Transcript Early Cutaneous Findings and Late Skin Complaints, Mousavi B

Chemical warfare victims: Early
cutaneous findings and late skin
complaints
Mousavi B, MD, MPH
Soroush MR, MD,
Honari G, MD
Janbazan Medical and Engineering Research Center (JMERC)
www.jmerc.ac.ir
Iran – Iraq war (1980-1988) :
200,000 lost their lives
400,000 war injured
Chemical warfare history
100,000 hospitalization
55000
chemical victims
10% Moderate & Severe
90% Mild
What is sulfur mustard gas?
AKA vesicants or blistering agent
Lipophilic liquids and cytotoxic alkylating
agent
Easy penetrate
Upon contacts with skin :

80 percent evaporates

20 percent penetrates the skin
10 percent binds to the skin sites
Mustard gas

Quickly cyclizes in tissue

Alkylates cell components
(DNA, proteins)

DNA damage leads to:


cell death
mutation
Direh
Study objectives
This study was part of a Health monitoring
project in chemical warfare victims
The specific objective of the study was to
assess the relationship between early and
late skin complaints in Chemical warfare
survivors suffering from moderate to
severe complications
Methods (N=149)
First,
All cases were interviewed for any skin complaints
Then,
History of the skin reactions at the time of exposure
- Patients recall, and
- Medical records
The most severe reactions were considered
Results
Mean age:
44.9 (SD 8.7) years
Range : 21-75 yrs
Mean age at the time of exposure:
23.3 (SD 8.5) years
Range: 1-53 yrs
Age Distribution
60%
50%
54.4%
40%
30%
20%
25.2%
10.9%
9.5%
10%
0%
<30
30-39
40-49
>50
Results
Marital status:
Married: 146
Single: 3
Education :
Illiterate: 10.7%
Less than 12 yrs of education: 35.5%
High school certificate and above: 53.8%
Results
Time of Chemical Exposure:

1985 – 1986 83%
 1985:
58.5%
 1986: 24.5%
Exposure frequency: (1-6)
33.7% (n= 50) > once
Results
Early cutaneous findings were based on:


Medical records : 21% (n = 31)
Patient recall
: 79% (n = 118)
Skin complaints at the time of study
100%
92.6%
80%
60%
40%
20%
7.4%
0%
Yes
No
Skin complaints at the time of study
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
83.9%
72.5%
57.0%
15.9%
i
it ch
ng
nin
r
u
b
g
s
dry
ki n
oth
er
Skin lesions at the time of exposure
100%
91.9%
80%
60%
40%
20%
8.1%
0%
Yes
No
Cutaneous findings at the time of exposure
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
85.0%
86.6%
78.5%
n es
d
e
R
71.8%
s
te
Blis
r
ing
l
a
Sc
ti on
a
t
n
me
g
i
p
dis
Combination of skin lesions
Blister, redness, scaling and dispigmentation: 100(67.1%)
Redness, scaling and dispigmentation: 16 (10.1%)
Scaling and dispigmentation: 10 (6.7%)
No skin lesions : 12 (8.1%)
Results
A significant relationship between
early cutaneous lesions and
developing latent skin complaints
(Odds ratio =13.5, P<0.001)
Early cutaneous lesions and developing
latent skin complaints
Early cutaneous
lesions
Odds ratio
P value
14.3
.000
Redness
5.2
.006
Scaling
9.1
.000
Dispigmentation
6.8
.001
Blister
Discussion
Early cutaneous lesions
Risk of developing latent skin
complaints
Discussion
Odds of having blister
among cases with latent skin
complaints
Limitation:
Part of the data was collected based on patient
recall after 22 years of exposure
“Recall bias”
Peace is not a gift from God to man, but a
gift from man to himself