Long-term skin findings of sulfur mustard exposure on the civilians of Sardasht, Iran

Abstract

Sulfur mustard (SM) was the most common chemical warfare agent used by Iraqi military forces against Iranian soldiers and civilians in border towns. Studies about late skin complications in SM-exposed people and its comparison with those in a proper control group are limited. The present paper, which is a part of the Sardasht-Iran Cohort Study is concerning with the skin findings of SM exposure 20 years after the chemical bombardment of Sardasht town (Iran) in comparison with the skin findings of the Rabat population. There are two major subgroups of SM exposure: a hospitalized group with moderate to severe problems at exposure time (n = 168), and a not hospitalized group with mild problems (n = 194), and the other is a control group (n = 128) selected from Rabat. Each participant was examined by a dermatologist in the research team. The most common skin lesions in the exposed groups based on their frequency were: eczema (27.6%), xerosis (24.6%), cherry angioma (19.9%), hyperpigmentation (15.5%), mustard scar (14.6%) and seborrheic dermatitis (10.8%), but in the control group, they were: eczema (28.9%), xerosis (11.7%), seborrheic dermatitis (11.7%) and cherry angioma (9.4%). In the exposed group, itching (P < 0.001), burning (P = 0.037), xerosis (P = 0.002), hyperpigmentation (P = 0.002) and cherry angioma (P = 0.007) were seen more often than in the control group and the differences were statistically significant. It is concluded that SM exposure causes significant delayed skin findings. In the exposed group, further follow up was needed for more long-term skin complications such as skin cancers, and there are many questions about the underlying pathophysiology and immunology of SM cutaneous complications that should be investigated.