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Reviews in Endocrine and Metabolic Disorders
Published in: Reviews in Endocrine and Metabolic Disorders 3/2016

01-09-2016

Endocrine-disrupting chemicals and skin manifestations

Authors: Qiang Ju, Christos C. Zouboulis

Published in: Reviews in Endocrine and Metabolic Disorders | Issue 3/2016

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Abstract

Endocrine-disrupting chemicals (EDCs) are exogenous compounds that have the ability to disrupt the production and actions of hormones through direct or indirect interaction with hormone receptors, thus acting as agonists or antagonists. Human health is affected after either individual occupation or dietary and environmental exposure to EDCs. On the other hand, skin is one of the largest organs of the body and its main function is protection from noxious substances. EDCs perturb the endocrine system, and they are also carcinogenic, immunotoxic, and hepatotoxic to human skin. In addition, their effects on keratinocytes, melanocytes, sebocytes, inflammatory and immunological cells, and skin stem cells produce inflammatory and allergic skin diseases, chloracne, disorders of skin pigmentation, skin cancer, and skin aging. Mechanisms, which EDCs use to induce these skin disorders are complicated, and involve the interference of endogenous hormones and most importantly the activation of the aryl hydrocarbon receptor signal pathway. Further studies on EDCs and skin diseases are necessary to elucidate these mechanisms.
Literature
1.
Diamanti-Kandarakis E, Bourguignon J-P, Giudice LC, Hauser R, Prins GS, Soto AM, et al. Endocrine-disrupting chemicals: an Endocrine Society scientific statement. Endocrine Reviews. 2009;30(4):293–342.CrossRefPubMedPubMedCentral
2.
Kavlock RJ, Daston GP, DeRosa C, Fenner-Crisp P, Gray LE, Kaattari S, et al. Research needs for the risk assessment of health and environmental effects of endocrine disruptors: a report of the US EPA-sponsored workshop. Environmental Health Perspectives. 1996;104:715–40.CrossRefPubMedPubMedCentral
3.
Bertin MJ, Moeller P, Guillette Jr LJ, Chapman RW. Using machine learning tools to model complex toxic interactions with limited sampling regimes. Environmental Science & Technology. 2013;47:2728–36.CrossRef
4.
Zoeller RT, Brown TR, Doan LL, Gore AC, Skakkebaek NE, Soto AM, et al. Endocrine-disrupting chemicals and public health protection: a statement of principles from the Endocrine Society. Endocrinology. 2012;153:4097–110.CrossRefPubMedPubMedCentral
5.
Caliman FA, Gavrilescu M. Pharmaceuticals, personal care products and endocrine disrupting agents in the environment—a review. Clean-Soil Air Water. 2009;37:277–303.CrossRef
6.
Balabanič D, Rupnik M, Klemenčič AK. Negative impact of endocrine-disrupting compounds on human reproductive health. Reprod Fertil Dev. 2011;23(3):403–16.PubMed
7.
Nicolopoulou-Stamati P, Hens L, Sasco AJ. Cosmetics as endocrine disruptors: are they a health risk? Rev Endocr Metab Disord. 2015;16(4):373–83.CrossRefPubMed
8.
Fingerhut M, Nelson DI, Driscoll T, Concha-Barrientos M, Steenland K, Punnett L, et al. The contribution of occupational risks to the global burden of disease: summary and next steps. La Medicina del lavoro. 2006;97:313–21.PubMed
9.
Greenberg H, Raymond SU, Leeder SR. The prevention of global chronic disease: academic public health's new frontier. American Journal of Public Health. 2011;101:1386–91.CrossRefPubMedPubMedCentral
10.
Boyle CA, Boulet S, Schieve LA, Cohen RA, Blumberg SJ, Yeargin-Allsopp M, et al. Trends in the prevalence of developmental disabilities in US children, 1997-2008. Pediatrics. 2011;127:1034–42.CrossRefPubMed
11.
Kabir ER, Rahman MS, Rahman I. A review on endocrine disruptors and their possible impacts on human health. Environmental Toxicology and Pharmacology. 2015;40:241–58.CrossRefPubMed
12.
Lu YC, Wong PN. PCB poisoning in Japan and Taiwan. Dermatological, medical, and laboratory findings of patients in Taiwan and their treatments. Progress in clinical and biological research. 1984;137:81–115.PubMed
13.
Mitoma C, Mine Y, Utani A, Imafuku S, Muto M, Akimoto T, et al. Current skin symptoms of Yusho patients exposed to high levels of 2,3,4,7,8-pentachlorinated dibenzofuran and polychlorinated biphenyls in 1968. Chemosphere. 2015;137:45–51.CrossRefPubMed
14.
Gallagher RP, Macarthur AC, Lee TK, Weber JP, Leblanc A, Mark Elwood J, et al. Plasma levels of polychlorinated biphenyls and risk of cutaneous malignant melanoma: a preliminary study. Int J Cancer. 2011;128(8):1872–80.CrossRefPubMed
15.
16.
Panteleyev AA, Bickers DR. Dioxin-induced chloracne—reconstructing the cellular and molecular mechanisms of a classic environmental disease. Experimental Dermatology. 2006;15:705–30.CrossRefPubMed
17.
Knerr S, Schrenk D. Carcinogenicity of 2,3,7,8-tetrachlorodibenzo-p-dioxin in experimental models. Mol Nutr Food Res. 2006;50(10):897–907.CrossRefPubMed
18.
Joshi AD, Corral R, Catsburg C, et al. Red meat and poultry, cooking practices, genetic susceptibility and risk of prostate cancer: results from a multiethnic case-control study. Carcinogenesis. 2012;33:2108–18.CrossRefPubMedPubMedCentral
19.
20.
Higginbotham S, RamaKrishna NV, Johansson SL, Rogan EG, Cavalieri EL. Tumor-initiating activity and carcinogenicity of dibenzo[a,l]pyrene versus 7,12-dimethylbenz[a]anthracene and benzo[a]pyrene at low doses in mouse skin. Carcinogenesis. 1993;14:875–8.CrossRefPubMed
21.
Guo Y, Kannan K. Comparative assessment of human exposure to phthalate esters from house dust in China and the United States. Environmental Science & Technology. 2011;45:3788–94.CrossRef
22.
Pan T-L, Wang P-W, Aljuffali IA, et al. Dermal toxicity elicited by phthalates: evaluation of skin absorption, immunohistology, and functional proteomics. Food and Chemical Toxicology. 2014;65:105–14.CrossRefPubMed
23.
Koniecki D, Wang R, Moody RP, Zhu J. Phthalates in cosmetic and personal care products: concentrations and possible dermal exposure. Environmental Research. 2011;111:329–36.CrossRefPubMed
24.
Beko G, Callesen M, Weschler CJ, et al. Phthalate exposure through different pathways and allergic sensitization in preschool children with asthma, allergic rhinoconjunctivitis and atopic dermatitis. Environmental Research. 2015;137:432–9.CrossRefPubMed
25.
Medeiros AM, Devlin DJ, Keller LH. Evaluation of skin sensitization response of dialkyl (C6-C13) phthalate esters. Contact Dermatitis. 1999;41:287–9.CrossRefPubMed
26.
Takano H, Yanagisawa R, K-i I, et al. Di-(2-ethylhexyl) phthalate enhances atopic dermatitis-like skin lesions in mice. Environmental Health Perspectives. 2006;114:1266–9.CrossRefPubMedPubMedCentral
27.
Just AC, Whyatt RM, Perzanowski MS, et al. Prenatal exposure to butylbenzyl phthalate and early eczema in an urban cohort. Environmental Health Perspectives. 2012;120:1475–80.CrossRefPubMedPubMedCentral
28.
Bekö G, Weschler CJ, Langer S, Callesen M, Toftum J, Clausen G. Children's phthalate intakes and resultant cumulative exposures estimated from urine compared with estimates from dust ingestion, inhalation and dermal absorption in their homes and daycare centers. PLoS One. 2013;8(4):e62442.CrossRefPubMedPubMedCentral
29.
Wang IJ, Karmaus WJ. The effect of phthalate exposure and filaggrin gene variants on atopic dermatitis. Environ Res. 2015;136:213–8.CrossRefPubMed
30.
Banerjee M, Banerjee N, Bhattacharjee P, Mondal D, Lythgoe PR, Martínez M, et al. High arsenic in rice is associated with elevated genotoxic effects in humans. Sci Rep. 2013;3:2195. doi:10.​1038/​srep02195.PubMed
31.
Ling-I Hsu, Meei-Maan Wu,Yuan-Hung Wang, Cheng-Yeh Lee, Tse-Yen Yang, Bo-Yu Hsiao, and Chien-Jen Chen. Association of environmental arsenic exposure, genetic polymorphisms of susceptible genes, and skin cancers in Taiwan. Biomed Res Int. 2015; 29. doi: 10.​1155/​2015/​892579
32.
Ahmed TS, Misbahuddin M. Role of linoleic acid in arsenical palmar keratosis. Int J Dermatol. 2016;55(3):289–95.CrossRefPubMed
33.
Rudolph C, Schnoor M, Eisemann N, Katalinic A. Incidence trends of nonmelanoma skin cancer in Germany from 1998 to 2010. Journal Der Deutschen Dermatologischen Gesellschaft. 2015;13:788–97.PubMed
34.
Diepgen TL, Mahler V. The epidemiology of skin cancer. British Journal of Dermatology. 2002;146:1–6.CrossRefPubMed
35.
Siddens LK, Larkin A, Krueger SK, et al. Polycyclic aromatic hydrocarbons as skin carcinogens: comparison of benzo[a]pyrene, dibenzo[def, p]chrysene and three environmental mixtures in the FVB/N mouse. Toxicol Appl Pharmacol. 2012;264(3):377–86.CrossRefPubMedPubMedCentral
36.
Tsai PJ, Shieh HY, Lee WJ, Lai SO. Health-risk assessment for workers exposed to polycyclic aromatic hydrocarbons (PAHs) in a carbon black manufacturing industry. Science of the Total Environment. 2001;278:137–50.CrossRefPubMed
37.
Baudouin C, Charveron M, Tarroux R, Gall Y. Environmental pollutants and skin cancer. Cell Biology and Toxicology. 2002;18:341–8.CrossRefPubMed
38.
Kim KE, Cho D, Park HJ. Air pollution and skin diseases: adverse effects of airborne particulate matter on various skin diseases. Life Sci. 2016;152:126–34.CrossRefPubMed
39.
Nebert DW, Dalton TP, Okey AB, Gonzalez FJ. Role of aryl hydrocarbon receptor-mediated induction of the CYP1 enzymes in environmental toxicity and cancer. Journal of Biological Chemistry. 2004;279:23847–50.CrossRefPubMed
40.
Abel J, Haarmann-Stemmann T. An introduction to the molecular basics of aryl hydrocarbon receptor biology. Biological Chemistry. 2010;391:1235–48.CrossRefPubMed
41.
Godschalk R, Curfs D, Bartsch H, Van Schooten FJ, Nair J. Benzo a pyrene enhances lipid peroxidation induced DNA damage in aorta of apolipoprotein E knockout mice. Free Radical Research. 2003;37:1299–305.CrossRefPubMed
42.
Gelboin HV. Benzo alpha pyrene metabolism, activation and carcinogenesis: role and regulation of mixed-function oxidases and related enzymes. Physiological reviews. 1980;60:1107–66.PubMed
43.
Shimizu Y, Nakatsuru Y, Ichinose M, et al. Benzo a pyrene carcinogenicity is lost in mice lacking the aryl hydrocarbon receptor. Proceedings of the National Academy of Sciences of the United States of America. 2000;97:779–82.CrossRefPubMedPubMedCentral
44.
Ide F, Suka N, Kitada M, et al. Skin and salivary gland carcinogenicity of 7,12-dimethylbenz[a]anthracene is equivalent in the presence or absence of aryl hydrocarbon receptor. Cancer Letters. 2004;214:35–41.CrossRefPubMed
45.
Giantin M, Vascellari M, Lopparelli RM. Expression of the aryl hydrocarbon receptor pathway and cyclooxygenase-2 in dog tumors. Res Vet Sci. 2013;94(1):90–9.CrossRefPubMed
46.
Haarmann-Stemmann T, Bothe H, Abel J. Growth factors, cytokines and their receptors as downstream targets of arylhydrocarbon receptor (AhR) signaling pathways. Biochemical Pharmacology. 2009;77:508–20.CrossRefPubMed
47.
Brokken LJ, Giwercman YL. Gene-environment interactions in male reproductive health: special reference to the aryl hydrocarbon receptor signaling pathway. Asian J Androl. 2014;16:89–96.CrossRefPubMed
48.
Chalubinski M, Kowalski ML. Endocrine disrupters—potential modulators of the immune system and allergic response. Allergy. 2006;61:1326–35.CrossRefPubMed
49.
Yang S-N, Hsieh C-C, Kuo H-F, Lee M-S, Huang M-Y, Kuo C-H, et al. The effects of environmental toxins on allergic inflammation. Allergy Asthma Immunol Res. 2014;6(6):478–84.CrossRefPubMedPubMedCentral
50.
Yamamoto O, Tokura Y. Photocontact dermatitis and chloracne: two major occupational and environmental skin diseases induced by different actions of halogenated chemicals. J Dermatol Sci. 2003;32(2):85–94.CrossRefPubMed
51.
Hafeez F, Maibach H. An overview of parabens and allergic contact dermatitis. 24 Skin therapy letter. 2013;18:5–7.
52.
Salles JC, Deschamps FJ. Allergic contact dermatitis due to a PVC table cover. Occupational Medicine-Oxford. 2010;60:662–4.CrossRef
53.
Mastrangelo G, Veller Fornasa C, Pavanello S, et al. Polyaromatic hydro-carbons administered in humans by dermal route increase total IgE. Int J Immunopathol Pharmacol. 2003;16(2):145–50.PubMed
54.
55.
Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR. Is eczema really on the increase worldwide? J Allergy Clin Immunol. 2008;121:947–54.CrossRefPubMed
56.
57.
Kato T, Tada-Oikawa S, Takahashi K, Saito K, Wang L, Nishio A, et al. Endocrine disruptors that deplete glutathione levels in APC promote Th2 polarization in mice leading to the exacerbation of airway inflammation. Eur J Immunol. 2006;36:1199–209.CrossRefPubMed
58.
Kepley CL, Lauer FT, Oliver JM, et al. Environmental polycyclic aromatic hydrocarbons, benzo(a)pyrene(BaP) and BaP-quinones, enhance IgE-mediated histamine release and IL-4 production in human basophils. Clin Immunol. 2003;107(1):10–9.CrossRefPubMed
59.
Walker DB, Williams WC, Copeland CB, et al. Persistent suppression of contact hypersensitivity, and altered T-cell parameters in F344 rats exposed perinatally to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Toxicology. 2004;197(1):57–66.CrossRefPubMed
60.
Tsuji G, Takahara M, Uchi H, et al. An environmental contaminant, benzo(a)pyrene, induces oxidative stress-mediated interleukin-8 production in human keratinocytes via the aryl hydrocarbon receptor signaling pathway. J Dermatol Sci. 2011;62(1):42–9.PubMed
61.
Hu T, Pan Z, Yu Q, Mo X, Song N, Yan M, et al. Benzo(a)pyrene induces interleukin (IL)-6 production and reduces lipid synthesis in human SZ95 sebocytes via the aryl hydrocarbon receptor signaling pathway. Environ Toxicol Pharmacol. 2016;43:54–60.CrossRefPubMed
62.
D'Cruz D. Autoimmune diseases associated with drugs, chemicals and environmental factors. Toxicol Lett. 2000;112–113:421–32.CrossRefPubMed
63.
Nguyen LT, Ramanathan M, Weinstock-Guttman B, et al. Detection of cytochrome P450 and other drug-metabolizing enzyme mRNAs in peripheral blood mononuclear cells using DNA arrays. Drug Metab Dispos. 2000;28(8):987–93.PubMed
64.
Esser C, Bargen I, Weighardt H, Haarmann-Stemmann T, Krutmann J. Functions of the aryl hydrocarbon receptor in the skin. Semin Immunopathol. 2013;35(6):677–91.CrossRefPubMed
65.
Pesatori AC, Consonni D, Bachetti S, Zocchetti C, Bonzini M, et al. Short- and long-term morbidity and mortality in the population exposed to dioxin after the “Sevesoaccident”. Ind Health. 2003;41:127–38.CrossRefPubMed
66.
Sorg O, Zennegg M, Schmid P, Fedosyuk R, Valikhnovskyi R, et al. 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) poisoning in Victor Yushchenko: identification and measurement of TCDD metabolites. Lancet. 2009;374:1179–85.CrossRefPubMed
67.
Ju Q, Yang K, Zouboulis CC, Ring J, Chen W. Chloracne: from clinic to research. Dermatol Sinica. 2012;30:2–6.CrossRef
68.
Saurat JH, Kaya G, Saxer-Sekulic N, Pardo B, Becker M, et al. The cutaneous lesions of dioxin exposure: lessons from the poisoning of Victor Yushchenko. Toxicol Sci. 2012;125:310–7.CrossRefPubMed
69.
70.
Patterson AT, Tian FT, Elston DM, Kaffenberger BH. Occluded cigarette smoke exposure causing localized chloracne-like comedones. Dermatology. 2015;231(4):322–5.CrossRefPubMed
71.
Sutter CH, Bodreddigari S, Campion C, Wible RS, Sutter TR. 2,3,7,8-Tetrachlorodibenzo-p-dioxin increases the expression of genes in the human epidermal differentiation complex and accelerates epidermal barrier formation. Toxicol Sci. 2011;124:128–37.CrossRefPubMedPubMedCentral
72.
Ju Q, Fimmel S, Hinz N, Stahlmann R, Xia L, et al. 2,3,7,8-Tetrachlorodibenzo-p-dioxin alters sebaceous gland differentiation characteristics in vitro. Exp Dermatol. 2011;20:320–5.CrossRefPubMed
73.
Forrester AR, Elias MS, Woodward EL, Graham M, Williams FM, Reynolds NJ. Induction of a chloracne phenotype in an epidermal equivalent model by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is dependent on aryl hydrocarbon receptor activation and is not reproduced by aryl hydrocarbon receptor knock down. J Dermatol Sci. 2014;73(1):10–22.CrossRefPubMedPubMedCentral
74.
75.
76.
Kawasaki G, Yoshitomi I, Yanamoto S, et al. Pigmentation of the oral mucosa by PCB poisoning in Yusho patients. Archives of Oral Biology. 2013;58:1260–4.CrossRefPubMed
77.
Luecke S, Backlund M, Jux B, et al. The aryl hydrocarbon receptor (AhR), a novel regulator of human melanogenesis. Pigment Cell Melanoma Res. 2010;23(6):828–33.CrossRefPubMed
78.
Zouboulis CC, Makrantonaki E. Clinical aspects and molecular diagnostics of skin aging. Clin Dermatol. 2011;29:3–14.CrossRefPubMed
79.
Vierkoetter A, Schikowski T, Ranft U, et al. Airborne particle exposure and extrinsic skin aging. Journal of Investigative Dermatology. 2010;130:2719–26.CrossRef
80.
Morita A, Torii K, Maeda A, Yamaguchi Y. Molecular basis of tobacco smoke-induced premature skin aging. Journal of Investigative Dermatology Symposium Proceedings. 2009;14:53–5.CrossRef
81.
Borska L, Andrys C, Krejsek J, Palicka V, Vorisek V, Hamakova K, et al. Influence of dermal exposure to ultraviolet radiation and coal tar (polycyclic aromatic hydrocarbons) on the skin aging process. J Dermatol Sci. 2016;81(3):192–202.CrossRefPubMed
82.
Li M, Vierkötter A, Schikowski T, Hüls A, Ding A, Matsui MS, et al. Epidemiological evidence that indoor air pollution from cooking with solid fuels accelerates skin aging in Chinese women. J Dermatol Sci. 2015;79(2):148–54.CrossRefPubMed
83.
Roberts WE. Pollution as a risk factor for the development of melasma and other skin disorders of facial hyperpigmentation—is there a case to be made? J Drugs Dermatol. 2015;14(4):337–41.PubMed
84.
Ono Y, Torii K, Fritsche E, et al. Role of the aryl hydrocarbon receptor in tobacco smoke extractinduced matrix metalloproteinase-1 expression. Experimental Dermatology. 2013;22:349–53.CrossRefPubMed
85.
Fu PP, Xia Q, Sun X, Yu H. Phototoxicity and environmental transformation of polycyclic aromatic hydrocarbons (PAHs)-light-induced reactive oxygen species, lipid peroxidation, and DNA damage. Journal of Environmental Science and Health Part C-Environmental Carcinogenesis & Ecotoxicology Reviews. 2012;30:1–41.CrossRef
Metadata
Title
Endocrine-disrupting chemicals and skin manifestations
Authors
Qiang Ju
Christos C. Zouboulis
Publication date
01-09-2016
Publisher
Springer US
Published in
Reviews in Endocrine and Metabolic Disorders / Issue 3/2016
Print ISSN: 1389-9155
Electronic ISSN: 1573-2606
DOI
https://doi.org/10.1007/s11154-016-9371-2

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