Long-Term Risk of Dermatoses Following Sulfur Mustard Exposure: A Retrospective Cohort Study

Sulfur mustard (SM) was extensively used during the Iraq-Iran War (1983-1988). The study assessed the prevalence of dermatoses in exposed survivors compared to the general population.

Using a retrospective cohort study, we visited and compared the prevalence of skin complaints and active dermatoses in 1538 SM-exposed survivors and 1425 unexposed controls. All participants underwent clinical evaluations by dermatologists across multiple centers.

The exposed group demonstrated a higher prevalence of chronic diseases (odds ratio [OR]: 4.57, 95% confidence interval [CI]: 3.92-5.34), history of dermatoses (OR: 2.32, 95% CI: 1.97-2.73), need for dermatologic care (OR: 5.91, 95% CI: 4.67-7.50), and corticosteroid use (OR: 10.98, 95% CI: 8.77-13.74) with concurrent use of multiple corticosteroid forms. Dermatologist examinations revealed a higher rate of skin complaints (92.1% vs. 23.4%; OR: 36.47, 95% CI: 29.24-44.5) and dermatoses (86.7% vs. 32.1%; OR: 13.81, 95% CI: 11.48-16.61) in the exposed group. The most prevalent symptom among the exposed group was itching (84.7% vs. 14.5%; OR: 32.46, 95% CI: 26.52-39.74), followed by burning sensation (38% vs. 3.6%; OR: 16.54, 95% CI: 12.28-22.28) and dry skin (36.2% vs. 5.6%; OR: 9.52, 95% CI: 7.43-12.20). Dermatologist visits indicated the highest odds in the exposed group compared to the control group for: blistering disorders (OR: 40.4, 95% CI: 2.4-667.4); persistent warts (OR: 17.7, 95% CI: 1.0-304.5); pruritus (OR: 17.1, 95% CI: 9.5-30.77); xerosis (OR: 11.98, 95% CI: 9.36-15.34); neurodermatitis (OR: 10.28, 95% CI: 5.79-18.56); lichen simplex chronicus (OR: 9.02, 95% CI: 6.13-13.28); and excoriated dermatitis (OR: 7.75, 95% CI: 5.88-10.23). There was no significant rise in the risk of vitiligo, psoriasis, keloids, drug-induced acne, basal cell carcinoma (BCC), morphea, discoid lupus erythematosus (DLE), systemic lupus erythematosus (SLE), squamous cell carcinoma (SCC), or melanoma in the exposed group compared to the control group.

Single-dose SM exposure-regardless of its amount or duration-leads to significantly more long-lasting skin conditions compared to the controls.