SULFUR MUSTARD - ITS CONTINUING THREAT AS A CHEMICAL WARFARE AGENT, THE CUTANEOUS LESIONS INDUCED, PROGRESS IN UNDERSTANDING ITS MECHANISM OF ACTION, ITS LONG-TERM HEALTH-EFFECTS, AND NEW DEVELOPMENTS FOR PROTECTION AND THERAPY

Although sulfur mustard (SM) has been used as a chemical warfare agent since the early twentieth century, it has reemerged in the past decad e as a major threat around the world. SM is an agent that is easily pr oduced even in underdeveloped countries and for which there is no effe ctive therapy. This agent is a potential threat not only on the battle field but also to civilian populations. The skin and other epithelial surfaces are the first targets as this agent is absorbed, and reaction s within the skin are the subject of active research into the mechanis m of action of this alkylating agent. The depletion of glutathione, ge neration of reactive oxygen species, and the formation of stable DNA a dducts remain theoretic and demonstrated by-products of SM exposure im plicated in the disease produced. However, new findings related to the effects of SM on the basement membrane zone; interest in delayed heal ing of the lesions induced; the inflammatory mediators, enzymes, and c ytokines that result; and cellular typing of the inflammatory infiltra te will increase our understanding of the pathophysiology of the lesio ns caused by SM. In addition, the recent development of a topical skin protectant for SM and for other chemical warfare agents may have broa d applications within dermatology.