Sulfur mustards skin decontamination

Blister/vesicant exposure is treated primarily as a thermal burn. Sulfur mustard decontamination is limited to immediate washing of exposed skin with water or soap and water, and flushing the eyes with copious amounts of water. Avoid 0.5% sodium hypochlorite solution or vigorous scrubbing as they may cause deeper tissue penetration. Typical burn therapy is accomplished with antibiotic ointment, sterile dressing, and other supportive... 

Outside of military conflicts, exposure to sulfur mustard has occurred or may occur in work environments associated with chemical weapon materiel (e.g. storage depots, demilitarization facilities, research laboratories), during emergency response operations or remediation and decontamination activities, or during treaty verification activities in support of the Chemical Weapons Convention. Chemical weapons such as the vesicants are stiU considered potential military threats and terrorist targets. The most likely route of exposure to sulfur mustard is via aerosol/vapor exposure of the skin, eyes, and respiratory tract. 

Gold, M.B., Bongiovanni, R., Scharf, B.A. (1993). Hypochlorite solution as a decontaminant in sulfur mustard contaminated skin defects in the euthymic hairless guinea pig. Proceedings of the U.S. Army Medical Defense Bioscience Review, Baltimore, MD, pp. 369-78. 

Skin decontamination deals primarily with liquid exposure. However, agent vapor from offgassing of clothing or materials can be a concern, particularly with sulfur mustard. Warfighters first... 

Though an ideal decontaminant may be difficult to attain, many alternatives exist that are readily available and meet many basic requirements, van Hooidonk et al. (1983) evaluated a variety of household products as decontaminants for VX, soman, and sulfur mustard. His paper provides an excellent comparison of these readily available decontaminants to include flour, soapy water, talcum powder, and tissue paper. We have selected several other candidate decontaminants that are under investigation, in advanced development, or currently fielded. These include the currently fielded U.S. Department of Defense skin decontaminants (M291 Skin Decontamination Kit [SDK], 0.5% hypochlorite, and 1% soapy water). Reactive Skin Decontaminant Lotion (RSDL), Diphoterine, Sandia Laboratory s Decontamination Foam, and the Decontamination Sponge. 

Gerasimo et al. (2000) compared the abihty of soapy water, physiological saline, and Diphoterine to decontaminate sulfur mustard. They exposed human skin obtained from elective abdominoplasty to C14 labeled sulfur mustard in vitro for 5 min. They added the lavage to the test tube and removed the skin after 3 min, 10 min, or 3 successive 10 min washes. In each case, Diphoterine significantly removed more sulfur mustard than the other two treatments. For the 3 successive washes, Diphoterine removed 50% of the applied agent compared to 37% for soapy water and 32% for physiological saline. 

Decontamination of conventional wounds in a contaminated environment continues to be a major concern. Researchers have looked at the effect of bleach decontamination on damaged skin exposed to CWAs. Gold et al. (1994) evaluated the effects of water or diluted bleach (0.5%) as a wound decontaminant 2 min after hairless guinea pig was exposed to sulfur mustard. The study found that 0.5% hypochlorite and even water soaking for 5 min in a wound contaminated with sulfur mustard (20 mg/kg) cause greater necrosis than when no decontamination was carried out. This does not mean that the wound should not be decontaminated but rather that bleach soaking in the wound is not the route to decontaminant. 

Hobson and Snider (1992) evaluated the effectiveness of hypochlorite solutions in decontaminating rabbit intact skin and wounds exposed to VX or sulfur mustard. When the intact skin was decontaminated with bleach at 5% or 0.5% hypochlorite concentrations 1 min after sulfur mustard exposure, lesion areas were reduced by 4.6- and 4.3-fold, respectively. For VX-contaminated intact skin, 5% and 0.5% sodium hypochlorite increased the median lethal dose of VX by 19- and 16-fold, respectively. The results indicate that 0.5 % bleach is as effective as 5 % in decontaminating sulfur mustard and VX on intact skin. However, when VX was applied to a wound site, the 0.5% bleach was not effective in increasing survival rate, whereas 5% bleach increased the median lethal dose 2-fold. 

Gerasimo, P., Blomet, J., Mathieu, L., and Hall, A., Diphoterine decontamination of C14—sulfur mustard contaminated human skin fragments in vitro. Toxicologist, 54(1), 152, 2000. 

Snider, T.H., Jarvis, R.J., Matthews, M.C.,etal., 2003. Contract DAMD17-99-D-0010, Task 0010, Assessment of Personal Skin Decontaminants Against Topical Challenges of Sulfur Mustard. Conducted at Battelle Memorial Institute Medical Research and Evaluation Facility, Columbus, OH 43201-2693. 

---