Chloracnegens are polychlorinated polycyclic hydrocarbon compounds, such as 2,3,7,8-tetrachlorodibenzo-p-dioxin, often used in many chemical industries. They are absorbed through ingestion or inhalation and exhibit an affinity for lipids, ultimately accumulating in the subcutaneous adipose tissue and sebum. Once localized within the sebum, they induce the expression of the transcriptional repressor known as B-lymphocyte–induced maturation protein 1, leading to abnormal sebocyte differentiation.
Diagnostic confirmation of chloracne can be achieved through the measurement of blood dioxin levels. Chloracne remains a persistent and recalcitrant condition, with noticeable improvement noted only on the complete elimination of chloracnegens from the individual’s system. Therefore, complete resolution of the disease typically requires 2 to 3 years, though associated scarring may be permanent.
Chloracne, a robust symptom of dioxin toxic effects, manifests as comedones localized to the lateral face, neck, forearms, shoulders, chest, and back typically appearing approximately 2 to 4 weeks after the onset of chemical exposure. Unlike acne vulgaris, the onset of chloracne is often preceded by an oily texture to the skin. Subsequent lesions demonstrate a predominance of open comedones and exhibit minimal inflammation. Additionally, in chloracne, comedones also develop in atypical sites such as the pinna and retroauricular regions. Beyond cutaneous involvement, systemic absorption of dioxins can lead to liver damage, pancreatitis, conjunctivitis, enlargement of meibomian glands, and features of neuropathy, requiring thoughtful screening of affected individuals.
References
Sorg O, Saurat JH. Corrigendum: development of skin diseases following systemic exposure. Front Toxicol. 2023;5:1323294.
Panteleyev AA, Bickers DR. Dioxin-induced chloracne—reconstructing the cellular and molecular mechanisms of a classic environmental disease. Exp Dermatol. 2006;15(9):705-730.
Saurat JH, Kaya G, Saxer-Sekulic N, et al. The cutaneous lesions of dioxin exposure: lessons from the poisoning of Victor Yushchenko. Toxicol Sci. 2012;125(1):310-317.
Ju Q, Yang K, Zouboulis CC, Ring J, Chen W. Chloracne: from clinic to research. Dermatologica sinica. 2012;30(1):2-6.
Singh S, Manoj R, Gupta A. Chloracne. JAMA Dermatol. 2024;160(6):668–669. doi:10.1001/jamadermatol.2024.0928
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