From the Guidelines
Sulfur mustard, also known as mustard gas, causes severe and potentially life-threatening side effects upon exposure, including intense eye pain, temporary blindness, skin redness, blistering, and respiratory issues, and immediate decontamination and medical attention are crucial for survival and minimizing long-term complications. The immediate effects of sulfur mustard exposure include:
- Intense eye pain and temporary blindness
- Skin redness and blistering
- Respiratory issues, such as coughing, shortness of breath, and sinus pain Within hours, victims develop fluid-filled blisters on the skin that can become large, painful wounds prone to infection. Respiratory exposure leads to pulmonary edema, airway damage, and potentially fatal respiratory failure. Long-term effects include:
- Permanent eye damage
- Chronic respiratory conditions
- Increased cancer risk, particularly lung and respiratory tract cancers
- Psychological trauma
- Compromised immune function Sulfur mustard works by alkylating DNA and proteins in cells, preventing cell division and causing cell death. Treatment is supportive rather than curative, focusing on decontamination, wound care, respiratory support, and pain management. There is no antidote for sulfur mustard exposure, making immediate decontamination and medical attention crucial for survival and minimizing long-term complications, as noted in the most recent guidelines 1.
From the Research
Side Effects of Sulfur Mustard Exposure
- Sulfur mustard (SM) exposure causes intense lesions that range in severity from mild erythema to blister formation and necrosis 2
- SM-induced damage to the skin is characterized by edema, inflammation, and cell death mainly of the basal keratinocyte layer, with varying immunological and pathological changes in the acute phase 2
- Long-term cutaneous effects of SM exposure include xerosis, hypo or hyper pigmentation, scars, and rarely, skin cancers 2
- Ocular complications of SM exposure include dry eye, persistent epithelial defects, limbal ischemia, limbal stem cell deficiency, corneal vascularization, and corneal opacities 3, 4, 5
- Respiratory tract damage and bone marrow depression are also common side effects of SM exposure 6
- Chronic obstructive lung disease, lung fibrosis, recurrent corneal ulcer disease, chronic conjunctivitis, and several forms of cancer are late effects of SM exposure 6
Organ-Specific Effects
- Skin: SM exposure causes lesions, edema, inflammation, and cell death, with long-term effects including xerosis, hypo or hyper pigmentation, scars, and skin cancers 2
- Eyes: SM exposure causes ocular surface disorders, including dry eye, persistent epithelial defects, limbal ischemia, limbal stem cell deficiency, corneal vascularization, and corneal opacities 3, 4, 5
- Respiratory Tract: SM exposure causes respiratory tract damage, with late effects including chronic obstructive lung disease and lung fibrosis 6
Treatment and Management
- Combination therapy of topical drugs and oral antihistamines, as well as iodine and antitumor necrosis factor alpha antibodies, are effective remedies in the treatment of skin lesions 2
- Supportive medical and surgical management, including punctual occlusion, autologous eye drops, and aggressive lubrication, can help manage ocular complications 3, 4
- Novel treatments, including amniotic membrane transplantation, cultivated stem cell transplantation, and anti-angiogenic therapies, may be considered as therapeutic options in SM-induced ocular damage in the future 5