H01 Chloracne: historical perspectives on an occupational disease, often the result of notorious environmental poisoning

Abstract

Abstract First described by the Heidelberg dermatologist Siegfried Bettman in 1897 as an occupational disease in chemical workers cleaning out towers filled with hydrochloric acid, chloracne—not a true acne, despite showing comedones, cysts and pustules, but the manifestation of systemic poisoning by halogenated aromatic compounds—has been the subject of several controversial environmental disasters for over a century (www.biusante.parisdescartes.fr/sfhd/wp-ontent/uploads/2021/05/chloracne.pdf). These disasters include the 1949 Monsanto plant explosion at Nitro, West Virginia, with 226 affected; the 1976 Seveso disaster, which released tetrachlorodibenzo-p-dioxin (TCDD) over a civilian population of around 100 000 (193 definite cases); and mass poisoning by cooking oils contaminated with polychlorinated biphenyls in Kyushu, Japan, in 1968 (> 2000 affected) and Taiwan in 1979 (> 2000 poisoned). Cases have even occurred in England. An explosion at the Coalite and Chemical Products Company works at Bolsover in 1968 released dioxin, leading to 79 cases of chloracne (https://api.parliament.uk/historic-hansard/lords/1980/mar/14/dioxin-escape-at-bolsover-april-1968). An outbreak in 1992 affected 17 workers in North Derbyshire at a plant manufacturing the herbicide dichloroaniline. Another incident occurred in 1997, when seven pharmaceutical chemists who manufactured triazoloquinoxalines, not previously known to be chloracnegenic but 100 times more powerful than dioxins, were affected. Perhaps the most notorious chloracne poisoning, with TCDD, was that of the Ukrainian president Viktor Yushchenko in 2004. Unless exposure is overwhelming, as it was in Seveso, chloracne takes a few weeks to manifest, and systemic changes can be found in the blood count and liver functions tests. Resolution typically takes about 3 years, although skin changes can be permanent. Dermatologists should be vigilant for new cases, especially at the time of industrial accidents, as the chloracnegenic potential of new chemicals is not always apparent.