Ma Yan, Cao Xue, Zhang Li, Zhang Jin-Yu, Qiao Zu-Sha, Feng Wen-Li
Department of Dermatology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China.
World J Clin Cases. 2021 Feb 16;9(5):1079-1086. doi: 10.12998/wjcc.v9.i5.1079.
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.
氯痤疮是一种罕见的皮肤疾病，由全身暴露于卤代芳香化合物引起。氯痤疮的主要特征是黑头粉刺，严重时可伴有全身症状。3,5,6-三氯吡啶-2-醇钠（STCP）是生产毒死蜱和绿草定的必要前体化合物，它们分别广泛用作杀虫剂和除草剂。STCP也是一种与氯痤疮有关的氯酚。STCP中毒可导致轻度髓鞘损伤。我们在此报告3例因接触STCP而患氯痤疮的病例。
同一工作场所的3名年轻男性，年龄分别为29岁、33岁和26岁，出现多形性皮肤损害，主要特征为粉刺和囊肿，其中1例生殖器部位还有痤疮样损害。这些临床表现分别在他们接触STCP 3天、1周和2周后出现。其中，发生了多发性神经病和肝损伤。我们对这些患者进行了皮肤镜检查以及临床和实验室检查。此外，对病情严重的患者采用组织病理学进行进一步诊断。这些患者被诊断为氯痤疮，并脱离了STCP接触。给患者开了口服维胺酯胶囊、外用阿达帕林凝胶，并定期进行血液学检查以监测天冬氨酸转氨酶和血脂。他们仍在接受随访。2例患者未出现新的皮损，实验室检查恢复正常。丘疹原部位留有色素沉着和浅瘢痕。然而，病情最严重的患者仍间歇性出现新的丘疹。所有这些都提醒我们，STCP所致氯痤疮的治疗困难，我们应高度重视这种与神经病和氯痤疮相关的新化合物。
STCP正成为一种新的可诱发氯痤疮的化学产品，应引起所有医学专业人员尤其是皮肤科医生的关注。由于对这种新化学物质缺乏了解，氯痤疮不能及时得到诊断。氯痤疮仍值得我们关注。
