Chemical warfare victims: Early cutaneous findings and late skin complaints

Mousavi B, Mousavi B, MD, MPHMD, MPH Soroush MR, Soroush MR, MDMD,,

Honari G, Honari G, MDMD

Janbazan Medical and Engineering Research Center (JMERC)Janbazan Medical and Engineering Research Center (JMERC)

www.jmerc.ac.irwww.jmerc.ac.ir

Iran – Iraq war (1980-1988)Iran – Iraq war (1980-1988): :

200,00200,0000 lost their liveslost their lives400,00400,000 war injured0 war injured

Chemical warfare historyChemical warfare history 100,000 100,000 hospitalizationhospitalization

5500055000 chemical victimschemical victims

10% 10% Moderate & SevereModerate & Severe

90% 90% MildMild

What is sulfur mustard gasWhat is sulfur mustard gas??

AKA vesicants or blistering agent vesicants or blistering agent

Lipophilic liquids and cytotoxic alkylating agentLipophilic liquids and cytotoxic alkylating agent Easy penetrateEasy penetrate

Upon contacts with skinUpon contacts with skin : : 80 percent evaporates 80 percent evaporates 20 percent penetrates the skin 20 percent penetrates the skin

1010 percent binds to the skin sitespercent binds to the skin sites

Mustard gas

Quickly cyclizes in tissue

Alkylates cell components (DNA, proteins)

DNA damage leads to: cell death mutation

Direh

Study objectivesStudy objectives

This study was part of a Health monitoring This study was part of a Health monitoring project in chemical warfare victimsproject in chemical warfare victims

The specific objective of the study was to The specific objective of the study was to assess the relationship between early assess the relationship between early and late skin complaints in in Chemical warfare survivors suffering from moderate to suffering from moderate to severe complicationssevere complications

Methods Methods (N=149)(N=149)First,

All cases were interviewed for any skin complaints

Then,

History of the skin reactions at the time of exposure

- Patients recall, and

- Medical records

The most severe reactions were considered

ResultsResults

Mean ageMean age::

44.944.9) ) SD 8.7SD 8.7 ( (yearsyears

Range : 21-75 yrsRange : 21-75 yrs

Mean age at the time of exposure: age at the time of exposure: 23.3 (SD 8.5) years 23.3 (SD 8.5) years

Range: 1-53 yrsRange: 1-53 yrs

9.5%

25.2%

54.4%

10.9%

0%

10%

20%

30%

40%

50%

60%

<30 30-39 40-49 >50

Age Distribution

ResultsResults

Marital status:Marital status: Married: 146 Married: 146 Single: 3Single: 3

Education :Education : Illiterate: 10.7%Illiterate: 10.7% Less than 12 yrs of education: 35.5%Less than 12 yrs of education: 35.5% High school certificate and above: 53.8High school certificate and above: 53.8% %

ResultsResults

Time of Chemical ExposureTime of Chemical Exposure:: 1985 – 1986 83% 1985 – 1986 83%

1985: 58.5%1985: 58.5% 1986: 24.5%1986: 24.5%

Exposure frequency: (1-6) 33.7%33.7%) ) n= 50n= 50 > ( > (onceonce

ResultsResults

Early cutaneous findings were based on:

Medical records : 21% (n = 31) Patient recall : 79% (n = 118)

Skin complaints at the time of studySkin complaints at the time of study

92.6%

7.4%

0%

20%

40%

60%

80%

100%

Yes No

Skin complaints at the time of studySkin complaints at the time of study

83.9%

72.5%

57.0%

15.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Skin lesions at the time of exposureSkin lesions at the time of exposure

91.9%

8.1%

0%

20%

40%

60%

80%

100%

Yes No

Cutaneous findings at the time of exposureCutaneous findings at the time of exposure

78.5%71.8%

85.0% 86.6%

0%10%20%30%40%50%60%70%80%90%

Combination of skin lesions

Blister, redness, scaling and dispigmentation: 100(67.1%)

Redness, scaling and dispigmentation: 16 (10.1%)

Scaling and dispigmentation: 10 (6.7%)

No skin lesions : 12 (8.1%)

ResultsResults

A significant relationship between A significant relationship between early cutaneous lesions and early cutaneous lesions and

developing latent skin complaints developing latent skin complaints (Odds ratio =13.5, P>0.001)(Odds ratio =13.5, P>0.001)

EEarly cutaneous lesions and developing arly cutaneous lesions and developing latent skin complaintslatent skin complaints

Early cutaneous Early cutaneous lesionslesions

Odds ratioP value

Blister14.3.000

Redness5.2.006

Scaling9.1.000

Dispigmentation6.8.001

Discussion

Early cutaneous lesions

Risk of developing latent skin complaints

Discussion

Odds of having blister

among cases with latent skin complaints

Limitation:

Part of the data was collected based on patient recall after 22 years of exposure

“ Recall bias”

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