What are the other Names for this Condition? (Also known as/Synonyms)

• Acne due to Chemical Exposure
• Acne due to Environmental Pollutants
• Environmental Pollution and Acne

What is Chloracne? (Definition/Background Information)

• Acne is a common skin condition that causes inflamed red spots/lesions to appear on the face, neck, shoulders, and other regions. The condition occurs when the tiny pilosebaceous follicles become clogged with dead cells and oil
• Chloracne is an acne-like skin condition that occurs due to exposure to a variety of chemicals. The primary class of chemicals responsible for this condition is halogenated aromatic hydrocarbon compounds (including dioxins), which are present in pesticides, preservatives, herbicides, and many other products. The causative chemicals are referred to as ‘chloracnegens’
• The term Chloracne was coined because it was initially thought that the condition was caused only by compounds containing the chemical chlorine (a naturally-occurring element). However, it is now understood that several chemical substances and toxins without the chlorine molecule can cause Chloracne
• In many cases, the skin condition may be an early indicator of chemical pollution or poisoning, owing to systemic exposure to the aforementioned compounds. The acne-like lesions (forming as a reaction of the skin to the chemical agents) may be seen on the face and neck region, hands and legs, and on the genitals
• Chloracne may also cause systemic signs and symptoms that may affect the nervous system, the digestive system, and even the reproductive system. Severe and prolonged exposure may result in a set of wide-ranging complications
• Generally, it is very difficult and challenging to treat Chloracne. Removing the affected individual from the potential contaminants as early as possible is the most crucial step to avoid further aggravation of the signs and symptoms
• The skin symptoms may be treated using medications, dermabrasion, and laser therapy. However, the prognosis of Chloracne is dependent upon a set of factors that include the degree of exposure, the chemical involved, and the severity of the signs and symptoms

Who gets Chloracne? (Age and Sex Distribution)

• Chloracne is commonly caused by exposure to certain chemicals that are present (dispersed) in the environment
• Individuals of any age category may be affected, although certain occupations may put some individuals more at risk than others
• The skin condition affects both males and females
• There is no racial or ethnic predilection observed, and Chloracne is prevalent worldwide

Note: Studies indicate that for some unknown reason, individuals with light-colored hair and children below the age of 8 years may have a higher susceptibility to Chloracne.

What are the Risk Factors for Chloracne? (Predisposing Factors)

Chloracne can occur due to exposure to industrial chemicals, environmental pollutants, and toxic wastes. The following are the risk factors of Chloracne:

• Industrial workers, military personnel (exposure to Agent Orange defoliant), individuals involved in waste disposal, farmers and agriculture workers, etc., have a high risk
• Chemical compounds called halogenated aromatic hydrocarbons, which are found in many products for agricultural use, such as fungicides, herbicides, and insecticides. It is also found in wood preservatives
• Exposure to dioxins (toxic chemicals that are classified as persistent organic pollutants) - these include several compounds containing chlorine such as:
  • Chlornaphthalene
  • Chlorobenzene
  • Chlorophenol contaminants
  • Polychlorbiphenyls (PCBc)
  • Polychlorinated dibenzofurone (PCDFs)
  • Polychlorinated dibenzo-p-dioxins (PCDDs)
  • Other compounds include pyrazole derivatives and trifluoromethyls

Dioxins (airborne) may be produced by industrial activities, burning of wastes, industrial bleaching of pulp and paper, smoking of tobacco products, etc. Dioxins are carcinogenic and belong to the family of halogenated aromatic hydrocarbons.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chloracne? (Etiology)

• Chloracne is similar to acne that occurs due to chemical exposure. A wide range of chemicals have been implicated, the most common among the lot being halogenated aromatic hydrocarbons (that includes dioxins)
• The chemicals that cause the skin condition are referred to as chloracnegens, which are known to be retained in the body for a long duration of time
• Direct skin contact with the chemical may be through the air when the chemical is dispersed in the form of smoke, dust, or fumes, or through inhalation. The condition is sometimes known to occur following ingestion of the compound.
• Following contact with the skin, which is often noted to be chronic and persistent, it triggers an inflammatory response that results in the formation of skin lesions
• The onset and severity of Chloracne depend upon factors such as the exposure period, toxicity of the substance, each individual’s susceptibility factor, and the quantum of exposure

What are the Signs and Symptoms of Chloracne?

The signs and symptoms of Chloracne may include the following:

• Reddish skin following contact with the chemical; the skin may appear swollen
• Formation of whiteheads and blackheads (comedones) or fluid-filled cysts
• The cysts are mostly seen on the neck and shoulders, trunk, abdomen, and genitalia
• The comedones are seen on the face (below the eyes, behind the ears, along the hairline) and parts of the neck region
• Loss of hair, change in skin color, and sweating of palms and soles can also be observed
• The region around the mouth, nose, and portion above the eyes are commonly found to be free of any skin lesions/rashes
• Increased exposure and more potent substances can cause aggravation of the skin lesions, including increased numbers and size of the lesions

Since the chemical may have entered the body and caused poisoning, it can result in certain systemic signs and symptoms that may include:

• Tiredness
• Loss of appetite
• Damage of nerves (neuropathy)

Studies indicate that from exposure to the onset of the signs and symptoms of Chloracne, the period involved may be around 2-4 weeks. In some cases of severe exposure to highly-toxic chemicals, the onset may be sudden and within a few days of the exposure event.

How is Chloracne Diagnosed?

The diagnosis of Chloracne may involve the following tests and procedures:

• Complete physical examination and assessment of the clinical signs and symptoms, either by the physician or a dermatologist
• Evaluation of medical history, including history of (occupational) exposure to environmental pollutants, industrial chemicals, etc.
• Complete blood count
• Blood lipid levels
• Blood tests to determine toxin/chloracnegen levels
• If secondary infections develop, then a culture test may be performed
• Skin biopsy: A biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed), and microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chloracne?

Some of the complications of Chloracne include:

• Severe exposure may cause a set of wide-ranging symptoms, including
  • Liver dysfunction
  • Inflammation of the thyroid gland
  • Anemia
  • Elevated blood lipids
  • Arthritis
  • Eye inflammation
• Severe neurological dysfunction
• In some males, the condition can lead to impotence
• In individuals with excess body fat, chloracnegens may be stored in the fat cells for prolonged periods resulting in a slower resolution of signs and symptoms, even long after the exposure is eliminated
• Development of secondary bacterial infections
• Cosmetic issues that may be severe, resulting in severe emotional and psychological stress

How is Chloracne Treated?

Chloracne is typically resistant to the established or available treatment measures for acne skin conditions. However, healthcare providers may recommend the following:

• Immediately remove individuals from the potential source of chemical contamination, thus preventing further exposure and worsening of the condition
• Undertake appropriate treatment to flush out the accumulated toxins from the body
• Symptomatic treatment is provided that may include the use of antibiotics, corticosteroids, and retinoids for the skin condition
• Dermabrasion and laser therapy may be used for more severe skin conditions

How can Chloracne be Prevented?

Chloracne occurs due to the exposure of chloracnegens from several sources, including environmental pollution. It may not be preventable.

• However, once recognition of the condition is made, either eliminating the source of exposure or immediately moving away from the source of such compounds can prevent further worsening of the condition
• Wearing appropriate respirators and masks while performing jobs that involve dust and chemicals
• While working in the industry, maintain a clean, dust-free work area. Also, regularly shower and change clothes after industrial work
• Ensure that industrial safety regulations for exposure to hazardous materials is adhered to at workplaces
• Ensure that the industries strictly comply with the implementation of prevalent statutory codes on occupational safety measures, especially concerning workplace exposure
• Undertake routine screening of individuals working in an environment where such exposure may be evident

What is the Prognosis of Chloracne? (Outcomes/Resolutions)

The prognosis of Chloracne can be highly variable. It depends upon a set of factors that include:

• The type and potency of the chemical involved
• The exposure duration and intensity
• Severity of the signs and symptoms (both skin and systemic)
• The patient’s response to treatment
• Health status of the individual

Following exposure cessation, an individual may take anywhere from 2-3 years to 20-30 years to fully recover, according to several studies.

Additional and Relevant Useful Information for Chloracne:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition
• A famous case involving a political candidate having been poisoned with dioxin to mar his physical appearance has been reported