Chloracne
| Classification according to ICD-10 | |
|---|---|
| L24.2 | Toxic contact dermatitis from solvent chlorine compound |
| ICD-10 online (WHO version 2019) | |
The chloracne (also Chlorarylakne ) is a subtype of Venenata Acne .
causes
Chloracne is a symptom of poisoning by chlorinated hydrocarbons such as chloronaphthalenes , chlorophenol / pentachlorophenol or polychlorinated dibenzodioxins and dibenzofurans . Acne-typical lesions can develop after direct skin contact, orally administered or inhaled as vapor . The skin changes occur particularly on the face and on parts of the body that come into contact with the chlorine compounds.
distribution
Chlorine acne occurs primarily in workers in the electrical and chemical industries (the so-called perna's disease caused by perchlorinated naphthalenes ), when handling wood preservatives containing pentachlorophenol , and after technical incidents. Chemical accidents can also be the trigger for chloracne.
Symptoms and ailments
The symptoms are characterized by follicular hyperkeratoses , i.e. thickening of the horny layer in the hair follicles, comedones or also nodes , abscesses or cysts .
Consequences and complications
Larger inflammatory lesions such as lumps, abscesses, and cysts can leave scars after they heal .
Changes to the internal organs and the central nervous system that are typical of poisoning can impair physical functions and possibly lead to death, e.g. B. from cancer .
treatment
Chloracne must be viewed as a chronic disease, as it often takes years, if at all, to heal. The treatment of chloracne is similar to the treatment of normal acne , u. a. with the administration of retinoids , with inflammatory processes with anti-inflammatory agents and later with cold therapy . Plastic procedures such as dermabrasion (skin removal) or peeling are also used for treatment.
history
The term chloracne was coined by Karl Herxheimer based on the well-known bromine or iodine acne . He had examined workers who were employed by Griesheim-Elektron in the chlor-alkali electrolysis plant and who had severe acne. A new process was introduced there in 1890 in which chlorine deposited on carbon anodes . As is known today, polychlorinated dibenzodioxins and dibenzofurans were also formed. Herxheimer assumed that chlorine itself was the cause of this disease. Soon, however, chlorinated tar derivatives were suspected of causing chloracne. The digestive system was recognized as the route of absorption, but feeding laboratory animals with chlorinated tar derivatives did not lead to chloracne, but to unspecific poisoning. Karl Bernhard Lehmann recommended that only workers with “resistant” skin be employed. In addition, there were occupational safety measures such as changing work clothes, showering or ventilating the work rooms. After a change in the procedure for chlor-alkali electrolysis, the cases of chloracne suddenly disappeared in 1905.
During the First World War , many workers who made filters for gas masks developed symptoms similar to chloracne. The filter material was soaked with perchlorinated naphthalenes , hence the name Perna disease . Exhaust gases and dusts during production were finally discharged into the open air through extraction systems, but this made the cattle on the surrounding pastures sick. After the war, perchlorinated naphthalenes were used in the manufacture of detonators for mining, and there were cases of illness here too, especially since the companies had not been informed about the dangers. The Prussian state medical doctor Ludwig Teleky recognized in 1927 that the danger of chlorinated naphthalenes increased with the degree of chlorination and called for the use of chlorinated hydrocarbons to be abandoned in the manufacture of detonators. Nonetheless, the demand for chlorinated naphthalenes continued to grow, especially in the manufacture of new types of consumer goods such as radios . In the USA in 1936 it could be proven that the yellow liver atrophy was due to these substances. During the Second World War , perchlorinated naphthalenes were used in the USA to protect ships against magnetic mines . Because of the damage to health, the shipyard workers had to be forced to their workplaces.
After World War II , there were some accidents in the production of chlorophenols that resulted in chloracne in workers. At Boehringer in Hamburg, all employees in the trichlorophenol manufacture fell ill with chloracne in 1954 . Shortly beforehand, the manufacturing process had been converted to the so-called "pressure phenol process". At the dermatology clinic of the University Medical Center Hamburg-Eppendorf , the assistant doctor Karl-Heinz Schulz tried unsuccessfully to narrow down the causative substance with the help of the rabbit ear test. When in 1956 Wilhelm Sandermann, Hans Stockmann and Reinhard Casten at the Institute for Wood Chemistry at the Federal Research Center for Forestry and Wood Management in Reinbek near Hamburg synthesized 2,3,7,8-tetrachlorodibenzodioxin (TCDD) for the first time , Sandermann and a laboratory assistant also developed chlorine acne. Through further tests by Schulz and Boehringer employees, TCDD was clearly identified as the trigger for chloracne in the manufacture of trichlorophenol. In 1957, Boehringer switched chlorophenol production to the “low-temperature process”, which produces significantly less dioxin. This finding was not made public, but Boehringer advised other chemical companies of the benefits of the new process.
According to the official count, 187 children developed chloracne after the Seveso accident in 1976. The cases of the disease occurred in several waves. It could not be clarified whether children react more sensitively than adults to dioxins or whether there are specific routes of absorption for them, for example via playgrounds. The population of the affected areas was screened for chloracne in three screenings. After about two years, the proportion of chloracne cases in Seveso was no longer noticeable. It took ten years or more for the severe cases of chloracne to heal.
A poison attack with 2,3,7,8-tetrachlorodibenzodioxin was carried out on the Ukrainian politician Viktor Yushchenko in September 2004, which caused him to suffer from chlorine acne.
Individual evidence
- ↑ Karl Herxheimer: About chloracne . Münchner Medicinische Wochenschrift 46, p. 278, 1899, quoted from Böschen: Riskogenesis - Processes of Societal Risk Perception , 2003, pp. 196–197
- ↑ a b c Stefan Böschen: Riskogenesis - Processes of Societal Risk Perception: CFC, DDT, Dioxin and Ecological Chemistry . Leske + Budrich, Opladen, 2003, p. 196, ISBN 3-8100-2691-3
