title: Skin diseases associated with Agent Orange and other organochlorine exposures.
abstract: 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.
authors.affiliation: Division of Dermatology, Ohio State University College of Medicine, Columbus, Ohio; US Air Force, San Antonio Military Medical Center.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Patterson
authors.affiliation: Division of Dermatology, Ohio State University College of Medicine, Columbus, Ohio. Electronic address: Benjamin.Kaffenberger@osumc.edu.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Kaffenberger
authors.affiliation: Dermatology, Audie L. Murphy Veterans Hospital, San Antonio, US Air Force, San Antonio, Texas.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Keller
authors.affiliation: Ackerman Academy of Dermatopathology; US Army (Retired).
authors.forename: Dirk M
authors.initials: DM
authors.lastname: Elston
mesh_terms: D015085:2,4,5-Trichlorophenoxyacetic Acid / Q000009:adverse effects*; D015084:2,4-Dichlorophenoxyacetic Acid / Q000009:adverse effects*; D000075182:Agent Orange; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006843:Hydrocarbons, Chlorinated / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008889:Military Personnel; D000072317:Polychlorinated Dibenzodioxins / Q000009:adverse effects*; D018570:Risk Assessment; D012871:Skin Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D014481:United States; D014744:Vietnam
chemical_list: D006843:Hydrocarbons, Chlorinated; D000072317:Polychlorinated Dibenzodioxins; D015084:2,4-Dichlorophenoxyacetic Acid; D000075182:Agent Orange; D015085:2,4,5-Trichlorophenoxyacetic Acid
keywords: 2,3,7,8-tetrachlorodibenzo-p-dioxin; Agent Orange; Vietnam; chloracne; dioxin exposure; organochlorine; skin disease; veteran