[Scleroderma induced by chemical agents. Description of a case and review of the literature]

The authors describe a case of a 24 years old man affected by eosinophilic fasciitis likely due to chemical exposure. The patient handled and inhaled a compound containing sodium hypochlorite, sodium hydrate and cationic surface agents. The clinical picture was characterized by sudden onset, oedema and pain on the limbs; laboratory tests revealed an erythrocyte sedimentation rate of 55 mm/hour, polyclonal hypergammaglobulinemia and eosinophilia. The histologic examination of a deep musculo-cutaneous biopsy showed an infiltrate composed of lymphocytes and macrophages localized in the fascia and in the muscle; skin and subcutaneous tissue turned out normal. Corticosteroid treatment (prednisone at the starting dosage of 30 mg/day) produced the healing of the disease in 5 months. Afterwards the authors reviewed the literature about the different expressions of scleroderma that can be caused by chemicals; the most famous example is the "Spanish toxic oil syndrome". Various compounds were associated with development of scleroderma: plastic materials, solvents, silica powder, drugs, silicone prosthesis; the list will lengthen with reference to use of new products. It was hypothesized that the generation of free radicals was the common mechanism through which different aetiological agents can provoke scleroderma in genetically predisposed individuals. In these subjects free radicals can cause either direct tissue damages (endothelial lesion, thickening of intimal layer, fibrosis) and autoimmune phenomena.