Delayed complications of sulfur mustard poisoning in the skin and the immune system of Iranian veterans 16–20 years after exposure

Abstract

Sulfur mustard is an alkylating agent with prolonged adverse effects on both the skin and the immune system. Although skin is a major transporting system for SM's systemic absorption, there is probably no correlation between the severity of late cutaneous and immunological complications of SM poisoning.

Topical nitrogen mustard exposure causes systemic toxic effects in mice

“…From the variety of mustard agents developed, sulfur mustard (SM; 2, 2-dichloroethyl sulfide) has been most widely used as a warfare agent earning it the name, “King of war gases” (Blewett, 1986). SM, a vesicating agent, upon exposure causes debilitating effects to the respiratory tract, and ocular and dermal systems (Balali-Mood and Hefazi, 2005, 2006, Balali-Mood et al, 2005, Balali-Mood et al, 2008, Borak and Sidell, 1992, Davis and Aspera, 2001, Geraci, 2008, Ghabili et al, 2011, Ghanei and Harandi, 2007, Ghanei et al, 2010, Hefazi et al, 2006, Mansour Razavi et al, 2012, Petrali et al, 2000, Rowell et al, 2009, Saladi, Smith, 2006, Shohrati et al, 2007). The extent of injury by SM depends upon the concentration and duration of its exposure.…”

Inhibition of function of T cell subpopulations and decrease in cytokine production during subacute poisoning with various toxicants

“…Th1 lymphocytes are more sensitive to corticosterone than Th2 lymphocytes [4]. Sulfur mustardinduced injury to Th1 and Th2 lymphocytes is associated with its alkylating effect on cell DNA [9].…”

Mustard Gas: Imminent Danger or Eminent Threat?

“…An association has been made between severe cutaneous injury and a chronically low postexposure hematocrit. 50 No other blood factors exhibit latent damage or persistent low levels (Table 3). 37,50,64…”

“…Skin erythema and pain may occur 2-48 hours after exposure; blistering of exposed area can occur within 6-8 hours Lungs runny nose, sneezing, hoarseness, epistaxis, sinus pain, shortness of breath, and cough 12-24 hours after mild exposure and 2-4 hours after severe exposure; pulmonary edema and bronchopneumonia may also develop Eyes irritation, pain, swelling, and tearing may occur within 2-12 hours after mild-to-moderate exposure; severe exposure may cause light sensitivity, blepharospasms, severe pain, and/or blindness; ocular symptoms generally last no more then 10 days DERMATOLOGIC Mustard gas is highly lipophilic, allowing rapid skin penetration. 50 Exposure to mustard gas causes skin irritation, erythema, pain, blister and ulcer formation, and, ultimately, necrosis. Painful symptoms of exposure are typically deferred, even though the chemical reaction with biological tissue occurs rapidly.…”