What is Chloracne (metabolizing acquired dioxin-induced skin hamartomas (MADISH))?
Chloracne is a type of acne that comes from exposure to certain chemical compounds. Dioxin is one of the most common triggers, but others include substances that affect our hormonal system, like polychlorinated biphenyls (PCBs). These are often found in industrial pollutants and even in some pesticides, like Agent Orange, which was used in the Vietnam War.
Common signs of Chloracne include the appearance of cysts, nodules, pustules, and both open and closed comedones (more commonly known as blackheads and whiteheads) on the skin. Often, it affects the cheeks, the area behind the ears, the underarms, and the groin.
The seriousness of Chloracne typically depends on how much of the chemical a person was exposed to. Notably, high-level exposure can result in harm to the eyes, liver, hormones, and nervous system. Also known as MADISH (metabolizing acquired dioxin-induced skin hamartomas), Chloracne’s symptoms have a far-reaching impact on the body and should not be overlooked.
What Causes Chloracne (metabolizing acquired dioxin-induced skin hamartomas (MADISH))?
Chloracnegens are substances that stick around in our body fat and skin for a long time after we’re exposed to them. They can get into our body in several ways, including direct contact with skin, swallowing, and breathing them in.
Most people come into contact with these substances at work or by accident. However, one famous case is a Ukrainian President who was deliberately poisoned using a chloracnegen called dioxin.
Chloracne, a skin condition, is usually the result of exposure to a group of chemicals called halogenated aromatic hydrocarbons. These chemicals can be found in several everyday products:
* Fungicides, which are used to kill fungus.
* Herbicides, which are used to kill unwanted plants.
* Insecticides, which are used to kill insects.
* Wood preservatives, which protect wood from rot and insects.
Some specific chemicals known to cause chloracne include:
* Chlornaphthalene
* Chlorobenzene
* PCBs
* Polychlorinated dibenzo-p-dioxins (PCDDs)
* Polychlorinated dibenzofurans (PCDFs)
* Pyrazole derivatives
* Chlorophenol contaminants
* Trifluoromethyl
Risk Factors and Frequency for Chloracne (metabolizing acquired dioxin-induced skin hamartomas (MADISH))
Chloracne is a rare skin condition usually linked to workplace hazards. This skin issue commonly affects people working in the chemical industry, especially those who handle or are exposed to certain pesticides contaminated with a chemical known as 2,3,7,8-tetrachlorodibenzo-para-dioxin or TCDD.
- There have been instances where a large number of people were accidentally exposed, causing outbreaks of chloracne.
- There have also been incidents of people being deliberately poisoned with this chemical.
- The first known exposure to TCDD-contaminated chemicals happened in 1949 when a reactor in West Virginia exploded.
- Communities in Missouri and Italy have also been affected by contaminated oil and industrial waste.
- The largest reported incident was in Japan in 1968, affecting approximately 1,600 people.
- During the Vietnam War, a chemical called Agent Orange, which can cause chloracne, was widely used. However, it’s unclear how many Vietnam veterans developed this skin condition as a result.
- Nowadays, the use of chemicals containing dioxin, like the ones causing chloracne, is limited and regulated.
Signs and Symptoms of Chloracne (metabolizing acquired dioxin-induced skin hamartomas (MADISH))
When a person is exposed to large amounts of toxic halogenated aromatic compounds, they might experience symptoms within a few days or weeks. Symptoms can range from gastrointestinal distress, such as nausea, vomiting, and diarrhea, to more serious conditions like liver dysfunction, pancreatitis, neuropathy, and joint pain. Skin changes often follow exposure, starting from the cheeks and behind the ears (postauricular skin), potentially spreading to other areas such as underarms (axillae), groin, shoulders, chest, back, and abdomen. In serious cases, these changes can even reach the limbs. Before these noticeable changes, the skin might become excessively oily.
The specific skin changes occurring are:
- Open and closed comedones (commonly known as blackheads and whiteheads)
- Nodules and cysts
- Pustules
In addition to these, some other skin and mucosal problems associated with this condition include:
- Sweaty hands or feet (Palmar or plantar hyperhidrosis)
- Pigmentation, increased hair growth, and blisters on skin exposed to light – a condition known as Porphyria cutanea tarda
- Significant increase in body hair (Hypertrichosis)
- Darkening of skin, hair or nails (Hyperpigmentation)
- Inflammation of the eye’s mucous membrane (Conjunctivitis), darkening of the conjunctival mucosa and swelling of the meibomian glands
Testing for Chloracne (metabolizing acquired dioxin-induced skin hamartomas (MADISH))
Gathering your medical history and doing a physical examination are vital steps that your doctor takes for an accurate diagnosis. Tests that screen for a group of chemicals, called halogenated aromatic hydrocarbons, may sometimes be carried out. However, these tests’ reliability is not always certain.
In the past, other related chemicals known as polyhydrocarbons were frequently measured in people’s blood and urine. In certain cases, changes in specific blood markers and hormones were linked to the levels of a specific chemical, 2,3,7,8-TCDD, in the blood. Yet, diagnosing a skin condition known as chloracne based on the levels of these toxic chemicals in the blood is tricky. This is because how sensitive a person is to these chemicals can vary greatly, and these substances tend to accumulate in the body’s fat and skin.
One way to better understand skin conditions is through a skin biopsy, a procedure where a small bit of skin is removed and examined closely. This can show changes in normal skin composition, such as fewer oil-producing sebaceous glands or skin growth abnormalities known as hamartomas. Special tests can also be done on the biopsy samples to look at gene expression, essentially measuring how specific genes (like CYP1A1) are functioning.
Treatment Options for Chloracne (metabolizing acquired dioxin-induced skin hamartomas (MADISH))
Once a person is diagnosed with chloracne, a skin condition related to chemical exposure, the most important step is to ensure no more contact with the harmful chemical – this is often enough to improve the skin sores. However, if the sores continue for a long time even after stopping any further exposure to the chemical, other treatments might be needed. These usually involve ways to manage common spots and acne, like skin creams known as retinoids, or medicines you take by mouth like antibiotics, or a drug called isotretinoin.
In case of skin bumps (comedones) and deeper lumps (cysts), there can be procedures to squeeze them out or surgically remove them. Interestingly, a small group of patients in Japan, who had suffered from dioxin-related health issues for 30 to 40 years, were treated with Keishibukuryogan – a herbal medicine containing a compound called cinnamaldehyde. This medicine, which blocks the actions of harmful chemical reactions and boosts antioxidant defenses in the body, was found to improve chloracne and the overall health condition of the patients.
It’s important to keep in mind that people who have a history of exposure to chemicals that cause chloracne need long-term health observation. This is because the harmful chemicals can affect other parts of the body apart from skin, and might even increase the risk of developing various types of cancers.
What else can Chloracne (metabolizing acquired dioxin-induced skin hamartomas (MADISH)) be?
When trying to diagnose chloracne, doctors need to rule out conditions that can have similar symptoms. These include:
- Acne vulgaris (common acne)
- Favre-Racouchot syndrome (also known as solar or senile comedones and nodular elastosis with cysts and comedones)
- Folliculitis (inflammation of the hair follicles)
- Dilated pore of Winer (a type of large blackhead)
- Epidermal inclusion cyst (a type of skin cyst)
- Milia (small white bumps on the skin)
- Folliculotropic mycosis fungoides (a type of skin cancer)
- Nevus comedonicus (a skin condition characterized by grouped, closely set blackheads)
What to expect with Chloracne (metabolizing acquired dioxin-induced skin hamartomas (MADISH))
The seriousness and how long the chloracne spots last are related to how long a person was exposed to the toxin and how much of it they came into contact with. When a person is no longer in contact with the toxin, the spots usually get better on their own, but this could take years.
Possible Complications When Diagnosed with Chloracne (metabolizing acquired dioxin-induced skin hamartomas (MADISH))
Chloracne, a skin condition, may lead to different degrees of long-lasting scarring. Skin blemishes on the cheekbones and the skin behind the ears often stay longer than those appearing anywhere else on the body.
Further complications can occur due to prolonged exposure to dioxin and compounds similar to dioxin. These complications include immunotoxicity – specifically weakening the immune system, and harmful effects on growth and development.
Additionally, exposure to substances that cause chloracne has been associated with certain types of cancer. These include non-Hodgkin lymphoma (a type of blood cancer), soft-tissue sarcomas (cancers that develop in the soft tissues of the body like fat, muscle, nerves, fibrous tissues), including dermatofibrosarcoma protuberans, and leiomyosarcomas, and non-melanoma skin cancer.
The Side Effects and Complications include:
- Permanent scarring from Chloracne
- Long-lasting blemishes particularly on the cheekbones and behind the ears
- Weakening of the immune system (immunosuppression)
- Harmful effects on growth and development
- Certain types of cancers: non-Hodgkin lymphoma, soft-tissue sarcomas (such as dermatofibrosarcoma protuberans, and leiomyosarcomas), and non-melanoma skin cancer
Preventing Chloracne (metabolizing acquired dioxin-induced skin hamartomas (MADISH))
If you work in a job where you’re regularly exposed to certain chemicals – like weed killers, bug sprays, fungus killers, or wood treatment substances – or if you’ve been in contact with the chemical Agent Orange, it’s important to watch out for symptoms related to a skin disorder called chloracne. Things to look out for include skin rashes and systemic signs, such as fever, fatigue, and weight loss.
There is some debate about whether exposure to these chemicals might also be linked to birth defects. While the evidence is not entirely clear, it would be a good idea for both partners to be aware of the possible risks, just to be on the safe side.
Finally, if you have been exposed to these substances and experience any of the symptoms outlined, don’t worry too much. Most of the time, skin conditions and other symptoms gradually get better on their own once you’re no longer in contact with the harmful chemicals.
