Chloracne is a disease of the skin caused by contact with chlorinated hydrocarbons and dioxins. It represents a symptom of extensive poisoning of the body. The healing process is very long.
What is chloracne?
Chloracne represents a subtype of acne venenata. Acne venenata is an exogenous form of acne caused by contact with a triggering substance. Thus, in addition to chloracne, the contact acne forms include oil acne, tar acne or acne cosmetica. Chloracne is a symptom of poisoning of the body with polychlorinated hydrocarbons and dioxins. These are skin changes typical of acne, but they are caused by direct skin contact with the contact toxin. The skin forms comedones (blackheads), abscesses, nodules and cysts. Cornification occurs on the hair follicle. The term chloracne was first used by the German physician Karl Herxheimer after he examined workers suffering from severe acne. He found that the diseased workers were employed in chlor-alkali electrolysis.
Causes
At that time, Karl Herxheimer still thought that chlorine alone was the trigger of chloracne. According to today’s knowledge, however, polychlorinated dibenzodioxins and dibenzofurans are formed as by-products during chlorine production. Over the years, it has become clear that chlorinated hydrocarbons such as chloronaphthalene, pentachlorophenol, chlorophenol and polychlorinated dibenzodioxins or dibenzofurans are the cause of chloracne. In this case, the skin change is only one symptom of a comprehensive poisoning. It results from direct contact of the poison with the skin, oral ingestion, or inhalation of toxic fumes. The parts of the body that come into contact with the chlorine compounds are particularly affected by acne. This is especially true for the face. As a trigger of chloracne, dioxin plays a special role. Dioxins are formed when chlorine-containing compounds are burned, melted and manufactured. Even in small quantities, dioxins are extremely toxic and carcinogenic. Among other things, they are contained in certain wood preservatives, pesticides or hydraulic oils. Therefore, intensive contact with these substances often results in the development of chloracne. There are also frequent cases of chloracne after chemical accidents. In 1976, for example, 187 children suffered from chloracne after the chemical accident in Seveso, Italy. It has not been clearly determined why children in particular developed chloracne. Either children react more sensitively than adults or they came into closer contact with the poison via contaminated playgrounds. In the electrical industry, the perchloronaphthalenes used there sometimes cause the so-called Perna disease with chloracne, nervousness, anemia and weight loss.
Symptoms, complaints and signs
Chloracne is characterized by severe skin changes. In this process, numerous comedones (blackheads), inflammatory abscesses, thickening of the horny layer, and nodules appear on the affected areas of the skin. Chloracne is always only one symptom of a comprehensive poisoning with chlorinated hydrocarbons. The overall appearance of the poisoning is more complex. Often there are additional nervousness, psychological problems, weight loss, anemia or liver insufficiency. In very severe cases, the internal organs are also severely affected. As a result of poisoning, cancer may develop. Depending on the degree of poisoning, the course of the disease can be very severe. In most cases, a chronic course develops. The healing process, if it occurs at all, is very protracted. The polychlorinated hydrocarbons are lipophilic and are therefore stored in the fatty tissue. Since the degradation of the toxins is very slow, the symptoms also persist for a very long time.
Diagnosis
The diagnosis of chloracne can only be made on the basis of the symptoms. When the typical skin changes occur, the physician will take an intensive medical history. This anamnesis will focus on clarifying possible exposure to pollutants in the living and working areas. Under certain circumstances, a pollutant measurement may also be useful to determine the source of the toxic exposure.
Complications
During and after the healing process, many complications can occur with chloracne.Scars may often remain on the skin due to larger inflamed skin areas, cysts and abscesses, depending on the degree of poisoning and the type and duration of therapies performed. Permanent damage to internal organs can lead to chronic impairment and even death. Among other things, sarcomas of skin and connective tissue and lung carcinomas can form. There is also an increased risk of leukemia. Elevated cholesterol levels and an increase in free fats in the blood are signs and consequences of liver damage. A disease of the gastrointestinal tract is often manifested by diarrhea and vomiting. Similarly, there may be ongoing damage to the central nervous system. Symptoms of this are motor and sensory deficits such as numbness of individual limbs, as well as headaches, irritability and insomnia. The sustained storage of the toxin also affects the reproductive organs. As a result, miscarriages may occur in the woman and infertility in the man. The body is generally more susceptible to infections and metabolic irregularities. As long as there is still toxin in the body, breastfeeding is not possible, because the toxins accumulate particularly high in the fatty breast milk.
When should you go to the doctor?
After contact with chlorinated hydrogens such as pentachlorophenol, chlorophenol or chloronaphthline, a doctor must be consulted immediately in any case. Even the mere suspicion of poisoning, for example due to possible exposure to pollutants in the living and working areas, requires immediate clarification by a physician. Inflammatory abscesses, nodules, blackheads and other skin changes are clear signs of chloracne and require immediate treatment. The physician can determine the condition based on a comprehensive history and visual diagnosis and initiate appropriate treatment. However, if left untreated, the poisoning can take a severe course. As a consequence of chloracne, physical and psychological complaints can occur, which additionally complicate the therapy. It is therefore advisable to talk to a specialist at the first sign of the disease. Ideally, possible exposure to harmful substances should be clarified by an expert at an early stage and remedied if necessary. By avoiding the toxin, which occurs for example in wood preservatives, pesticides and technical oils, the outbreak of chloracne can be reliably prevented.
Treatment and therapy
The therapy of chloracne is very lengthy and usually leads to healing after a very long time, if at all. Treatment is carried out, for example, by opening and draining cysts. At the same time, hormone-containing and anti-inflammatory drugs are administered. Hormone-containing drugs are available in the form of tablets. Anti-inflammatory drugs can be applied with the help of creams and ointments or applied in the form of tablets. Furthermore, vitamin A acid preparations (retinoids) are given. These are non-aromatic retinoids of the first generation. Their main representatives tretinoin and isotretinoin are used both locally (topically) and systemically. However, the efficacy of retinoids for the control of chloracne has not been clearly demonstrated. Cold therapy can be used to attenuate scarring. This involves removing excess scar tissue by applying ice for a short period of time. Skin peels and skin abrasion (dermabrasion) are also performed. Nevertheless, scars often remain if the condition is chronic and persistent. In dermabrasion, a special abrasive instrument is used to remove the top layer of skin. Wound treatment is performed by applying a medication that combines with the wound secretion. The scab dissolves after about eight to ten days. Complete healing only occurs after a very long time. However, healing does not always occur because the toxins remain in the fatty tissue for a very long time and are broken down only very slowly.
Outlook and prognosis
The prognosis of chloracne is unfavorable and depends on the severity of the disease as well as the start of treatment. A cure for chloracne is not available with current medical options in most patients. Therefore, treatment is aimed at alleviating the existing symptoms. In addition, an attempt is made to prevent the damage from progressing and spreading.In the case of severe poisoning, the course of the disease is fatal within a short time. Most patients have lifelong impairments due to severe skin changes or dysfunctions of individual bodily systems. The organ tissue destroyed by the poisoning is irreparable and cannot be regenerated. Depending on the intensity of the disease and the patient’s state of health, there is the possibility of organ transplantation. Therapy of the disease is often lifelong. Usually it takes a chronic course. Many symptoms of chloracne cannot be treated medically despite great efforts. With only a few patients and mild chloracne, there is a chance of a cure. This is protracted and usually lasts for decades. The reason for this is that the toxins are only broken down very slowly due to their natural half-life and can only then be removed from the organism. More likely are secondary diseases such as organ failure or cancer.
Prevention
Because chloracne is caused by poisoning with polychlorinated hydrocarbons, it can only be prevented by avoiding contact with these toxins. If necessary, measurements of pollutants in living and working areas provide information about the presence of polychlorinated hydrocarbons from wood preservatives, pesticides, and technical oils.
Aftercare
Chloracne can be followed up with anti-inflammatory therapy using home remedies such as ice packs and aloe vera. However, therapy can last for several years. Thus, the transition from treatment to aftercare is fluid. With medical ointments, the skin disease can usually only be alleviated, but not completely cured. In this context, it is important that the damage does not worsen and spread. The chronic course can only be stopped completely in a few cases. Therefore, patients should remain patient and be careful with their activities. Contact with chlorinated water should be avoided at all costs. Work in the chemical or electrical industry can also have a negative effect on the clinical picture. It may sometimes be necessary to change jobs if protective suits and other protective measures do not have the desired effect. An optimistic basic attitude helps those affected to accept the situation. Skin care should also be adapted to avoid itching and further problems. It may be useful to consult a naturopath who uses natural active ingredients. Together with a balanced diet, this prevents the disease of internal organs. Against possible depression and complexes, psychotherapy helps.
This is what you can do yourself
Chloracne is especially widespread among workers in the electrical and chemical industries. It is a chronic disease and the chances of cure are low. Contact with water containing chlorine also produces symptoms. Since even inhaling the vapors has noticeable consequences, applying protective ointments, such as petroleum jelly, does not help. Inflammatory processes can be alleviated using home remedies. Anti-inflammatory ointments, ice packs, aloe vera and lean curd are helpful. The latter is often used for external inflammations and is very effective. Peelings are also often recommended. Since chloracne is mainly not curable, a positive attitude towards life is a helpful tool to cope with it. Self-acceptance with all shortcomings also strengthens the attitude towards life. Skin care should be adjusted and – very important – any contact with chlorine should be avoided. If necessary, sufferers should change jobs if protective suits prove inadequate. Scratching is not helpful and leaves scars. A healthy and balanced diet helps to prevent diseases of the internal organs. If necessary, a naturopath can be consulted who can target natural agents. Depression can occur, but is detrimental to relief. If they do occur, they can be remedied with the help of family, friends and a psychotherapist.