Chloracne

Chloracne is the one human effect universally linked to dioxin exposure. The presence of chloracne is considered a clinical sign of exposure.

The 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)

Chloracne is an acne-like eruption of comedones, cysts, and postules that usually involve the malar area of the face. Cysts are frequently coalescent, and filled with straw colored fluid.

Note: 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.

 

What is chloracne?

Chloracne 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 Orange.

It 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.

What does chloracne look like and where does it appear?

The 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 the exposure.

Physicians, 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.

The 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.

Has chloracne been a problem for a large number of Vietnam veterans?

No, 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.

What did Public Law 102-4, the Agent Orange Act of 1991, do for Vietnam veterans with chloracne?

Section 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 agents.

In 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).

VA 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.

What 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?

The 832-page report included the following statements:

In summary, chloracne has been linked to TCDD exposure in numerous epidemiologic studies of occupationally and environmentally exposed populations. The data on Vietnam veterans potentially exposed to Agent Orange and other herbicides are less convincing

Evidence 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; cacodylic acid; and picloram) and chloracne

Because TCDD-associated chloracne becomes evident shortly after exposure, there is no risk of new cases occurring long after service in Vietnam.

What did the NAS conclude about chloracne in its 1996 update?

The NAS reviewers essentially reached the same conclusion in 1996 they had in the earlier report.

What should a Vietnam veteran do if he or she thinks his or her skin condition may be chloracne?

Contact 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 dioxin.

Chloracne: 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.