Organochlorine exposure is an important cause of cutaneous and systemic toxicity. Exposure has been associated with industrial accidents, intentional poisoning, and the use of defoliants, such as Agent Orange in the Vietnam War. Although long-term health effects are systematically reviewed by the Institute of Medicine, skin diseases are not comprehensively assessed. This represents an important practice gap as patients can present with cutaneous findings. This article provides a systematic review of the cutaneous manifestations of known mass organochlorine exposures in military and industrial settings with the goal of providing clinically useful recommendations for dermatologists seeing patients inquiring about organochlorine effects. Patients with a new diagnosis of chloracne, porphyria cutanea tarda, cutaneous lymphomas (non-Hodgkin lymphoma), and soft-tissue sarcomas including dermatofibrosarcoma protuberans and leiomyosarcomas should be screened for a history of Vietnam service or industrial exposure. Inconclusive evidence exists for an increased risk of other skin diseases in Vietnam veterans exposed to Agent Orange including benign fatty tumors, melanomas, nonmelanoma skin cancers, milia, eczema, dyschromias, disturbance of skin sensation, and rashes not otherwise specified. Affected veterans should be informed of the uncertain data in those cases. Referral to Department of Veterans Affairs for disability assessment is indicated for conditions with established associations.Le texte complet de cet article est disponible en PDF.
Key words : Agent Orange, chloracne, dioxin exposure, organochlorine, skin disease, veteran, Vietnam, 2,3,7,8-tetrachlorodibenzo-p-dioxin
Abbreviations used : AFHS, CDC, NMSC, ORH, PCT, TCDD, VA
| Funding sources: None.
| Disclosure: Dr Keller is a full-time employee of the US Department of Veterans Affairs. Dr Patterson is employed as an active duty member of the US Air Force. Drs Kaffenberger and Elston have no conflicts of interest to declare.
| The contents of this article represent the authors' views and opinions, but do not represent the views or policy of the US Department of Veterans Affairs or the US Armed Forces.