Long-Term Effects of Sulfur Mustard Poisoning in Iranian Chemical Warfare Victims: A Systematic Review

Long-term effects of sulfur mustard poisoning have been investigated in several studies. This study was performed to systematically summarize the results of papers about physical effects of sulfur mustard poisoning in Iranian chemical warfare victims. Scientific Information Databases (SID), IranMedex, and Magiran were searched for articles published from 1988 to November 2012. 128 papers were found by using sulfur mustard, complication, and chemical agent as keywords. Overall, 64 papers were excluded due to irrelevant abstracts or titles. After revisions, only 25 studies were selected for final assessments. The reviewed studies had reported prevalence of long-term dermatological, ophthalmological, and respiratory complications as 89.8%, 88.2%, and 83.6%, respectively. Chronic dermatological complications were mainly chronic severe itching, scars, dry skin, and skin discoloration. Ophthalmological complications included pinguecula, pterygium, chronic conjunctivitis, vascular tortuosity, limbal ischemia, thin corneas, diffuse corneal opacity, dry eye, and keratitis and their clinical symptoms. Respiratory complications were mainly obstructive chronic bronchitis, bronchiolitis, bronchiectasis, asthma, and fibrosis. Respiratory and ophthalmological symptoms were strongly associated with each other. Long-term dermatological complications were the most prevalent problems caused by sulfur mustard exposure. Ophthalmological and respiratory complications were the second and third most frequent problems. However, respiratory complications had more burden and severity and their incidence and severity increased by increasing age. Oligospermia was not confirmed. There was an increased incidence of leukemia but strong evidence for a direct effect of mustard gas on cancer (less than 30 years after exposure) was not found.