Chloracne - Clinical Features, Diagnosis, and Treatment

Introduction

Chloracne is an acneiform dermatosis condition, a rare condition. The chloracne is caused due to exposure to aromatic compounds containing halogens. The chloracne causes systemic toxicity, thereby causing cutaneous manifestations. The skin conditions in chloracne due to systemic toxicity are the hallmark feature of this condition. It is observed that the characteristic features of chloracne are primarily observed in the malar region of the cheeks, postauricular skin, groin, and axillary region. In severe forms of chloracne, multiorgan failure occurs. The severity of chloracne will follow the typical dose-response relationship curve. Chloracne is an occupation-related hazardous reaction, and the treatment is done according to the severity of the condition.

What Is Chloracne?

Chloracne, also known as MADISH, describes Metabolizing Acquired Dioxin-Induced Skin Hamartomas. Chloracne is the rare acneiform dermatosis condition characterized as the typical lesion, which includes cysts, nodules, and abscesses. The open and closed comedones (tiny, white, flesh-colored, or dark bumps giving the skin a rough texture) are also a feature of chloracne. The chloracne most commonly affected areas are the malar region of the cheeks, skin behind the ear, groin, and axillary region. In severe conditions, chloracne affects the multiorgan, including the liver, eyes, nervous system, and endocrine system. The most common etiology of chloracne is Dioxin, and Dioxin is the significant environmental chloracnegen. Chloracne is a rare condition but has a history of various outbreaks. The hazardous breakdown of chloracne is mentioned below:

• Dioxin poisoning of Ukrainian President Victor Yushchenko.

• Trichlorophenol reactor explosion in Nitro and West Virginia in 1949.

• Human exposure to 2, 3, 7, 8- tetrachlorodibenzo-p-dioxin TCDD.

• In Missouri, due to contaminated oil.

• Industrial waste in Seveso, Italy.

• Japan, 1968.

• Vietnam war.

What Are the Causes of Chloracne?

Numerous factors of chloracnegens cause chloracne. The aromatic halogenated hydrocarbon-containing products are the primary causative agent of chloracne. The routes of exposure to chloracne include direct skin contact, inhalation, and ingestion of halogenated compounds. Chloracnegens are fat-soluble and remain in the fat tissues and skin present in the body after exposure. The causative agents are mentioned below:

• Fungicides.

• Herbicides.

• Wood preservatives.

• Insecticides.

• Endocrine disturbing compounds.

• Chloro naphthalene.

• Polychlorobiphenyls, PCBs.

• Chlorobenzene.

• Polychlorinated dibenzo-p-dioxins, PCDDs.

• Polychlorinated dibenzofuran, PCDFs.

• Pyrazole derivatives.

• Trifluoromethyl.

• Chlorophenol contaminants.

What Are the Clinical Features of Chloracne?

Chloracne is the acneiform condition caused due to toxic chemicals and other products. The action of toxins in the sebaceous glands and the hamartomas occurs. Hamartomas are cyst-like structures formed because of the alteration in normal physiology. The symptoms are seen in the face, but in advanced conditions, areas like the shoulders, abdomen, chest, and abdomen are also involved. The signs and symptoms of chloracne will vary according to the severity of the condition. Sometimes, the skin lesions in chloracne will not appear after exposure. However, the systemic symptoms are observed in the severe form of chloracne. Some of the various signs and symptoms of chloracne are mentioned below:

• Blackheads, open comedones.

• Closed comedones, whiteheads.

• Nodules.

• Cysts.

• Pustules.

• Hyperhidrosis in the palm and plantar regions include excessive sweating in the palms and soles.

• Body hair shows hypertrichosis.

• Skin, hair, and nails show hyperpigmentation.

• Porphyria cutanea tarda includes pigmentation, blisters in the affected area, and increased hair growth.

• Conjunctivitis.

• The mucous membrane in the conjunctiva shows hyperpigmentation.

• Enlargement of meibomian glands.

• Other systemic symptoms include nausea, vomiting, and diarrhea.

• Gastrointestinal distress.

• Liver problems.

• Pancreatitis.

• Arthritis.

• Neuropathy.

How Is Chloracne Diagnosed?

The diagnosis of chloracne is based on the history of exposure and physical examinations. Halogenated aromatic compounds cause chloracne, and toxicologic screening is done to rule out chloracnegen. Some of the diagnostic measures for the diagnosis of chloracne are mentioned below:

• History of exposure.

• Occupational history.

• Physical examinations.

• Toxicologic screening.

• Complete blood cunt examination.

• Liver function tests.

• Hemoglobin A1c.

• Serum cholesterol is also examined.

• Blood and urine analysis for measuring polyhydrocarbons.

• Serum toxic equivalent values.

• Skin biopsy.

• Immunohistochemistry.

How Is Chloracne Treated?

After the confirmed diagnosis of chloracne, the treatment is done to improve the symptoms of chloracne. Avoiding exposure to toxins will improve the symptoms. The various treatment modes of therapy for treating chloracne are mentioned below.

• Topical retinoids.

• Oral antibiotics.

• Isotretinoin.

• Keishibukuryogan, an herbal remedy, cinnamaldehyde containing antioxidants, can be administered orally.

• Regular follow-up.

What Are the Differential Diagnosis of Chloracne?

The clinical features of chloracne include nodules, bumps, and blisters similar to other skin conditions. Therefore, the comparison of symptoms leads to differential diagnosis and avoids misdiagnosis. Some of the differential diagnoses of chloracne are mentioned below.

• Acne vulgaris.

• Favre-racouchot syndrome (a disorder consisting of multiple open comedones that occur in skin damaged by sunlight, particularly under and lateral of the eyes).

• Solar or senile comedones (a tiny skin-colored papule found on the face of an elderly person).

• Folliculitis.

• The dilated pore of the Winer (a common, blackhead pimple originating where hair grows at the hair follicle).

• Epidermal inclusion cyst.

• Milia (benign subepidermal keratin cysts).

• Folliculotropic mycosis fungoides (the most common subtype of mycosis fungoides with specific clinical-pathologic features)

What Are the Complications of Chloracne?

Chloracne has various complications in severe cases. Systemic toxicity is the hallmark feature of chloracne. Some other difficulties of chloracne are mentioned below:

• Permanent scarring.

• Immunotoxicity.

• Malignancy.

• Non- Hodgins lymphoma.

• Soft tissue sarcomas.

• Skin cancer.

• Occupational risk factors include congenital abnormalities.

• Abnormal liver function.

• Fatigue.

• Disturbed sleep.

• Impotence.

• Type 2 diabetes mellitus.

• Hyperlipidemia.

• Encephalopathy.

• Liver dysfunction.

• Encephalopathy.

• Depression.

• Transient peripheral neuropathy.

Conclusion

Chloracne is a rare acneiform dermal condition caused due to exposure to aromatic compounds containing halogens. Chloracne is an occupation-related hazardous condition, and chloracne is characterized as cysts, nodules, bumps, blisters, and systemic symptoms. Systemic toxicity and multiorgan failure are considered to be the hallmark feature of chloracne in advanced cases. The most commonly affected areas of chloracne include maar cheeks, skin behind the ear, groin, and axillary regions. Sometimes, the shoulder and trunk are also affected. The diagnosis is based on the history of symptoms and physical examination associated with serum analysis. The treatment is based on the severity of chloracne. Avoiding exposure will improve the lesion and its symptoms. However, the prognosis of chloracne is good.