Late cutaneous complications in chemical warfare victims in Kerman province

Abstract

Iraq has used chemical warfare agents in recent Iran-Iraq conflict ( 1980-88) . There are few studies regarding late complications of chemical warfare and there is no report concerning late cutaneous complications. The present study is concerned with the late clinical manifestation of cutaneous complications in chemical warfare casualties in comparison to non – chemical injured soldiers. Upon this, we have selected in random 500 chemical warfare exposed victims and 500 non- chemical injured soldiers as a control group. From the files in the Kerman branch of Iranian foundation of War casualties. For 3 successive years ( 1992-1995), in 3 months intervals each case was examined physically accompanied by thorough cutaneous examination and skin biopsy was taken when it was clinically indicated. Skin complications which were found in chemical warfare victims more than the control group were as follows: dryness of the skin to 7 folds severe dryness of the skin to 19 folds burning of the skin to 23.2 folds, pruritus to 5 folds, hyperpigmentation to 6 folds , chronic articaria to 5 hypopigmentation to 4 folds , scaling to 5 folds, diffuse hair loss to 1.7 folds, alopecia arearia to 5.5 folds, eczema to 9.3 folds, and vitiligo to 18 folds. All of these differences were statistically significant. Apparently normal skin was 2 folds less frequent in chemical warfare victims than in control group. In contrast to these findings, Acne vulgaris and tinea- versicolor were noted in 5.2℅ and 7.4℅ of non – chemical crash injured soldiers respectively, but absent in chemical warfare exposed victims. Although non- chemical crash injured soldiers were younger than chemical warfare victims ( 30.6 +_5.7 years vs. 32.1+_ 7.6 years) and this difference was statistically significant ( p<0.001) . The prevalence of each disorder was adjusted for age. After adjustment , differences were still present. Based cell epithelium (0.2℅) and chronic myelogenous leukemia with purpuric eruption in the skin (0.4℅) were observed only in chemical warfare victims. In spite of skin dryness in about 50℅ of chemical warfare exposed victims, skin biopsies revealed neither a decrease in the number, nor in the size of the sebaceous glands of eccrine sweat glands, which were the main target of injury after the sulfur mustard gas exposure. Specific tests for measuring the amount of secretion of the eccrine sweat glands have been performed on 60 chemical warfare victims which revealed no sign of decrease in the activity of these glands.