Comparison of Skin Erythema and Melanin Level in Sulfur Mustard Induced Chronic Skin Lesions and Normal Skin

Background: Sulfur mustard gas is a chemical agent that has been used in many wars, especially in Iran-Iraq war. This chemical agent affects many organs including lungs, eyes and skin, causing numerous acute and chronic lesions including erythema and hyperpigmentation, respectively. This study was conducted to evaluate erythema and melanin in subjects with a history of exposure to sulfur mustard.Methods: This case-control study was done on 309 subjects. They were divided into four groups: sulfur mustard-exposed patients with skin lesions (n=87), sulfur mustard-exposed cases without current skin lesions (n=71), non sulfur mustard-exposed patients with dermatitis (n=78) and normal controls (n=74). Erythema and melanin were measured in 4 areas (forehead, suprasternal, palm and back of hands) by Mexameter MX18 (Courage-Khazaka, Germany).Results: Erythema was significantly lower in suprasternal and palmar aspect of hands in sulfur mustard-exposed patients with dermatitis (P<0.05) while there was no significant difference in other areas. In terms of melanin, there was a significant difference in the dorsal aspect of hands in all four groups (P<0.05), where patients with dermatitis (both sulfur mustard exposed and normal population) had higher levels of melanin, probably due to pruritus in such areas. Forehead melanin of the normal population was also significantly lower than other three groups (P<0.05) while there was no significant difference between the melanin level of sulfur mustard exposed subjects (with or without dermatitis) and patients with dermatitis.Conclusion: Sulfur mustard contact can affect erythema and melanin content of the skin.