Agent Orange and Chloracne

What is chloracne?

Chloracne is a skin condition that looks like common forms of acne that affect teenagers. At present, chloracne is the only well established long-term effect of exposure to TCDD or dioxin, the contaminant found in one of the ingredients of Agent Orange.

It is important to note that skin disorders are among the most common health problems experienced by combat forces. Because of the environment and living conditions in Vietnam, veterans developed a variety of skin problems, ranging from bacterial and fungal infections to a condition known as “tropical acne.” However, the only skin disorder consistently reported to be associated with Agent Orange and other herbicides is chloracne.

What does chloracne look like and where does it appear?

Cloracne PhotosThe first sign of chloracne may be excessive oiliness of the skin. This is accompanied or followed by the appearance of numerous blackheads. In mild cases the blackheads may be limited to the area around the eyes extending along the temples to the ears. In more severe cases blackheads may appear in many places on the body, especially over the malar (or cheek bone) area, other facial areas, behind the ears, and along the arms. The blackheads are usually accompanied by fluid-filled cysts and by an increased or darker growth of body hair. The skin may become thicker and flake or peel. In severe cases, the acne may result in open sores and permanent scars. The condition fades slowly after exposure. Minor cases may disappear altogether, but more severe cases may persist for years after the exposure.

Physicians, even dermatologists, sometimes have difficulty in distinguishing chloracne from other more common skin disorders. While chloracne may be a sensitive indicator of exposure to dioxins in some people, it may not be in other individuals who had equal or greater exposure to dioxins. The absence of chloracne is not necessarily a reliable basis for concluding that a person has not been exposed to a chemical, which is known to cause chloracne.

Has chloracne been a problem for a large number of Vietnam veterans?

No, it has not. Of course, many veterans have complained of skin problems. Skin ailments are the most common medical problem in veteran and non-veteran populations. After traumatic injuries, skin disorders are among the most common health problems encountered in combat.

What did Public Law 102-4, the Agent Orange Act of 1991, do for Vietnam veterans with chloracne?

Section 2, Public Law 102-4, enacted February 6, 1991, established by statute the presumption of service connection for certain diseases -- including chloracne or another acne form disease consistent with chloracne manifested to a degree of disability of 10 percent or more within a year after military service in Vietnam -- associated with exposure to certain herbicide agents.

In July 1992, a proposed rule implementing the presumptions established by this law was published in the Federal Register for public comment. (See 57 Fed. Reg. 30707, July 10, 1992). In May 1993, the rule was finalized and published in the Federal Register. (See 58 Fed. Reg. 29107, May 19, 1993).

VA had recognized chloracne as service connected for Vietnam veterans based on exposure to Agent Orange for many years prior to the enactment of this legislation.

What did the National Academy of Sciences conclude about chloracne in its 1993 report, entitled Veterans and Agent Orange - Health Effects of Herbicides Used in Vietnam?

The 832-page report included the following statements:

In summary, chloracne has been linked to TCDD exposure in numerous epidemiologic studies of occupationally and environmentally exposed populations. The data on Vietnam veterans potentially exposed to Agent Orange and other herbicides are less convincing....

Evidence is sufficient to conclude that there is a positive association between exposure to herbicides (2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram) and chloracne....

Because TCDD-associated chloracne becomes evident shortly after exposure, there is no risk of new cases occurring long after service in Vietnam.

What did the NAS conclude about chloracne in its 1996 update?

The NAS reviewers essentially reached the same conclusion in 1996 they had in the earlier report.

What did the NAS conclude about chloracne in its 1998 update?

The NAS reviewers essentially reached the same conclusion as they had in the earlier reports.

The 1998 update included the following statements:

No new informative publications were identified that relate chloracne to exposure to herbicides or dioxin in humans. Because TCCD-associated chloracne becomes evident shortly after exposure, there is no risk that new cases will occur in veterans due to Vietnam service-related exposures…

Evidence is sufficient to conclude that there is a positive association between exposure to herbicides considered in this report and chloracne. The evidence regarding association is drawn from occupational and other studies in which subjects were exposed to a variety of herbicides and herbicide components.

What did the NAS conclude about chloracne in its 2000 update?

The 2000 Update included the following statements:

There is no change in the previous conclusion that there is sufficient and adequate evidence to conclude that chloracne is associated with exposure to herbicides and TCDD in particular. The fact that Ranch Hand veterans did not experience this condition does not change the overall conclusion.

What did the NAS conclude about chloracne in its 2002 update?

The 2002 update stated that there is sufficient evidence of an association between exposure...to the chemicals of interest and chloracne. Chloracne is associated with exposure to chemicals used in Vietnam, but it would appear shortly, not after a long period of time.

What should a Vietnam veteran do if he or she thinks his or her skin condition may be chloracne?

A great deal of information can be obtained at our website: www.va.gov/agentorange. Contact the nearest VA medical center for a medical examination and possible treatment and file a claim for disability compensation at the nearest VA medical center or regional office. For many years, VA has recognized chloracne as a service-connected disability based on the results of scientific research that links this condition with exposure to dioxin. For information about the VA examination and treatment programs, see Agent Orange Brief, B1 and B2. For information regarding disability compensation, see Agent Orange Brief, B3.

Where can a veteran obtain additional information about Agent Orange-related issues?

The following Agent Orange fact sheets (including the one you are reading) are available on the World Wide Web at www.va.gov/agentorange. Hard copies can be obtained from local VA medical centers or from the VA Central Office at the Environmental Agents Service (131), Department of Veterans Affairs, 810 Vermont Avenue, N.W., Washington, DC 20420. The briefs are A1 – General Information, A2 Class Action Lawsuit, B1 – Registry, B2 – Health Care Eligibility, B3 – VA Disability Compensation, B4 – VA Information on Agent Orange and Related Matters, C1 – Agent Orange - The Problems Encountered in Research, C2 – Agent Orange - Vietnam Related Research - VA Efforts, C3 – Agent Orange - Vietnam Related Research - Non-VA Efforts, D1 – Birth Defects, D2 – Chloracne, D3 – Non–Hodgkin’s Lymphoma, D4 – Soft Tissue Sarcomas, D5 - Peripheral Neuropathy, D6 – Hodgkin’s Disease, D7 – Porphyria Cutanea Tarda, D8 – Multiple Myeloma, D9 – Respiratory Cancers, D10 – Prostate Cancer, D11 – Spina Bifida, D12 – Diabetes and D13 - Chronic Lymphocytic Leukemia.

This fact sheet was prepared in late July 2003 and does not include any subsequent developments.