At birth, my three and one-half year had a mild hypospadias. I read somewhere that exposure to dioxin may cause hypospadias. At age two and one-half, he was diagnosed with type 1 diabetes. I have since read that exposure to dioxin may contribute to that as well. For eight years before he was born and for two years after his birth, I worked in a major environmental laboratory. I also have psoriasis and psoriatic arthritis. The psoriasis started before I worked in the lab, and psoriatic arthritis developed while I worked there. Should I be looking for any connections? Could exposure “kick start” the autoimmune processes to begin?

The idea of linking hypospadias to psoriasis via a dioxin-induced autoimmunity is an intriguing one, but I don’t think that it is valid. You are quite right, of course, in saying that fetal exposure to dioxin can lead to developmental anomalies in the urogenital system including hypospadias. That’s in laboratory rats though, and I can find no reports of this in man, although the population at risk in the U.S. must be very small. it would be interesting if this were recorded in the Vietnamese medical literature. However, dioxin can lead to diabetes in man although it is based on hyperinsulinemia and hypothyroid and therefore more like type 2 diabetes than the kind your son has.

I don’t know if your son is actually known to have type 1A (autoimmune) diabetes. That is to say if he had a positive antibody test at the time of diagnosis. It is by far the most common form in Caucasian families in the U.S. A positive test would of course quite rule out any link to dioxin, but it would probably be too late to do the test now if it was not done initially.

You are also right in supposing that psoriasis has both a specific genetic component and a basis in an abnormal immune response. I am no expert in this, but it seems to have a different mechanism to that in type 1A diabetes, and, unlike Dermatitis Herpetiformis, for example, it is not one of the conditions linked to diabetes and other autoimmune based conditions like hypothyroidism and celiac disease in the hyperimmune polyendocrine syndromes.

Two reports that might interest you and which any good local librarian can get for you are by Ortonne, JP in Br.J.Dermatol 54:1,1999 on psoriasis, and by Gray, AL in Toxicol.Ind.Health. 14:159,1998. on dioxin effects.

DOB