Sulphur mustard induced poikiloderma: a case report

Sulphur Mustard is a potent chemical warfare agent that was widely used during first world war and Iran ‌Iraq conflict. Over 100,000 Iranians were injured by sulphur mustard and one-third is of them were suffering from late effects until today. This vesicant agent has a lot of acute and chronic destructive effects on the skin, eye and respiratory system. Sulphur mustard via the alkylations of several cellular proteins (structural, cytoplasmic and enzymes) and cell nuclei, produce several toxic, mutagenic and carcinogenic effects on epidermis, dermis, dermal appendages and hypodermis. We report a 41-year-old man who was poisoned with sulphur mustard in 1988.After exposure he developed severe skin blisters on upper trunk, posterior aspect of both hands and genitalia along with ocular and respiratory complications. He also had atrophy, pigmentation and vascular changes on skin of penis with pigmentation, atrophy and related findings in histopathologic studies, so the diagnosis of "sulphur mustard induced poikiloderma" was postulated. The absence of any complication on palms despite of their recurrent exposure to sulphur mustard is another remarkable finding in this case. It has been suggested that palms can act as a transport vector of sulphur mustard to other sites of skin.