Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(3):e2022128 1

Dermatology Practical & Conceptual

An Exuberant Case of Retentional Acne: Chloracne
Philippe Visintainer Melo1, Gabriela Fortes Escobar1 

1 Department of Dermatology, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil

Citation: Visintainer Melo P, Fortes Escobar G. An exuberant case of retentional acne: Chloracne. Dermatol Pract Concept. 2022;12(3):e2022128.  
DOI: https://doi.org/10.5826/dpc.1203a128

Accepted: November 15, 2021; Published: July 2022

Copyright: ©2022 Melo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: Both authors have contributed significantly to this publication

Corresponding author: Philippe Visintainer Melo, MD, Ramiro Barcelos street, number 2350, 1st floor, Dermatology Department – Porto 
Alegre, Rio Grande do Sul, Brazil- 90035-903. E-mail: phvisintainer@gmail.com

Case Presentation 

A 39-year-old woman presented with an 11-year history of 

facial lesions. She had worked on tobacco, corn and bean 

plantings for 23 years, having contact with multiple pesti-

cides. Physical examination showed open comedones and 

cysts, predominating on the malar region, over a grayish 

background (Figure 1, A and B). Her family history revealed 

2sisters with similar lesions, who had also worked in agricul-

ture, while four other sisters without contact with pesticides, 

had no skin lesions. Laboratory exams were normal and skin 

biopsy showed diffuse hyperkeratosis and infundibular dil-

atation, with sebaceous gland disappearance (Figure 1C). At 

the moment, the patient is using isotretion 40 mg/day with 

a partial response, mostly on the open comedones. Further-

more, manual extraction of the larger retentional lesions was 

associated and she remains under follow-up.

Teaching Point

Chloracne is an acneiform eruption caused by the ingestion, 

inhalation or transcutaneous penetration of halogenated ar-

omatic hydrocarbons [1]. These compounds induce hyper-

keratinization of keratinocytes, transformation of sebocytes 

to a keratinocytic phenotype and increase melanogenesis 

[2]. Most importantly, the sudden onset of a large number 

of acneiform lesions in the same household should lead the 

physician to consider chloracne.



2 Image Letter | Dermatol Pract Concept. 2022;12(3):e2022128

Figure 1. (A and B) Numerous open comedones and cysts over a light grayish background, predominating on the malar region. (C) Histopa-

thology showing infundibular dilatation, diffuse hyperkeratosis and absence of sebaceous gland (H&E, x40).

References

1. Chessa MA, La Placa M, Patrizi A, et al. Six cases of chloracne 

in Italy: the success of combined therapy. J Eur Acad Dermatol  

Venereol. 2021;35(2):e108-e111. DOI: 10.1111/jdv.16835. 

PMID: 32706914.

2. Furue M, Tsuji G. Chloracne and Hyperpigmentation Caused by 

Exposure to Hazardous Aryl Hydrocarbon Receptor Ligands. Int 

J Environ Res Public Health. 2019;16(23):4864. DOI: 10.3390/

ijerph16234864. PMID: 31816860. PMCID: PMC6926551.

A B C