Sulfur mustard erythema

Skin erythema and blistering watery, swollen eyes upper airways sloughing with pulmonary edema metabolic failure neutropenia and sepsis (especially sulfur mustard, late in course). 

Dermal (skin) contact with sulfur mustard agents causes erythema and lesions (blistering), while contact with vapor may result in first and second degree burns contact with liquid typically produces second and third degree chemical burns. Any burn area covering 25 percent or more of the body surface area may be fatal. Respiratory contact is a dose-related factor in the sense that inflammatory reactions in the upper and lower airway begin to develop several hours after exposure and progress over several days. 

Jakubowski et al. (13) were able to monitor the excretion of TDG in a subject accidentally exposed to sulfur mustard in a laboratory. The casualty developed blisters on hands and arms (< 1% of body area) and erythema on his face and neck (< 5 % of body area). Urine was collected over a 10-day period. A maximum excretion rate of TDG of 20 ug per day was observed between days 3 and 4, the highest concentration being 65 ng/ml. It was noted that the total amount of urine produced for analysis during the first three days was low. Concentrations >10 ng/ml were detected in urine for 7 days after the exposure. The half-life of excretion was estimated as 1.18 days. The total amount of TDG excreted over the 10-day period was 243 ug. There was mass spectrometric evidence of oligomers of TDG (e.g. 

The skin and eyes are especially sensitive to the toxic effects of sulfur mustard. When applied to human skin, about 80% of the dose evaporates and 20% is absorbed (Vogt et al., 1984). About 12% of the amount absorbed remains at the site and the remainder is distributed systemically (Renshaw, 1946). Doses up to 50 pg/ cm cause erythema, edema, and sometimes small vesicles. Doses of 50-150 pg/cm cause bullous-type vesicles, and larger doses cause necrosis and ulceration with peripheral vesication. Droplets of liquid sulfur mustard containing as little as 0.0025 mg may cause erythema (Ward et al., 1966). Eczematous sensitization reactions were reported in several early studies and may occur at concentrations below those causing direct primary irritation (Rosenblatt et al., 1975). In humans, the LCtso (estimated concentration x exposure period lethal to 50% of exposed individuals) for skin exposures is 10,000 mg-min/m (DA, 1974) (for masked personnel however, the amount of body surface area exposed was not reported). The ICt 50 (estimated concentration x exposure period incapacitating to 50% of exposed individuals) for skin exposures is 2000 mg-min/m at 70-80°F in a humid enviromnent and 1000 mg-min/m at 90°F in a dry enviromnent (DA, 1974, 1992). The ICtso for contact with the eyes is 200 mg-min/m (DA, 1974, 1992). The LDl for skin exposure is 64 mg/kg and the LD50 is estimated to be about 100 mg/kg (DA, 1974,1992). 

Sulfur mustard exerts a local action on the eyes, respiratory tract, and skin followed by a systemic action on the central nervous, gastrointestinal and hematopoietic systems (Dacre and Goldman, 1996). A moderate exposure to sulfur mustard can cause blisters, conjunctivitis, erythema, lacri-mation, nausea, and respiratory inflammation whereas... 

Yourick, J.J., Dawson, J.S., Mitcheltree, L.W. (1995). Reduction of erythema in hairless guinea pigs after cutaneous sulfur mustard vapor exposure by pretreatment with niacinamide, promethazine and indomethacin. J. Appl. Toxicol. 15 133-8. 

There may be no skin lesions following mild vapor exposures. However, severe vapor or liquid exposure to nitrogen mustard will produce effects similar to those of sulfur mustard (but the onset is sooner than with sulfur mustard). These effects include erythema, irritation, and itching, with blisters developing in the erythematous areas. 

The chronic physiological effects may include, for severe exposure, scarring of the cornea, and the iris frequently becomes discolored and atrophied. Repeated skin burns may lead to hypersensitivity of the skin, which is an effect similar to that of sulfur mustard. That is, reexposure will cause erythema, with or... 

Once the skin is exposed, blisters develop after a period of itching and erythema, with the basal epidermal cell as the key cellular target of sulfur mustard in skin. By light microscopy, nuclear swelling begins within 3 to 9 hr after exposure, followed by nuclear pyknosis and vacuolation of cytoplasm. Edema at the epidermal-dermal junction is seen within 12 hr of exposure, and by 16 hr there is separation, with formation of coalescing vesicles. Blisters break and denude during the first week after exposure, and new blisters may form near others that are well developed. 

The skin and eyes are especially sensitive to the toxic effects of sulfur mustard. When applied to human skin, about 80% of the dose evaporates and 20% is absorbed (Vogt et al. 1984). Skin penetration is at a rate of about 1 ig cm" min at a temperature of 75 °F (Renshaw 1946). About 12% of the amount absorbed remains at the site and the remainder is distributed systemically (Renshaw 1946). Doses to 50 pg/cm cause erythema, edema, and sometimes small vesicles. Doses of 50-150 pg/cm cause bullous-type vesicles, and larger doses cause necrosis and ulceration with peripheral vesication. Droplets of liquid sul-... 

Physiological Effects. The sulfur and nitrogen mustards act first as cell irritants and finally as a cell poison on all tissue surfaces contacted. The first symptoms usually appear in 4—6 h (4). The higher the concentration, the shorter the interval of time between the exposure to the agent and the first symptoms. Local action of the mustards results in conjunctivitis (inflammation of the eyes) erythema (redness of the skin), which may be followed by blistering or ulceration and an inflammatory reaction of the nose, throat, trachea, bronchi, and lung tissue. Injuries produced by mustard heal much more slowly and are much more Fable to infection than bums of similar intensity produced by physical means or by other chemicals. 

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