Chloracne: Still Cause for Concern

Familial comedones is a rare autosomal dominant disorder characterized by thousands of comedones developing in teens. Some pits or inflammatory lesions may coexist. Only 32 patients from three families have previously been reported. We report herein 12 cases in two unrelated families with familial comedones. Clinical manifestations among members in the same family vastly vary from scattered comedones on the face, trunk, upper and lower extremities to generalized thousands of open comedones, a large number of skin pits and acneiform inflammatory lesions over the entire body. Additionally, multiple severe purulent nodules and abscesses that leave unsightly scars similar to those of hidradenitis suppurativa are observed. Lesions of long-standing inflammation in two patients had developed into squamous cell carcinoma with a poor prognosis. The phenotypic spectrum of familial comedones varies to a large degree. Most importantly, there is potential for some long-standing inflammatory lesions to develop into squamous cell carcinoma. Extra vigilance in surveillance and prompt treatment for such lesions are recommended.

Section: Discussionmentioning

confidence: 99%

Expanding Phenotypic Spectrum of Familial Comedones

Rerknimitr¹,

Korkij²,

Wititsuwannakul³

et al. 2014

“…The key histological pattern indicating AhR activation includes (i) disappearance of the sebaceous glands (fully seen in major AhR agonist exposure, and a reduction in milder exposure) and (ii) epidermal cysts with mantle-like epithelial projections [11,13,14,15]. Consensus amongst dermatopathologists in weighing these signs in mild cases is in progress.…”

Section: Introductionmentioning

confidence: 99%

Aryl Hydrocarbon Receptor Activation in Acne Vulgaris Skin: A Case Series from the Region of Naples, Italy

Fabbrocini

Kaya²,

Silverio³

et al. 2015

Background: Dioxins are persistent organic pollutants present in the environment. They exert their biological effects by binding to an intracellular receptor, the aryl hydrocarbon receptor (AhR). Activation of AhR leads to the induction of cytochrome p450 1A1 (CYP1A1). Expression of CYP1A1 in human skin is a key marker for AhR activation, and it may induce comedogenesis resulting in acne-like lesions known as chloracne/metabolising acquired dioxin-induced skin hamartomas (MADISH). The contribution of this pathway in patients seen in a busy acne clinic is unknown. Materials and Methods: We explored the expression of CYP1A1 by immunohistochemistry in the acne lesions of 16 patients living in the region of Naples, Italy, where epidemiological studies have suggested a possibly increased exposure to environmental dioxins. A composite score to outline potential components of the chloracne/MADISH histological pattern was used. Results: CYP1A1 expression was observed in 11 lesions (69%) and was distributed in sebaceous glands, follicular epithelium, cystic wall and endothelial cells. The histological score for chloracne/MADISH was ‘likely' in 3 cases and ‘possible' in 11 cases. Compared to current data on CYP1A1 expression in the skin of 67 patients with proven exposure to AhR agonists, these data indicate a high incidence of AhR activation in this series. Conclusion: This is the first study analysing AhR activation in skin in a series of patients from a hospital-based acne clinic. It provides information for future controlled prospective studies. The significance of CYP1A1 expression in terms of AhR ligand exposure is discussed.

“…In MADISH, the clinical tableau is led by comedo-like lesions with a histology showing the disappearance of the sebaceous glands and the formation of epidermal cysts [9,10]. These latter pathological features have not been identified in our patients because of the lack of skin biopsies.…”

Section: Discussionmentioning

confidence: 94%

Exogenous Inflammatory Acne due to Combined Application of Cosmetic and Facial Rubbing

Sénéschal

Kubica²,

Boursault³

et al. 2012

Background: Exogenous acne refers to acneiform lesions due to external factors such as cosmetic agents, exposure to various oils, skin rubbing or friction or chloracne, now better called metabolizing acquired dioxin-induced skin hamartoma (MADISH). Here we report a new form of severe inflammatory exogenous acne due to the association of two factors: facial friction with cosmetic agents. Observations: A 15-, 17- and 19-year-old female presented at the department with severe inflammatory acne. In all cases, the face had been strongly rubbed in a compulsory manner in the previous weeks with cosmetic agents. The disease has not responded to various conventional acne treatments and was well controlled by a combination of oral corticosteroids and low-dose isotretinoin. Conclusion: Because cosmetic face friction as a cosmetic care becomes more and more fashionable, dermatologists should be aware of this severe clinical condition, which can occur in patients without a personal history of acne.