Pathophysiological Effects of Sulfur Mustard on Skin and its Current Treatments: Possible Application of Phytochemicals

Abstract

Background: Sulfur-(SM) and nitrogen (NM)-based mustards are mutagenic incapacitating compounds that are widely used in vesicating chemical warfare and cause toxicity in many organs especially skin. SM, as a potent vesicating agent, contributes to the destruction of skin in dermis and epidermis layers. The progression of lesion is dependent on the concentration of SM and duration of exposure. Body responses start with pruritus, erythema, edema and xerosis, which lead to the accumulation of immune cells in the target sites and recruitment of mast cells and paracrine-mediated activity. Quickly pro-inflammatory effectors are accumulated in the epidermis, hair follicles, and sebaceous glands resulting in the destruction of basement membrane beneath epidermis. There is still no satisfactory countermeasure against SM-induced lesions in the clinical therapy and symptomatic or supportive treatments are routine management approaches. Objective: This review highlights recent progression of herbal medicines application in SM-induced injuries through illustrative examples also demonstrate their efficacies, properties and mechanism of actions as therapeutic agents. Conclusion: Phytochemicals and herbal extracts with anti-bacterial, anti-inflammatory and anti-oxidant properties have been recently shown to hold therapeutic promise against SM-induced cutaneous complications. The current review elaborates on the possible application of herbal medicines in the healing of SM-induced injuries.

Mitigation of Nitrogen Mustard–Induced Skin Injury by theβ-Blocker Carvedilol and Its Enantiomers

“…Since ROS formation and DNA damage, as well as DNA damage sensing, are interconnected (reviewed in (Srinivas et al, 2019)), the antioxidant property of carvedilol may be an alternative mechanism underlying the protective effect against NM. Supporting the ROS hypothesis, many studies reported ROS scavengers as experimental treatments for vesicant exposure (Bobb et al, 2005;Etemad et al, 2019;Hassanpour et al, 2021).…”

“…The early NM-induced inflammatory and apoptotic mechanisms depend on p53 (Inturi et al, 2013). Although several studies have focused on anti-inflammatory drugs and natural products against mustards over the past few decades (Bobb et al, 2005;Etemad et al, 2019;Hassanpour et al, 2021), no satisfactory therapeutic outcomes have been reported. One major limitation is the lack of knowledge of the specific mechanisms underlying NM-induced cutaneous inflammation.…”