Tobacco Smoke and Chloracne: An Old Story Comes to Light

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(1)Article. Tobacco Smoke and Chloracne: An Old Story Comes to Light. SORG, Olivier. Reference SORG, Olivier. Tobacco Smoke and Chloracne: An Old Story Comes to Light. Dermatology, 2015, vol. 231, no. 4, p. 297-297. DOI : 10.1159/000439250 PMID : 26382236. Available at: http://archive-ouverte.unige.ch/unige:136346 Disclaimer: layout of this document may differ from the published version..

(2) Commentary Received: August 5, 2015 Accepted: August 5, 2015 Published online: September 19, 2015. Dermatology 2015;231:297 DOI: 10.1159/000439250. Tobacco Smoke and Chloracne: An Old Story Comes to Light Olivier Sorg Swiss Center for Applied Human Toxicology, University of Geneva, Geneva, Switzerland. In this issue of Dermatology, Patterson et al. [1] report the formation of localised open comedones following occluded cigarette smoke exposure near the nasal cavity due to infrequently changed gauze following rhinectomy. A relationship between cigarette smoke and acne is frequently observed; however, its mechanism of action is still not well understood. Although acne is a very common skin condition, its aetiology remains somewhat elusive, and the sequence of events leading to acne lesions has to be revisited, an idea developed by Saurat [2] in a recent review. There are various forms of acne, and so different sequences of events are likely. A severe form of acne, known as ‘chloracne’ and leading to the formation of metabolising acquired dioxin-induced skin hamartoma (MADISH) [3, 4], is clearly associated with the exposure of chemicals such as polychlorinated dibenzodioxins and dibenzofurans [5–7], and does not require the presence of Propionibacterium acnes [8]. The main feature of these chemicals is the activation of aromatic hydrocarbon re-. ceptor (AhR). Cigarette smoke contains various polycyclic aromatic hydrocarbons (PAH) such as naphthalene, anthracene or benzo(a)pyrene, some of which are relatively potent AhR agonists, and yields a concentration of approximately 1,500 ng PAH per cigarette [9]. Given the high potency of certain of these PAH and the number of cigarettes smoked daily, it seems reasonable to state that many smokers have a permanent activation of the AhR signalling pathway in their skin. Such a strong and sustained activation of this pathway may be able to alter the differentiation of sebaceous gland progenitor cells (Lrig1 cells?) towards an epithelial type, leading to MADISH formation at the expense of sebogenesis [3, 10], an event described as ‘the comedone switch’ and which is a hallmark of MADISH development [2, 4]. The case reported by Patterson et al. [1] describes a very unusual situation where the contact of cigarette smoke to the skin is maintained in a local area under occlusion over a long period of time, and comedones appear precisely in this area.. 4 Saurat JH, Sorg O: Chloracne, a misnomer and its implications. Dermatology 2010;221:23–26. 5 Tindall JP: Chloracne and chloracnegens. J Am Acad Dermatol 1985;13:539–558. 6 Panteleyev AA, Bickers DR: Dioxin-induced chloracne – reconstructing the cellular and molecular mechanisms of a classic environmental disease. Exp Dermatol 2006; 15: 705– 730. 7 Suskind RR: Chloracne, ‘the hallmark of dioxin intoxication’. Scand J Work Environ Health 1985;11:165–171. 8 Shaheen B, Gonzalez M: Acne sans P. acnes. J Eur Acad Dermatol Venereol 2013;27:1–10.. © 2015 S. Karger AG, Basel 1018–8665/15/2314–0297$39.50/0 E-Mail karger@karger.com www.karger.com/drm. 9 Machala M, Vondracek J, Blaha L, Ciganek M, Neca JV: Aryl hydrocarbon receptor-mediated activity of mutagenic polycyclic aromatic hydrocarbons determined using in vitro reporter gene assay. Mutat Res 2001;497: 49–62. 10 Schäfer M, Willrodt AH, Kurinna S, Link AS, Farwanah H, Geusau A, Gruber F, Sorg O, Huebner AJ, Roop DR, Sandhoff K, Saurat JH, Tschachler E, Schneider MR, Langbein L, Bloch W, Beer HD, Werner S: Activation of Nrf2 in keratinocytes causes chloracne (MADISH)-like skin disease in mice. EMBO Mol Med 2014;6:442–457.. Dr. Olivier Sorg Swiss Center for Applied Human Toxicology University of Geneva CH–1211 Geneva 14 (Switzerland) E-Mail olivier.sorg @ unige.ch. Downloaded by: Université de Genève 198.143.58.65 - 11/27/2015 4:40:33 PM. References 1 Patterson AT, Tian FT, Elston DM, Kaffenberger BH: Occluded cigarette smoke exposure causing localized chloracne-1 like comedones. Dermatology 2015; 231: 322–325. 2 Saurat JH: Strategic targets in acne: the comedone switch in question. Dermatology 2015; 231:105–111. 3 Saurat JH, Kaya G, Saxer-Sekulic N, Pardo B, Becker M, Fontao L, Mottu F, Carraux P, Pham X, Barde C, Fontao F, Zennegg M, Schmid P, Schaad O, Descombes P, Sorg O: The cutaneous lesions of dioxin exposure: lessons from the poisoning of V. Yushchenko. Toxicol Sci 2012;125:310–317..

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