Chloracne

Chloracne
papules and cystlike lesions.
Specialty	Dermatology

Chloracne is an

The condition was first described in German industrial workers in 1897 by Siegfried Bettmann,[2] and was initially believed to be caused by exposure to chlorine (hence the name "chloracne"). It was only in the mid-1950s that chloracne was associated with aromatic hydrocarbons.^[3] The substances that may cause chloracne are now collectively known as chloracnegens.

Chloracne is particularly linked to toxic exposure to

Chloracne normally results from direct skin contact with chloracnegens, although ingestion and inhalation are also possible causative routes.

Chloracnegens are

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.[3]^[4]

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

Secondary infections on severe or persistent lesions may need to be treated with oral

The course of the disease is highly variable. In some cases the lesions may disappear 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).[5]

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 mid-1960s,
  Dow Chemical paid Dr Albert Kligman $10,000 in conduct the experiments on the toxicity effects of Dioxin (TCDD) on at least 70 prisoners at the Holmesburg Prison in Philadelphia. No records of the prisoners' identities appear to have been kept and there were no follow-up studies after the testing period. Several of the inmates developed severe cases of chloracne and some developed blisters that, untreated, lasted four to seven months.^[6]
• In 1949, 226 workers became ill after a container of
  Monsanto Company plant in Nitro, West Virginia.^[7] Many were diagnosed with chloracne; a medical report at the time described "systemic intoxication in the workers involving most major organ systems."^{[citation needed}
  ]
• 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.^[8]
• Thousands of individuals were exposed at Fort McClellan, Alabama, when a chemical weapons training center and a nearby Monsanto factory disposed of chemicals into a creek over several decades.^[9] Many individuals ^[quantify] settled out of court, but a class-action suit is still ongoing.^[10] Although the incineration of the chemical weapons at Fort McClellan ended in 2011, areas of the base remain closed or off-limits due to the residual contamination.
• In 1968, almost 2,000 individuals in northern
  PCDFs. The syndrome came to be called Yushō disease
  or "Rice Oil" disease.
• In 1979, 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.^[11]
• Ukrainian President Viktor Yushchenko suffered from prominent facial chloracne and was diagnosed with dioxin poisoning in late 2004.^[12]
• A Hong Kong journalist from the Stand News, Chan Yu-hong, declared in a Facebook post that he was diagnosed by a
  2019 Hong Kong Protests.^[13][14]