Skin manifestations in sulfur mustard exposed victims with ophthalmologic complications: Association between early and late phase

Somayeh Hejazi; Mohammadreza Soroush; Ahmad Moradi; Sara Khalilazar; Batool Mousavi; Alireza Firooz; Shima Younespour

doi:10.1016/j.toxrep.2016.08.007

Skin manifestations in sulfur mustard exposed victims with ophthalmologic complications: Association between early and late phase

Toxicol Rep. 2016 Sep 1:3:679-684. doi: 10.1016/j.toxrep.2016.08.007. eCollection 2016.

Authors

Somayeh Hejazi¹, Mohammadreza Soroush², Ahmad Moradi³, Sara Khalilazar¹, Batool Mousavi², Alireza Firooz⁴, Shima Younespour⁵

Affiliations

¹ Skin and Stem Cell Research Center, Tehran University of Medical Sciences, No 4, Maryam alley, Pashazohri St, Sadr Blvd, Tehran, Iran.
² Janbazan Medical and Engineering Research Center(JMERC), No.17, Farokh st, Moghadas Ardabili st, Tehran, Iran.
³ Moradi Skin Laser Clinic & Chemical Warfare Victims' Clinic, Eram building, Next to Amin Ali pharmacy, Daneshjoo square, Eram St, Shiraz, Iran.
⁴ Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, No. 415, Taleqani Ave., Tehran, Iran.
⁵ Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina Avenue, Qods Street, Enqelab Square, Tehran, Iran.

Abstract

Context: Sulfur mustard (SM) was used during the Iraq-Iran war (1980-1988). Exposed veterans continue to suffer from its ocular, skin, and respiratory complications.

Objective: We aimed to evaluate associations between early (at the time of acute exposure) and decades later skin manifestations in individuals with severe ophthalmologic complications secondary to sulfur mustard exposure.

Materials and methods: One hundred forty-nine veterans with severe ocular injuries were evaluated for acute and chronic skin complications. Logistic regression models were used to examine the associations between early and late skin manifestations.

Results: Late skin complaints were observed in nearly all survivors who had early skin lesions (131 out of 137; 95.62%). Seven out of 12 patients (58.33%) who did not have early skin lesions ultimately developed late skin complications. There was a significant relationship between the presence of lesions at the time of exposure and developing late skin complaints (two-sided Fisher's exact test, OR = 15.59, p < 0.001). There was an association between having at least one early skin lesion and occurrence of late skin complications. Survivors with blisters at the time of chemical exposure were more likely to complain of itching (95% CI: 3.63-25.97, p < 0.001), burning (OR = 11.16; 95% CI: 2.97-41.89, p < 0.001), pigmentation changes (OR = 10.17; 95% CI: 2.54-40.75, p = 0.001), dryness (OR = 6.71, 95% CI: 1.22-37.01, p = 0.03) or cherry angioma (OR = 2.59; 95% CI:1.21-5.55, p = 0.01) during the late phase. Using multivariate logistic models, early blisters remained significantly associated with latent skin complaints. Of note, the genitalia and great flexure areas were the most involved anatomical sites for both early and late skin lesions in SM exposed survivors.

Conclusion: According to this study, the presence of blisters at the time of exposure to SM is the most important predictor of developing dermatologic complications decades later in patients with severe ophthalmologic complications from sulfur mustard exposure.

Keywords: Ophthalmologic complications; Skin manifestations; Sulfur mustard.