Background: Sulfur Mustard (SM), a chemical agent that is fat soluble with garlic-like or
mustard odor and it needs moisture for activation. The mustard agent has alkylating, blistering and
vesicating properties. Various cellular and molecular mechanisms of different signaling pathways are
responsible for these acute and delayed cutaneous complications in the SM-exposed victims. The aim
of this study is to review these mechanisms and signaling pathways.
Methods: Published articles, books, and conference papers were searched in PubMed, Scopus and
Google Scholar using relevant keywords to find studies describing the mechanisms of SM-induced
Results: Ninety percent of the SM-exposed victims show cutaneous lesions. Erythema, small vesicle,
large blisters, erosion and partial or complete skin loss, are an acute sign of cutaneous SM exposure.
Burning, dry skin, hypo and hyperpigmentation, pain, pruritus, redness are the most common chronic
complications of SM-exposure. Various cellular and molecular mechanisms such as DNA adduct
formation, inflammation, oxidative stress, and apoptosis are responsible for these acute and delayed
cutaneous complications in the SM-exposed victims.
Conclusion: Inflammation and formation of blister, ulcer and pseudomembrane are consequences of
SM exposure in the skin. Cellular infiltration, separation of cell layers and cell death are responsible
for these complications.