4. Erythema of Skin from General Exposure to Mustard Gas Vapour
Dermatitis of this distribution, associated with conjunctivitis, forms a picture characteristic of poisoning by this vesicant.
History of the case. Exposed to mustard gas at Ypres on the 12th July, 1917, when this substance was first employed by the enemy. Wore box respirator for only 30 minutes, so that he was exposed without any protection for nearly four hours. No symptoms were felt until some hours later, when severe vomiting commenced and conjunctivitis developed.
Drawing made on the fifth day. The laryngitis and bronchitis were slight, so that the poisonous vapour must have acted only in low concentration. But the reddening of the skin was fairly intense because the man had been sweating freely when exposed to the gas, and he was not washed afterwards nor was his clothing changed. The erythema was succeeded by staining in the same areas of the skin.
Plate 4
This reddening, as though the skin had been scorched or deeply sunburned, is the first cutaneous reaction to mustard gas, though it sometimes may not appear until several days after exposure. It is accompanied by only a slight feeling of warmth, but the irritation is frequently severe. In addition to the face and arms which are directly exposed to the vapour in the air, the moist surfaces of the axffix, the flexures of the elbows, and the perineum and inner surfaces of the thighs are particularly affected, that is, in the places where the skin is often sodden with fatty perspiration. This special distribution of the diffuse erythema characterizes the general dermatitis of mustard gas vapour, but the reaction may be limited to a smaller area in any part of the body, for example where the clothing may have chanced to be splashed by the liquid.
This inflammatory reaction is chiefly superficial, and is not accompanied by much oedema of the subcutaneous tissues except in the eyelids and over. the penis and scrotum. Later the dusky-red colour deepens, and patches of cyanotic or whitish oedema may arise amid it. Blisters then appear, and the cuticle becomes excoriated; or the skin may be retained while the erythema fades and a brown staining slowly darkens the original area of irritation.