10.5826/dpc.1203a128
text/xml
2160-9381
1919
en
Gabriela Fortes Escobar
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
facial lesions
An Exuberant Case of Retentional Acne: Chloracne
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2022-07-28
2021-07-27
2022-07-28
2023-06-06
e2022128
Dermatol Pract Concept
Gabriela Fortes Escobar
2022/07/28
10.5826/dpc.1203a128
e2022128
Department of Dermatology, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
2160-9381
facial lesions
en
e2022128
Furue M, Tsuji G. Chloracne and Hyperpigmentation Caused by Exposure to Hazardous Aryl Hydrocarbon Receptor Ligands. Int J Environ Res Public Health. 2019;16(23):4864. DOI: 10.3390/ijerph16234864. PMID: 31816860. PMCID: PMC6926551.
An Exuberant Case of Retentional Acne: Chloracne
https://dpcj.org/index.php/dpc/article/download/1919/1678
                    Dermatology Practical & Conceptual


  An Exuberant Case of Retentional Acne: Chloracne
                               Philippe Visintainer Melo1, Gabriela Fortes Escobar1


1 Department of Dermatology, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil



Citation: Visintainer Melo P, Fortes Escobar G. An exuberant case of retentional acne: Chloracne. Dermatol Pract Concept. 2022;12(3):e2022128.
DOI: https://doi.org/10.5826/dpc.1203a128
Accepted: November 15, 2021; Published: July 2022
Copyright: ©2022 Melo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: Both authors have contributed significantly to this publication
Corresponding author: Philippe Visintainer Melo, MD, Ramiro Barcelos street, number 2350, 1st floor, Dermatology Department – Porto
Alegre, Rio Grande do Sul, Brazil- 90035-903. E-mail: phvisintainer@gmail.com




Case Presentation                                                        a partial response, mostly on the open comedones. Further-
                                                                         more, manual extraction of the larger retentional lesions was
A 39-year-old woman presented with an 11-year history of                 associated and she remains under follow-up.
facial lesions. She had worked on tobacco, corn and bean
plantings for 23 years, having contact with multiple pesti-              Teaching Point
cides. Physical examination showed open comedones and
cysts, predominating on the malar region, over a grayish                 Chloracne is an acneiform eruption caused by the ingestion,
background (Figure 1, A and B). Her family history revealed              inhalation or transcutaneous penetration of halogenated ar-
2sisters with similar lesions, who had also worked in agricul-           omatic hydrocarbons [1]. These compounds induce hyper-
ture, while four other sisters without contact with pesticides,          keratinization of keratinocytes, transformation of sebocytes
had no skin lesions. Laboratory exams were normal and skin               to a keratinocytic phenotype and increase melanogenesis
biopsy showed diffuse hyperkeratosis and infundibular dil-               [2]. Most importantly, the sudden onset of a large number
atation, with sebaceous gland disappearance (Figure 1C). At              of acneiform lesions in the same household should lead the
the moment, the patient is using isotretion 40 mg/day with               physician to consider chloracne.




Image Letter | Dermatol Pract Concept. 2022;12(3):e2022128                                                                                  1
A                                           B                                            C




Figure 1. (A and B) Numerous open comedones and cysts over a light grayish background, predominating on the malar region. (C) Histopa-
thology showing infundibular dilatation, diffuse hyperkeratosis and absence of sebaceous gland (H&E, x40).



References                                                            2. Furue M, Tsuji G. Chloracne and Hyperpigmentation Caused by
                                                                         Exposure to Hazardous Aryl Hydrocarbon Receptor Ligands. Int
 1. Chessa MA, La Placa M, Patrizi A, et al. Six cases of chloracne      J Environ Res Public Health. 2019;16(23):4864. DOI: 10.3390/
    in Italy: the success of combined therapy. J Eur Acad Dermatol       ijerph16234864. PMID: 31816860. PMCID: PMC6926551.
    Venereol. 2021;35(2):e108-e111. DOI: 10.1111/jdv.16835.
    PMID: 32706914.




2                                                                           Image Letter | Dermatol Pract Concept. 2022;12(3):e2022128
