A review on delayed toxic effects of sulfur mustard in Iranian veterans

Mustard gas or sulfur mustard is a chemical warfare agent (King of the battle gases) [1] with cytotoxic, vesicant and blistering effects on exposed skin [2]. This agent can enter the body through various routes including the skin, the respiratory system, conjunctiva and the gastrointestinal system by contaminated foods [3]. It can cause both acute and delayed manifestations and late complications even 40 years after the exposure as reported for victims of the first worldwar [4]. People can be exposed to small or large amounts of mustard gas through terroristic actions, wars, leakage from the factories, and even activities like fishing [5].Sulfur mustard can be easily produced. It has a delayed, extensive absorption, multi-organ effects and quick penetration. It is stable in the environment, has a low production cost, is easy to use and has the ability to debilitate soldiers [6,7]. After dissemination in an area, mustard gas remains in that area for a long time and makes that area non-habitable. Mustard gas victims temporarily lose their vision a few hours after exposure which is a critical strategy in warfare [7], and so far, it has been used in >10 military conflicts [8].Human losses related to destructive effects from this agent in the World War l are as follow: the soldiers were only equipped with protective breathing masks and lack of skin protection resulted in the death of more than 90,000 soldiers and about 1.3 million injured people [8] and out of which, 400,000 people required long term medical care [9]. According to the other reports mustard gas caused 14,000 injuries in the first 3 months of use in World War I and a total of 120,000 injuries [10]. In the US army, out of the total of 36,965 chemical warfare victims, 27,711 (75%) were due to sulfur mustard gas, and according to a report from the contamination control unit of the British army, of a total of 160,970 chemically injured soldiers, 124,752 (77.5%) had been injured by sulfur mustard gas. The great