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Chlorodontia — Clinical Guidelines

Overview

Chloracne is an acneiform skin eruption resulting from systemic poisoning by halogenated polycyclic aromatic hydrocarbons, including dioxins, dibenzofurans, and certain chlorinated phenols. It often indicates significant exposure to toxic chemicals and can persist for extended periods without additional exposure 6 17.

Diagnosis

Clinical Presentation: Acneiform lesions, comedones, and follicular cysts, typically affecting face, chest, and back 6 18.

Laboratory Tests: Elevated blood lipid concentrations of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and other dioxins/dibenzofurans 4 7 12.

Histology: Follicular infundibular dilatation and comedo formation on skin biopsy 18.

Environmental Exposure Assessment: Evaluation of occupational or environmental exposure to chloracnegens 1 2 14.

Management

First-Line Treatment: Oral isotretinoin for persistent cases, typically starting at 0.5-1 mg/kg/day 16.

Adjunctive Therapies: Topical retinoids, antibiotics, and anti-inflammatory agents to manage symptoms 6.

Supportive Care: Regular dermatological follow-up to monitor lesion progression and systemic effects 17.

Special Populations

Pediatrics: Children are particularly susceptible to chloracne following environmental exposure, with prolonged persistence of lesions 15 24.

Comorbidities: Increased prevalence of abnormal liver enzymes (e.g., GGT) in affected individuals 19.

Key Recommendations

Monitor Blood Lipid Concentrations of TCDD for diagnosis and follow-up in exposed individuals (Evidence: Moderate 7 12).

Initiate Oral Isotretinoin for severe or persistent chloracne cases, adjusting dose based on response and side effects (Evidence: Expert opinion 16).

Conduct Comprehensive Occupational Exposure Assessments to identify and mitigate sources of chloracnegens (Evidence: Moderate 1 14).

Provide Regular Dermatological Monitoring for long-term management and to detect potential systemic effects (Evidence: Expert opinion).

Evaluate Liver Function Tests in patients with chloracne due to potential hepatotoxicity (Evidence: Moderate 19).

References

1 Baccarelli A, Pfeiffer R, Consonni D, Pesatori AC, Bonzini M, Patterson DG et al.. Handling of dioxin measurement data in the presence of non-detectable values: overview of available methods and their application in the Seveso chloracne study. Chemosphere 2005. link 2 Baccarelli A, Pesatori AC, Consonni D, Mocarelli P, Patterson DG, Caporaso NE et al.. Health status and plasma dioxin levels in chloracne cases 20 years after the Seveso, Italy accident. The British journal of dermatology 2005. link 3 Geusau A, Tschachler E, Meixner M, Sandermann S, Päpke O, Wolf C et al.. Olestra increases faecal excretion of 2,3,7,8-tetrachlorodibenzo-p-dioxin. Lancet (London, England) 1999. link04271-3) 4 Coenraads PJ, Olie K, Tang NJ. Blood lipid concentrations of dioxins and dibenzofurans causing chloracne. The British journal of dermatology 1999. link 5 Rosas Vazquez E, Campos Macias P, Ochoa Tirado JG, Garcia Solana C, Casanova A, Palomino Moncada JF. Chloracne in the 1990s. International journal of dermatology 1996. link 6 Coenraads PJ, Brouwer A, Olie K, Tang N. Chloracne. Some recent issues. Dermatologic clinics 1994. link 7 Jansing PJ, Korff R. Blood levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin and gamma-globulins in a follow-up investigation of employees with chloracne. Journal of dermatological science 1994. link90001-9) 8 McDonagh AJ, Gawkrodger DJ, Walker AE. Chloracne--study of an outbreak with new clinical observations. Clinical and experimental dermatology 1993. link 9 Cheng WN, Coenraads PJ, Hao ZH, Liu GF. A health survey of workers in the pentachlorophenol section of a chemical manufacturing plant. American journal of industrial medicine 1993. link 10 Ott MG, Messerer P, Zober A. Assessment of past occupational exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin using blood lipid analyses. International archives of occupational and environmental health 1993. link 11 Mocarelli P, Needham LL, Marocchi A, Patterson DG, Brambilla P, Gerthoux PM et al.. Serum concentrations of 2,3,7,8-tetrachlorodibenzo-p-dioxin and test results from selected residents of Seveso, Italy. Journal of toxicology and environmental health 1991. link 12 Neuberger M, Landvoigt W, Derntl F. Blood levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin in chemical workers after chloracne and in comparison groups. International archives of occupational and environmental health 1991. link 13 O'Malley MA, Carpenter AV, Sweeney MH, Fingerhut MA, Marlow DA, Halperin WE et al.. Chloracne associated with employment in the production of pentachlorophenol. American journal of industrial medicine 1990. link 14 Bond GG, McLaren EA, Brenner FE, Cook RR. Incidence of chloracne among chemical workers potentially exposed to chlorinated dioxins. Journal of occupational medicine. : official publication of the Industrial Medical Association 1989. link 15 Caputo R, Monti M, Ermacora E, Carminati G, Gelmetti C, Gianotti R et al.. Cutaneous manifestations of tetrachlorodibenzo-p-dioxin in children and adolescents. Follow-up 10 years after the Seveso, Italy, accident. Journal of the American Academy of Dermatology 1988. link70238-8) 16 Cole GW, Stone O, Gates D, Culver D. Chloracne from pentachlorophenol-preserved wood. Contact dermatitis 1986. link 17 Tindall JP. Chloracne and chloracnegens. Journal of the American Academy of Dermatology 1985. link70196-x) 18 Moses M, Prioleau PG. Cutaneous histologic findings in chemical workers with and without chloracne with past exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Journal of the American Academy of Dermatology 1985. link70070-9) 19 Moses M, Lilis R, Crow KD, Thornton J, Fischbein A, Anderson HA et al.. Health status of workers with past exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin in the manufacture of 2,4,5-trichlorophenoxyacetic acid: comparison of findings with and without chloracne. American journal of industrial medicine 1984. link 20 Puhvel SM, Ertl DC. Decreased induction of aryl hydrocarbon hydroxylase activity in hyperproliferative hairless mouse epidermis. The British journal of dermatology 1984. link 21 Sehgal VN, Ghorpade A. Fume inhalation chloracne. Dermatologica 1983. link 22 May G. Tetrachlorodibenzodioxin: a survey of subjects ten years after exposure. British journal of industrial medicine 1982. link 23 Passi S, Nazzaro-Porro M, Boniforti L, Gianotti F. Analysis of lipids and dioxin in chloracne due to tetrachloro-2,3,7,8-p-dibenzodioxin. The British journal of dermatology 1981. link 24 Caramaschi F, del Corno G, Favaretti C, Giambelluca SE, Montesarchio E, Fara GM. Chloracne following environmental contamination by TCDD in Seveso, Italy. International journal of epidemiology 1981. link 25 Hill RH, Rollen ZJ, Kimbrough RD, Groce DF, Needham LL. Tetrachloroazobenzene in 3,4-dichloroaniline and its herbicidal derivatives: propanil, diuron, linuron, and neburon. Archives of environmental health 1981. link 26 Zack JA, Suskind RR. The mortality experience of workers exposed to tetrachlorodibenzodioxin in a trichlorophenol process accident. Journal of occupational medicine. : official publication of the Industrial Medical Association 1980. link 27 Cook RR, Townsend JC, Ott MG, Silverstein LG. Mortality experience of employees exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Journal of occupational medicine. : official publication of the Industrial Medical Association 1980. link 28 Bisanti L, Bonetti F, Caramaschi F, Del Corno G, Favaretti C, Giambelluca SE et al.. Experiences from the accident of Seveso. Acta morphologica Academiae Scientiarum Hungaricae 1980. link 29 Morse DL, Baker EL, Kimbrough RD, Wisseman CL. Propanil-chloracne and methomyl toxicity in workers of a pesticide manufacturing plant. Clinical toxicology 1979. link 30 Taylor JS, Wuthrich RC, Lloyd KM, Poland A. Chloracne from manufacture of a new herbicide. Archives of dermatology 1977. link

Chlorodontia