Chloracne associated with employment in the production of pentachlorophenol

Mortality of US pentachlorophenol production workers through 2005

A cohort of 2122 US pentachlorophenol (PCP) production workers from four plants in the National Institute for Occupational Safety and Health Dioxin Registry was exposed to PCP and to polychlorinated dibenzo-p-dioxin and dibenzofuran contaminants of PCP production. A subcohort of 720 was also exposed to 2,3,7,8-tetrachlorodibenzodioxin, a contaminant of trichlorophenol (TCP) while using TCP or a TCP derivative. PCP and several production contaminants have been implicated as animal carcinogens. A priori hypotheses were that the cohort would have elevated standardized mortality ratios (SMRs) for aplastic anemia, soft-tissue sarcoma, and non-Hodgkin lymphoma, as suggested by human studies, and for leukemia and liver, adrenal, thyroid, and parathyroid cancer, as suggested by animal studies. From 1940 to 2005 1165 deaths occurred with an overall SMR of 1.01 [95% confidence limits (CI), 0.95-1.07]. Overall cancer mortality (326 deaths, SMR 1.17, CI 1.05-1.31) was in statistically significant excess. There were excess deaths for trachea, bronchus and lung cancers (126 deaths, SMR 1.36, CI 1.13-1.62), non-Hodgkin lymphoma (17 deaths, SMR 1.77, CI 1.03-2.84), chronic obstructive pulmonary disease (63 deaths, SMR 1.38, CI 1.06-1.77), and medical complications (5 deaths, SMR 3.52, CI 1.14-8.22). In race- and sex-specific analyses, white males had increased non-Hodgkin lymphoma mortality (17 deaths, SMR 1.98, CI 1.15-3.17) and males of other races had increased leukemia mortality (four deaths, SMR 4.57, CI 1.25-11.7). The excess of cancers of a priori interest, non-Hodgkin lymphoma and leukemia, provide some support for the carcinogenicity of PCP, however, further studies with more detailed exposure assessment are needed.

Pentachlorophenol and other chlorinated phenols are substrates for human hydroxysteroid sulfotransferase hSULT2A1

Pentachlorophenol (PCP) is a persistent chemical contaminant that has been extensively investigated in terms of its toxicology and metabolism. Similar to PCP, other chlorinated phenol derivatives are also widely present in the environment from various sources. Even though some of the chlorine-substituted phenols, and particularly PCP, are well-known inhibitors of phenol sulfotransferases (SULTs), these compounds have been shown to undergo sulfation in humans. To investigate the enzymatic basis for sulfation of PCP in humans, we have studied the potential for PCP as well as the mono-, di-, tri-, and tetra-chlorinated phenols to serve as substrates for human hydroxysteroid sulfotransferase, hSULT2A1. Our results show that all of these compounds are substrates for this isoform of sulfotransferase, and the highest rates of sulfation are obtained with PCP, trichlorophenols, and tetrachlorophenols. Much lower rates of sulfation were obtained with isomers of monochlorophenol and dichlorophenol as substrates for hSULT2A1. Thus, the sulfation of polychlorinated phenols catalyzed by hSULT2A1 may be a significant component of their metabolism in humans.

Pentachlorophenol Poisoning

Despite being banned in many countries and having its use severely restricted in others, pentachlorophenol (PCP) remains an important pesticide from a toxicological perspective. It is a stable and persistent compound. In humans it is readily absorbed by ingestion and inhalation but is less well absorbed dermally. Its distribution is limited, its metabolism extensive and it is eliminated only slowly. Assessment of the toxicity of PCP is confounded by the presence of contaminants known to cause effects identical to those attributed to PCP. However, severe exposure by any route may result in an acute and occasionally fatal illness that bears all the hallmarks of being mediated by uncoupling of oxidative phosphorylation. Tachycardia, tachypnoea, sweating, altered consciousness, hyperthermia, convulsions and early onset of marked rigor (if death occurs) are the most notable features. Pulmonary oedema, intravascular haemolysis, pancreatitis, jaundice and acute renal failure have been reported. There is no antidote and no adequate data to support the use of repeat-dose oral cholestyramine, forced diuresis or urine alkalinisation as effective methods of enhancing PCP elimination in poisoned humans. Supportive care and vigorous management of hyperthermia should produce a satisfactory outcome. Chronic occupational exposure to PCP may produce a syndrome similar to acute systemic poisoning, together with conjunctivitis and irritation of the upper respiratory and oral mucosae. Long-term exposure has also been reported to result in chronic fatigue or neuropsychiatric features in combination with skin infections (including chloracne), chronic respiratory symptoms, neuralgic pains in the legs, and impaired fertility and hypothyroidism secondary to endocrine disruption. PCP is a weak mutagen but the available data for humans are insufficient to classify it more strongly than as a probable carcinogen.

Effects of pentachlorophenol (PCP) on the pituitary and thyroidal hormone regulation in the rat

Investigations on rats after repeated application of pentachlorophenol (PCP) should clarify whether thyroid side effects caused by this xenobiotic can be seen in a dose range which does not cause major toxic effects. Female rats of the Wistar strain were treated with 3 and 30 mg PCP/kg body wt. daily by gavage for 28 days. To assess the potential impact of impurities the study was performed both with pure and technical grade PCP at the dosage of 3 mg.kg-1.day-1, and at a level of 30 mg.kg-1.day-1 with pure PCP only. The effects in animals on normal iodine diet were compared to those in animals on a low iodine diet. No decrease of body wt. was noticed, only the liver weights were increased slightly in animals treated with 30 mg.kg-1.day-1 PCP. However distinct effects on thyroid hormones as well as on thyrotropin (TSH) were observed: a pronounced fall of circulating thyroxine (T4) and triiodothyronine (T3) levels was accompanied by lower levels of both free thyroid hormones and TSH, and the T4:T3 ratio was decreased in serum. Furthermore the intrathyroidal hormone stores were reduced. An interference of PCP at pituitary or hypothalamic level is assumed as a major mode of action. Additional effects of the test substance on peripheral conversion can be suspected.

Human pentachlorophenol poisoning

Pentachlorophenol (PCP) was, and still is, one of the most frequently used fungicides and pesticides. Its toxicity is due to interference with oxidative phosphorylation. Acute and chronic poisoning may occur by dermal absorption, inhalation or ingestion. Chronic poisoning occurs mainly in sawmill workers or people living in log homes treated with PCP-containing wood protecting formulations. Quantitative determination of PCP in urine and serum is useful to detect occupational or subclinical exposure. The clinical features of acute and chronic PCP poisoning can be classified systematically into effects on the skin, metabolism (fever), the haematopoietic tissue, the respiratory system, the central and peripheral nervous system, the kidney and the gastrointestinal tract. Although PCP is not classified as a human carcinogen, some epidemiological observations suggest that exposure to chlorophenols in general and PCP solutions in particular may result in an increased risk for certain malignant disorders such as nasal carcinoma and soft tissue sarcoma. There is concern that contamination of PCP-solutions with products such as chlorodibenzo-p-dioxins is the real cause of this suspected carcinogenicity. No specific antidote exists for the treatment of (acute) PCP poisoning. The basis of the treatment of acute poisoning is intensive supportive care with prevention of dangerous rise in temperature. Use of PCP-based products as indoor wood preservatives poses an unacceptable risk to human health.

A health survey of workers in the pentachlorophenol section of a chemical manufacturing plant

During 1968 to 1985, 109 workers who had been engaged in the production of pentachlorophenol, using non-gamma isomers of hexachloroclohexane (BHC) as the raw material, were surveyed. Endemic chloracne among them had been noted since 1974. The prevalence of chloracne was 73.4% (80/109) in total and 95.2% (20/21) in a trichlorobenzene (TCB) tank area where dioxin and dibenzofurans levels were thousands of ppm. To our knowledge, PCDDs and PCDFs have not previously been reported from thermal decomposition of BHC. Urinary porphyrins were significantly higher among exposed workers than among the controls but there was no significant difference between the workers with chloracne and those without. The conduction velocities of the median motor nerves were much slower among the workers in the TCB tank area where the highest PCDDs contamination appeared. The mortality study cohort was relatively young. Based on the three deaths observed during the follow-up, no association could be drawn.