Detoxifying organ (Image: AFP / Getty)

Benign skin growths that erupted on the face of Ukrainian president Victor Yushchenko helped save his life after he was poisoned with dioxin five years ago.

That’s the verdict of doctors who have treated and monitored Yushchenko since an unknown assassin made the attempt on his life by lacing his soup with dioxin during a dinner in Kiev on 5 September 2004.

It now turns out that the lumps that grew on his face and body as a result probably saved his life by isolating the dioxin away from his vital, internal organs. They also helped to detoxify the poison, known chemically as TCDD (2,3,7,8-tetrachlrodibenzo-p-dioxin), by producing powerful enzymes called cytochrome p450s that are normally confined to the liver.


‘Detoxifying organ’

The growths are rearrangements of skin, created from skin stem cells. “A new organ was created out of normal structures of the skin, and the tissue expressed very high levels of dioxin-metabolizing enzymes,” says Jean Saurat, the dermatologist heading the team which treated Yushchenko at the Swiss Centre for Human Applied Toxicology in Geneva. “They were made to detoxify the dioxin.”

“A hamartoma is a new organisation of normal cells that simply organise themselves differently,” says Saurat. “So skin can be regarded as a detoxifying organ,” he says.

Saurat says that at the start of treatment, Yushchenko had concentrations of TCDD 50,000 times higher than those typically found in people.

Fat stores

Saurat declined to specify details of how his team treated Yushchenko, saying these will be disclosed in a forthcoming paper.

However, the study released this week reveals that the treatment involved the anti-obesity drug orlistat, and olestra, a zero-calorie, indigestible fat product developed but rejected for use in food because it absorbed vitamins on its way through the gut, and caused “anal leakage” in some consumers. Dioxin is known to be stored in fat. Saurat said Olestra was used early on, but was not the main component of the treatment.

By monitoring concentrations of dioxin in blood, fatty tissue, faeces, skin, urine and sweat, Saurat established that about 60 per cent of the dioxin was excreted unchanged, mainly in the faeces. It took about 15 months for half of the contaminant to be excreted.

“He’s not completely clean yet, but we’ve got more than 95 per cent of it out now,” says Saurat.

Measurements of 17 different types of dioxin showed that all except the TCDD were at concentrations expected in the general population, proving that he was poisoned with pure TCDD.

‘Strong constitution’

Saurat says that if he’d died early on – before the skin lesions became apparent – the source of his poisoning may never have been known. He says that it was three months before he received treatment, and was only saved by his strong constitution.

“God knows what would’ve happened if we didn’t treat him,” says Saurat. “When he first came in, he was very, very ill, and he might have died from poisoning, but he excreted a lot of dioxin early on through vomiting and diarrhoea,” he says.

The skin lesions are still there, but less severe. “His skin will still need special care,” says Saurat, adding that the data from the case will be invaluable for treating and detecting milder cases of dioxin poisoning or contamination.

Journal reference: The Lancet (DOI: 10.1016/S0140-6736(09)60912-0)