is the one human effect universally linked to dioxin exposure.
The presence of chloracne is considered a clinical sign of
severity and abrupt onset of chloracne follows a dose response
curve. The lesions are remarkably persistent, and resistant to
usual acne treatment regimens. One study of workers in an
industrial accident revealed the mean duration of residual
chloracne to be 26 years. Chloracne was still present in some
workers 30 years after the original exposure. (Moses, 1984)
is an acne-like eruption of comedones, cysts, and pustules
that usually involve the malar area of the face. Cysts are
frequently coalescent, and filled with straw colored fluid.
It has been our experience that skin conditions are one of the
most common health problems reported by Vietnam veterans. Most
of these conditions are not chloracne, although diagnosis is
often inconclusive. We suspect that the frequency and
persistence of these skin conditions may be related to
parasitic or other infections the veteran acquired in Vietnam,
but they are widely varied. To our knowledge, no significant
study of this problem has ever been attempted.
is a skin condition that looks like common forms of acne that
affect teenagers. At present, chloracne is the only well
established long-term effect of exposure to TCDD or dioxin,
the contaminant found in one of the ingredients of Agent
is important to note that skin disorders are among the most
common health problems experienced by combat forces. Because
of the environment and living conditions in Vietnam, veterans
developed a variety of skin problems, ranging from bacterial
and fungal infections to a condition known as "tropical
acne." However, the only skin disorder consistently
reported to be associated with Agent Orange and other
herbicides is chloracne.
does chloracne look like and where does it appear?
first sign of chloracne may be excessive oiliness of the skin.
This is accompanied or followed by the appearance of numerous
blackheads. In mild cases the blackheads may be limited to the
area around the eyes extending along the temples to the ears.
In more severe cases blackheads may appear in many places on
the body, especially over the malar (or cheek bone) area,
other facial areas, behind the ears, and along the arms. The
blackheads are usually accompanied by fluid-filled cysts and
by an increased or darker growth of body hair. The skin may
become thicker and flake or peel. In severe cases, the acne
may result in open sores and permanent scars. The condition
fades slowly after exposure. Minor cases may disappear
altogether, but more severe cases may persist for years after
even dermatologists, sometimes have difficulty in
distinguishing chloracne from other more common skin
disorders. While chloracne may be a sensitive indicator of
exposure to dioxins in some people, it may not be in other
individuals who had equal or greater exposure to dioxins.
absence of chloracne is not necessarily a reliable basis for
concluding that a person has not been exposed to a chemical
which is known to cause chloracne.
chloracne been a problem for a large number of Vietnam
it has not. Of course, many veterans have complained of skin
problems. Skin ailments are the most common medical problem in
veteran and non-veteran populations. After traumatic injuries,
skin disorders are among the most common health problems
encountered in combat.
did Public Law 102-4, the Agent Orange Act of 1991, do for
Vietnam veterans with chloracne?
2, Public Law 102-4, enacted February 6, 1991, established by
statute the presumption of service connection for certain
diseases including chloracne or another acneform disease
consistent with chloracne manifested to a degree of disability
of 10 percent or more within a year after military service in
Vietnam -- associated with exposure to certain herbicide
July 1992, a proposed rule implementing the presumptions
established by this law was published in the Federal Register
for public comment. (See 57 Fed. Reg. 30707, July 10, 1992).
In May 1993, the ru1e was finalized and published in the
Federal Register. (See 58 Fed. Reg. 29107, May 19, 1993).
had recognized chloracne as service connected for Vietnam
veterans based on exposure to Agent Orange for many years
prior to the enactment of this legislation.
did the National Academy of Sciences conclude about chloracne
in its 1993 report, entitled Veterans and Agent Orange -
Health Effects of Herbicides Used in Vietnam?
832-page report included the following statements:
summary, chloracne has been linked to TCDD exposure in
numerous epidemiological studies of occupationally and
environmentally exposed populations. The data on Vietnam
veterans potentially exposed to Agent Orange and other
herbicides are less convincing
is sufficient to conclude that there is a positive association
between exposure to herbicides (2,4-D; 2,4,5-T and its
contaminant TCDD; acetylic acid; and picloram) and chloracne
TCDD-associated chloracne becomes evident shortly after
exposure, there is no risk of new cases occurring long after
service in Vietnam.
did the NAS conclude about chloracne in its 1996 update?
NAS reviewers essentially reached the same conclusion in 1996
they had in the earlier report.
should a Vietnam veteran do if he or she thinks his or her
skin condition may be chloracne?
the nearest VA medical center for a medical examination and
possible treatment and file a claim for disability
compensation at the nearest VA medical center or regional
office. For many years, VA has recognized chloracne as a
service-connected disability based on the results of
scientific research that links this condition with exposure to
Chloracne, a chemically induced skin condition, is the only
completely established effect on human beings of the chemicals
known as dioxins. The best-known dioxin is a contaminant of a
herbicide, but others occur in various chemicals that humans
manufacture. These chemicals include some paints and varnishes
and some oils used as lubricants in cutting tools.
Parts affected Chloracne is a serious skin rash that appears
on parts of the body that are exposed to dioxins or to many
other chemical compounds based on chlorine. The skin condition
appears as blackheads and pimples on those parts of the body
that have been exposed, usually the face and neck and bare
arms and hands.
Related symptoms Dioxins are considered among the most
dangerous chemicals because even tiny amounts kill many
different animals; effects on humans, other than inducing
chloracne, have been hard to establish. Limited statistical
evidence suggests that in humans dioxins may increase cancer
rates, especially for soft-tissue cancers, lymphomas, multiple
melanoma, or cancer of the liver or gallbladder.
Associations There are about 75 dioxins, which are produced at
high temperatures in various chemical processes. Therefore
they contaminate incinerator ashes as well as chlorine-based
chemicals manufactured using high temperatures, such as the
bleaches used in making white paper. The most famous dioxin,
however, is 2,3,7,8-TCDD, which is a contaminant of
insecticides and herbicides. It is the dioxin that
contaminated the Agent Orange herbicide used by American
soldiers to defoliate forests during the Vietnam War.
Many soldiers believe that their exposure to Agent Orange in
Vietnam later caused a variety of illnesses ranging from
cancer to low sperm count. The U.S. government has compensated
soldiers who were exposed to Agent Orange and who developed
any of the following disorders: chloracne; a kind of cancer
called a soft-tissue sarcoma; lymphoma (non-Hodgkin's or
Hodgkin's, two different varieties); or a rare skin disease
called porphyria cutanea tarda.
Prevention and possible actions Chloracne only occurs in
people who are exposed to chlorinated chemicals. Avoid contact
with pesticides completely and wash thoroughly soon after any
contact with liquid paints, varnishes, or cutting oils.