usual.

Other skin problems seen in patients with chloracne include:

• Sweaty palms and soles (hyperhidrosis)
• Porphyria cutanea tarda (pigmentation, increased hair growth and blisters on exposed skin)

Other health problems

Other health problems may include:

• Abnormal liver function
• Tiredness (sleep disturbance)
• Nerve conditions (transient peripheral neuropathy, encephalopathy resulting in poor concentration and depression)
• High levels of circulating blood fats (hyperlipidaemia)
• Impotence
• Type 2 diabetes

The data for an association with other health problems and birth defects are conflicting.

Management

Once chloracne has been recognised, the source of exposure must be identified and the affected individual and other workers must be removed from exposure to it.

Occupational disease due to chemical exposure is a notifiable condition. Contact Occupational Safety and Health Service of the Department of Labour, New Zealand for further information.

Most chloracne lesions clear up within two years providing exposure to the chemical has stopped. In some cases they persist much longer because the chemical continues to be slowly released from fat cells.

Persistent cases may be helped by standard treatments for acne, particularly oral antibiotics and sometimes isotretinoin. Comedones and cysts can be cauterised.