OBJECTIVE: To increase awareness of the widespread environmental prevalence of the chemical warfare agent mustard gas, examine the acute and chronic toxic effects to exposed humans, and discuss medical treatment guidelines for mustard gas exposures.

DATA SOURCES: Literature retrieval of medical case reports and clinical studies was accomplished using PubMed and the Cochrane Database (1919-March 2007). Search terms included mustard, mustard gas, sulfur mustard, chemical warfare, blister agents, vesicants, and war gas. Historical information and current events were accessed through military field manuals and Internet searches.

STUDY SELECTION AND DATA EXTRACTION: All articles in English identified from the data sources were evaluated. Adult and pediatric populations were included in the review.

DATA SYNTHESIS: Mustard gas and other chemical weapons are feared for their use as weapons of terror; however, the major threat of mustard gas lies elsewhere. Tons of this chemical agent were produced for war, then subsequently buried in landfills, disposed of at sea, or left to decay in storage facilities. There are documented and anecdotal reports of chemical weapon burial sites and ocean dumps across the globe spanning from the Arctic Circle to Australia. Numerous accidental exposures have occurred over the past decade. Mustard gas is corrosive to the skin, eyes, and respiratory tract. Extensive exposures can also affect other organ systems. Its ability to cause harm to multiple organ systems at extremely low doses in virtually any environmental condition makes it an extremely dangerous agent. Immediate decontamination of people exposed to mustard gas liquids and vapors is paramount. Supportive care and long-term followup is necessary for exposed persons. Research is under way to find antidotes or treatment methods for mustard gas exposure, but currently there are no definitive treatment guidelines.

CONCLUSIONS: Mustard gas is a weapon, but also a prevalent environmental threat. Recognizing the immense environmental presence of mustard gas disposal sites and the signs and symptoms of exposure will help speed treatment to those accidentally or purposefully exposed.

Key Words: blister agent, chemical burns, chemical warfare agent, mustard gas, sulfur mustard, toxicology, vesicant.

Ann Pharmacother 2008;42:237-46.
Published Online, 22 Jan 2008. www.theannals.com, DOI 10.1345/aph.1K445