Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2021; 9(5): 1079-1086
Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1079
Neuropathy and chloracne induced by 3,5,6-trichloropyridin-2-ol sodium: Report of three cases
Yan Ma, Xue Cao, Li Zhang, Jin-Yu Zhang, Zu-Sha Qiao, Wen-Li Feng
Yan Ma, Xue Cao, Li Zhang, Jin-Yu Zhang, Zu-Sha Qiao, Wen-Li Feng, Department of Dermatology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Author contributions: Ma Y and Feng WL provided the concept for the study and drafted the manuscript; Zhang L and Cao X participated in collecting the data; Zhang JY and Qiao ZS provided the images; all authors have read and approved the content of the manuscript.
Informed consent statement: Informed consent was obtained from the patients for the publication of this case report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Li Feng, MSc, Doctor, Department of Dermatology, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan 030001, Shanxi Province, China. fengwenli@sxmu.edu.cn
Received: June 4, 2020
Peer-review started: June 4, 2020
First decision: November 30, 2020
Revised: December 13, 2020
Accepted: December 23, 2020
Article in press: December 23, 2020
Published online: February 16, 2021
Processing time: 234 Days and 21.3 Hours
Abstract
BACKGROUND

Chloracne is a rare skin condition that is caused by systemic exposure to halogenated aromatic compounds. The main characteristic of chloracne is blackhead, and in severe cases, it can be accompanied by systemic symptoms. Sodium 3,5,6-trichloropyridin-2-ol (STCP) is a necessary precursor compound for the production of chlorpyrifos and triclopyr, which are extensively used as a pesticide and herbicide, respectively. STCP is also a chlorophenol that has been associated with chloracne. STCP poisoning could induce mild myelin sheath damage. We herein report three cases with chloracne due to exposure to STCP.

CASE SUMMARY

Three young men, aged 29, 33, and 26 years, respectively, in the same workplace had polymorphic skin lesions, characterized mainly by comedones and cysts, and one of them also had acne like lesions in the genital area. These clinical manifestations appeared when they were exposed to STCP for 3 d, 1 wk, and 2 wk, respectively. Among them, polyneuropathy and liver damage occurred. We performed dermoscopy and clinical and laboratory tests on these patients. Additionally, histopathology was used for further diagnosis in the serious patient. These patients were diagnosed with chloracne and separated from STCP. The patients were prescribed oral viaminate capsules, topical adapalene gel, and regular hematologic follow-up for aspartate transaminase and lipids. They are still under follow-up. There was no new lesions and the laboratory tests returned to normal in two patients. Pigmentation and shallow scars remained in the original areas of papules. However, in the most serious patient, new papules still appeared intermittently. All these remind us that the treatment of chloracne caused by STCP is difficult, and we should attach great importance to this new compound related with the neuropathy and chloracne.

CONCLUSION

STCP is becoming a new chemical product to induce chloracne, which should attract the attention of all medical professionals, especially dermatologists. Due to the lack of knowledge on the new chemical, the diagnosis of chloracne cannot be made in time. Chloracne still deserves our attention.

Keywords: Chloracne; 3,5,6-Trichloropyridin-2-ol sodium; Skin disease; Industrial accidents; Case report

Core Tip: Chloracne, an acneiform eruption resulting from poisoning by halogenated aromatic compounds, is a rare clinical disease with systemic effects in severe instances. In recent years, new chloracnegens are emerging with the increasing number of new chemical compounds. Chloracne is on the rise again, and it is often misdiagnosed and missed, and cannot be treated. We report three cases of chloracne patients who were delayed due to not getting a correct diagnosis in time, which reminds us to be alert to the emergence of chloracne induced by sodium 3,5,6-trichloropyridin-2-ol.