Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1079
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
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.
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.
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.
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.