Neuropathy and chloracne induced by 3,5,6-trichloropyridin-2-ol sodium:Report of three cases

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.

Agent Orange Chemical Plant Locations in the United States and Canada: Environmental and Human Health Impacts

During the Vietnam War, millions of liters of six tactical herbicides were sprayed on the southern Vietnam landscape to defoliate forests, to clear military perimeters and to destroy enemy food supplies. The environmental and human health impacts of spraying these herbicides, especially Agent Orange and those formulated with mixtures that included 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) which was contaminated with 2,3,7,8-tetracholorodibenzo-p-dioxin (TCDD) have been documented over the last 60 years. The dioxin TCDD clean-up efforts at former military bases and other Vietnam hotspots are ongoing. However, the lesser-told story was the environmental and human health impacts on the communities and chemical plant workers who manufactured Agent Orange and other herbicides that became contaminated with dioxin TCDD in the manufacturing processes at seven locations in the United States and one site in Canada. The pollution at these chemical plant sites, adjacent rivers and groundwater is well known within each affected state or province but not widely recognized beyond their localities. In this paper we assess the national long-term effects on land, groundwater and river resources where Agent Orange and other agricultural herbicides containing 2,4,5-T with unknown amounts of dioxin TCDD were manufactured, transported, and temporarily stored. The sites where residual tactical herbicides with contaminated by-products were applied to public lands or disposed of by military and civilian workers within the United States and Canada are identified. After 60 years, these communities are still paying the price for the U.S. Government, DOD and USDA decisions to provide and use agricultural herbicides as tactical chemical weapons during the Vietnam War (1962-1971). There have been human health issues associated with the chemical manufacture, transport, storage and disposal of these herbicides related to workers who moved these chemical weapons from United States and Canada to SE Asia. Most of these dioxin contaminated tactical herbicides were transported via railroads to ports at Mobile, Alabama and Gulfport, Mississippi. They were then loaded on ocean-going ships and transported via the Panama Canal for use during the Vietnam War. The objective of this study is to document the environmental and human consequences of the manufacture of tactical herbicides with dioxin TCDD and arsenic on the chemical plant, transportation, application, storage and disposal workers. The costs of cleanup of these North America chemical plant sites, transportation corridors, temporary and long-term storage areas, supply chain storage facilities with residual tactical herbicide, application, and disposal sites to date, is in the billions of dollars. Billions have been spent on hazardous waste incineration to destroy the dioxin TCDD or bury it in certified landfills. Government mandated environmental covenants are on titles of properties still contaminated with high levels of dioxin TCDD. If landowners attempt to rescind land use restrictions, many more billions of dollars will be needed to finish the environmental cleanup and restore natural resources. These cost estimates do not include the billions of dollars needed to treat the effects of dioxin TCDD exposure of U.S. and Canadian civilian workers who manufactured and handled these contaminated herbicides during the Vietnam War as well as address human health issues of their offspring.