Severe cutaneous reaction to CS gas

Varma, Sandeep; Holt, P.J.A.

doi:10.1046/j.1365-2230.2001.00806.x

Cited by 30 publications

(24 citation statements)

References 12 publications

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“…Dermal contact to CS typically causes a tingling or burning sensation,16 28 34 37 39 40 43 65 66 but prolonged exposure can lead to a range of other adverse effects, including erythema, oedema, blistering and superficial burns 16 30–32 36 41 43 56 59 65 67–71. The latter more severe dermal symptoms are more commonly encountered with exposure to CN, which tends to cause more severe dermal injuries than CS.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Additionally, adverse skin effects may be accentuated by moisture such as from perspiration, lacrimation, rhinorrhoea or high humidity 17 27 28 32 67 71. Further dermal effects, including irritant or allergic contact dermatitis and acute generalised exanthematous pustulosis, may be delayed in onset, not presenting until 12–24 h or longer post-exposure 41 43 59 65 69 70 72–75 77 78 81 82. Additional risks in riot control situations where tear gases are used include burns from direct contact with the hot metal canister used to disperse these agents or burns caused by the flame generated by the pyrotechnic mixture used 31 68 82…”

Section: Clinical Featuresmentioning

confidence: 99%

“…It is rare that severe contact dermatitis occurs,87 in which case it is generally treated with topical corticosteroids and/or antihistamines such as diphenhydramine; systemic steroids may be required if symptoms are severe. Significant chemical burns should be treated in the same way as thermal burns 1 18 33 41 43 64 81 83 87…”

Section: Managementmentioning

confidence: 99%

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Riot control agents: the tear gases CN, CS and OC—a medical review

2013

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Introduction2-Chloroacetophenone (CN),o-chlorobenzylidene malonitrile (CS) and oleoresin capsicum (OC) are common riot control agents. While serious systemic effects are uncommon, exposure to high concentrations may lead to severe complications and even death. The aim of this narrative review is to summarise all main aspects of the riot control agents CN, CS and OC toxicology, including mechanisms of toxicity, clinical features and management.MethodsOVID MEDLINE and ISI Web of Science were searched for terms associated with CN, CS and OC toxicity in humans and those describing the mechanism of action, clinical features and treatment protocols.ResultsCN, CS and OC are effective lacrimating agents; evidence for toxicity, as measured by the threshold for irritation, is greatest for CN, followed by CS and OC. Typically, ocular and respiratory tract irritation occurs within 20–60 s of exposure. Ocular effects involve blepharospasm, photophobia, conjunctivitis and periorbital oedema. Following inhalation, effects may include a stinging or burning sensation in the nose, tight chest, sore throat, coughing, dyspnoea and difficulty breathing. Dermal outcomes are variable, more severe for CN and include dermal irritation, bulla formation and subcutaneous oedema. Removal from the contaminated area and fresh air is a priority. There is no antidote; treatment consists of thorough decontamination and symptom-directed supportive care. Ocular exposure requires thorough eye decontamination, an eye exam and appropriate pain management. Monitoring and support of respiratory function is important in patients with significant respiratory symptoms. Standard treatment protocols may be required with patients with pre-existing respiratory conditions. Dermal exposures may require systemic steroids for patients who develop delayed contact dermatitis.ConclusionsCN, CS and OC are effective riot control agents. In the majority of exposures, significant clinical effects are not anticipated. The irritant effects can be minimised both by rapid evacuation from sites of exposure, decontamination and appropriate supportive care.

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Section: Clinical Featuresmentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

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Riot control agents: the tear gases CN, CS and OC—a medical review

2013

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“…[7][8][9] Varma and Holt report a case of severe contact dermatitis. 10 Further case reports record delayed effects with various types of dermatitis and blisters. [11][12][13][14][15] No deaths have been attributed to CS.…”

mentioning

confidence: 99%

An investigation into the short term and medium term health impacts of personal incapacitant sprays. A follow up of patients reported to the National Poisons Information Service (London)

Euripidou

MacLehose²,

Fletcher³

2004

Emergency Medicine Journal

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Objectives: The aim of this study is to describe the pattern of ill health after personal incapacitant spray (PIS) exposures reported to the National Poisons Information Service-London (NPIS-L) and the Chemical Incident Response Service and to evaluate the relation between sub-categories of PIS exposure and adverse health effects. Methods: Case series study of patients reported to the NPIS-L, by attending medical personnel during the period 16 January to 31 September 1998. Data collected by questionnaire sent to these medical personnel.Results: Several ''adverse'' symptoms, particularly dermatitis and blisters were reported for cases exposed to police PIS. These cases were more frequent than in those people exposed to non-police PIS. Adverse effects occurring more than six hours after exposure were also observed, which is in conflict with the recorded immediate, short lived, and self limiting symptoms that PIS are designed to cause. Most patients with persisting symptoms required further treatment. Conclusions: These findings suggest that the formulation of CS (o-chlorobenzylidine malononitrile) with MiBK (methyl iso-butyl ketone) used by the police is more harmful that has been previously assumed. If confirmed then the continued use of this formulation should be reviewed because of longer duration of adverse effects. Less concentrated formulations may reduce the severity or persistence of the adverse effects. Most UK police forces now use hand held CS spray canisters containing O-chlorobenzylidine malononitrile dissolved in the solvent methyl iso-butyl ketone (MiBK). In 1996 the National Poisons Information ServiceLondon (NPIS-L) received over 750 emergency personal incapacitant spray (PIS) incident inquiries. This figure probably represents a small fraction of total PIS incidents reported in the UK as the NPIS-L is only usually contacted if advice on patient management is required.

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“…In one case the patient required intravenous antibiotics and systemic steroids on the second, separate, exposure to CS gas. 2 Healthcare professionals need guidance to help to reduce the chances of secondary exposure to irritant substances such as CS gas. CS gas lingers in hair and skin and therefore decontamination must form part of patient management (figure⇓).…”

mentioning

confidence: 99%