Chloracne: First manifestation of dioxin toxicity

June 5, 2010, 10:11 pm

★★★☆☆

Chloracne: Still Cause for Concern. Passasrini B et al.  Dermatology [Published online June 2 2010 ahead of print]

Abstract

When Viktor Yushchenko (picture) — a candidate for President of the Ukraine — was poisoned with dioxin in 2004, the image of his ravaged face was an unforgettable reminder of the dermatologic effects of this toxicity.

Chloracne is a skin condition caused by exposure to halogenated cyclic hydrocarbons. Features include:

• presence of comedones (blackheads) and yellowish cysts on the cheeks, trunk, and other areas not often involved in acne vulgaris (for example, the genital region)

• grayish discoloration of involved skin

• prominent involvement lateral to the eyes and behind the ears

• relative sparing of nose

Other manifestations included hepatic inflammation, elevated γ-GT, peripheral neuritis, and elevated white blood count.

This presentation of nine cases and clinical discussion, from the University of Bologna, points out that chloracne can be the first sign of dioxin exposure, and thus it is important not to miss the diagnosis.  Skin biopsy can show distinctive features such as absence of sebaceous glands and hyperpigmented stratum corneum.  Differential diagnosis includes acne vulgaris, rosacea, and chronic discoid lupus.

The article contains some good photographs illustrating the skin changes of chloracne, and is worth tracking down.

Interesting factoid: Chloracne is the only clinical condition I know of whose treatment has included massive doses of Pringle’s Fat-Free Potato Chips. The hypothesis was that olestra — the fat substitute in the chips — would increase clearance of the highly lipophilic cyclic hydrocarbons.  As it turned out, the patients put on this regimen could not tolerate it.  In my opinion, if you’re going to try this, selection of a really good dip is crucial.

Environmental Health Perspectives presents two cases of dioxin poisoning, with good pictures.

To read my column on the Yushchenko poisoning in Emergency Medicine News, click here.

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