Chloracne: a case series on cutaneous expression of CYP1A1 as diagnostic biomarker.

none12siChloracne, also known as metabolizing acquired dioxin-induced skin hamartomas (MADISH), is a rare disfiguring disease related to dioxin exposure. There is a paucity of literature on the clinical manifestations and pathogenesis of chloracne/MADISH. The aim of this study was to assess the clinical features of this very unusual acneiform eruption and to explore the pathogenesis of the disease. This was a retrospective, observational report study was conducted on five patients belonging to the same nuclear family (father, mother and three children) and a relative (father's brother) living in the same house. Histopathological, immunohistochemical, laboratory and toxicological analyses were performed for all patients. The results suggest that CYP1A1 in human skin is a diagnostic biomarker in chloracne, and was positive for all the patients in our sample. Tetrachlorodibenzo-p-dioxin is the most investigated dioxin responsible for chloracne; however, several other agonists, whether dioxin-like or not, can activate the aryl hydrocarbon receptor. To our knowledge, this Italian case series is the first study to suggest polychlorinated biphenyls as a possible cause of an overstimulation of aryl hydrocarbons causing the consequent acneiform eruption.openChessa MA, La Placa M, Patrizi A, Virdi A, Misciali C, Fedrizzi G, Filippi F, Saurat JH, Sorg O, Fontao F, Kaya G, Neri I.Chessa MA, La Placa M, Patrizi A, Virdi A, Misciali C, Fedrizzi G, Filippi F, Saurat JH, Sorg O, Fontao F, Kaya G, Neri I