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Journal of the American Academy of Dermatology
Volume 74, n° 1
pages 143-170 (janvier 2016)
Doi : 10.1016/j.jaad.2015.05.006
accepted : 5 May 2015

Skin diseases associated with Agent Orange and other organochlorine exposures

Andrew T. Patterson, MD a, b, Benjamin H. Kaffenberger, MD a, , Richard A. Keller, MD c, Dirk M. Elston, MD d, e
a Division of Dermatology, Ohio State University College of Medicine, Columbus, Ohio 
b US Air Force, San Antonio Military Medical Center 
c Dermatology, Audie L. Murphy Veterans Hospital, San Antonio, US Air Force, San Antonio, Texas 
d Ackerman Academy of Dermatopathology 
e US Army (Retired) 

Reprint requests: Benjamin H. Kaffenberger, MD, Ohio State University Dermatology, 915 Olentangy River Road, Suite 4000, Columbus, OH 43212.

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.

The full text of this article is available in PDF format.

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.

© 2015  American Academy of Dermatology, Inc. All Rights Reserved.