mustard gas


Summary: Severe irritant and vesicant of skin, eyes, and lungs. It may cause blindness and lethal lung edema and was formerly used as a war gas. The substance has been proposed as a cytostatic and for treatment of psoriasis. It has been listed as a known carcinogen in the Fourth Annual Report on Carcinogens (NTP-85-002, 1985) (Merck, 11th ed).

Top Publications

  1. Hosseini Khalili A, Thompson J, Kehoe A, Hopkinson N, Khoshbaten A, Soroush M, et al. Angiotensin-converting enzyme genotype and late respiratory complications of mustard gas exposure. BMC Pulm Med. 2008;8:15 pubmed publisher
    Exposure to mustard gas frequently results in long-term respiratory complications. However the factors which drive the development and progression of these complications remain unclear...
  2. Emadi S, Mortazavi M, Mortazavi H. Late cutaneous manifestations 14 to 20 years after wartime exposure to sulfur mustard gas: a long-term investigation. Arch Dermatol. 2008;144:1059-61 pubmed publisher
  3. Emad A, Emad Y. Levels of cytokine in bronchoalveolar lavage (BAL) fluid in patients with pulmonary fibrosis due to sulfur mustard gas inhalation. J Interferon Cytokine Res. 2007;27:38-43 pubmed
    ..Nineteen veterans had mustard gas-induced PF, and 19 normal veterans were used as a control group...
  4. Vijayaraghavan R, Gautam A, Kumar O, Pant S, Sharma M, Singh S, et al. Protective effect of ethanolic and water extracts of sea buckthorn (Hippophae rhamnoides L.) against the toxic effects of mustard gas. Indian J Exp Biol. 2006;44:821-31 pubmed
    ..The present study shows that percutaneous administration of SM induces oxidative stress and ethanolic extract of leaf of H. rhamnoides and H. rhamnoides flavone from fruit can significantly protect it...
  5. Paromov V, Qui M, Yang H, Smith M, Stone W. The influence of N-acetyl-L-cysteine on oxidative stress and nitric oxide synthesis in stimulated macrophages treated with a mustard gas analogue. BMC Cell Biol. 2008;9:33 pubmed publisher
    Sulphur mustard gas, 2, 2'-dichlorodiethyl sulphide (HD), is a chemical warfare agent...
  6. Ghaedi G, Ghasemi H, Mousavi B, Soroush M, Rahnama P, Jafari F, et al. Impact of psychological problems in chemical warfare survivors with severe ophthalmologic complication, a cross sectional study. Health Qual Life Outcomes. 2012;10:36 pubmed publisher
    ..The study showed that severe ophthalmologic complications in chemical survivors are accompanied with destructive effects on psychological health status. Appropriate management may improve psychological health status in these patients. ..
  7. Emad A, Emad Y. Relationship between eosinophilia and levels of chemokines (CCL5 and CCL11) and IL-5 in bronchoalveolar lavage fluid of patients with mustard gas-induced pulmonary fibrosis. J Clin Immunol. 2007;27:605-12 pubmed
    ..Fifteen veterans with mustard gas-induced PF and 14 normal veterans as control group...
  8. Ghanei M, Amiri S, Akbari H, Kosari F, Khalili A, Alaeddini F, et al. Correlation of sulfur mustard exposure and tobacco use with expression (immunoreactivity) of p53 protein in bronchial epithelium of Iranian "mustard lung" patients. Mil Med. 2007;172:70-4 pubmed
    ..Initial data trends suggest an additive contribution of SM exposure and smoking to p53 immunoreactivity. These results illustrate the use of p53 immunoreactivity in the characterization of COPD, including mustard lung. ..
  9. Emad A, Emad V. Elevated levels of MCP-1, MIP-alpha and MIP-1 beta in the bronchoalveolar lavage (BAL) fluid of patients with mustard gas-induced pulmonary fibrosis. Toxicology. 2007;240:60-9 pubmed
    ..003; r=-0.48, p=0.04; respectively). Neutrophils alveolitis, presence of eosinophils, and higher concentrations of interleukin MCP-1, MIP-1 alpha, and MIP-1 beta in BAL fluid are associated with the development of fibrosis in SM victims. ..

More Information


  1. Geraci M. Mustard gas: imminent danger or eminent threat?. Ann Pharmacother. 2008;42:237-46 pubmed publisher
    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...
  2. Gould N, White C, Day B. A role for mitochondrial oxidative stress in sulfur mustard analog 2-chloroethyl ethyl sulfide-induced lung cell injury and antioxidant protection. J Pharmacol Exp Ther. 2009;328:732-9 pubmed publisher
    ..These findings suggest a role for oxidative stress in CEES toxicity and provide a rationale to investigate antioxidants as rescue agents in SM exposures. ..
  3. Hefazi M, Maleki M, Mahmoudi M, Tabatabaee A, Balali Mood M. Delayed complications of sulfur mustard poisoning in the skin and the immune system of Iranian veterans 16-20 years after exposure. Int J Dermatol. 2006;45:1025-31 pubmed
    ..Although skin is a major transporting system for SM's systemic absorption, there is probably no correlation between the severity of late cutaneous and immunological complications of SM poisoning. ..
  4. Tewari Singh N, Rana S, Gu M, Pal A, Orlicky D, White C, et al. Inflammatory biomarkers of sulfur mustard analog 2-chloroethyl ethyl sulfide-induced skin injury in SKH-1 hairless mice. Toxicol Sci. 2009;108:194-206 pubmed publisher
  5. Wattana M, Bey T. Mustard gas or sulfur mustard: an old chemical agent as a new terrorist threat. Prehosp Disaster Med. 2009;24:19-29; discussion 30-1 pubmed
  6. Hosseini Khalili A, Haines D, Modirian E, Soroush M, Khateri S, Joshi R, et al. Mustard gas exposure and carcinogenesis of lung. Mutat Res. 2009;678:1-6 pubmed publisher
    Sulfur mustard (SM), also known as mustard gas, is an alkylating compound used as a chemical weapon in World War I and by Iraqi forces against Iranians and indigenous Iraqi Kurds during the Iran-Iraq War of the 1980s...
  7. Ghanei M, Poursaleh Z, Harandi A, Emadi S, Emadi S. Acute and chronic effects of sulfur mustard on the skin: a comprehensive review. Cutan Ocul Toxicol. 2010;29:269-77 pubmed publisher
    ..The aim of this article is to review the acute and long-term cutaneous findings resulting from SM exposure. Also, cellular and molecular mechanism involved in SM-induced skin pathology have been discussed. ..
  8. Taghaddosinejad F, Fayyaz A, Behnoush B. Pulmonary complications of mustard gas exposure: a study on cadavers. Acta Med Iran. 2011;49:233-6 pubmed
    Sulfur mustard gas is one of the chemical warfare gases that roughly about 45000 soldiers continue to suffer long-lasting consequences of exposure during the Iran-Iraq war between 1980 and 1988...
  9. Kadar T, Dachir S, Cohen L, Sahar R, Fishbine E, Cohen M, et al. Ocular injuries following sulfur mustard exposure--pathological mechanism and potential therapy. Toxicology. 2009;263:59-69 pubmed publisher
    ..Further studies are required to investigate the effects of SM on epithelial stem cells and their involvement in the pathogenesis of the long-term injuries. ..
  10. Mousavi B, Soroush M, Montazeri A. Quality of life in chemical warfare survivors with ophthalmologic injuries: the first results form Iran Chemical Warfare Victims Health Assessment Study. Health Qual Life Outcomes. 2009;7:2 pubmed publisher
    ..the health related quality of life (HRQOL) in people who had ophthalmologic complications due to the sulfur mustard gas exposure during the war...
  11. Pal A, Tewari Singh N, Gu M, Agarwal C, Huang J, Day B, et al. Sulfur mustard analog induces oxidative stress and activates signaling cascades in the skin of SKH-1 hairless mice. Free Radic Biol Med. 2009;47:1640-51 pubmed publisher
    ..These novel molecular targets could be supportive in the development of prophylactic and therapeutic interventions against HD-related skin injury. ..
  12. Smith W. Therapeutic options to treat sulfur mustard poisoning--the road ahead. Toxicology. 2009;263:70-3 pubmed publisher
  13. Shohrati M, Peyman M, Peyman A, Davoudi M, Ghanei M. Cutaneous and ocular late complications of sulfur mustard in Iranian veterans. Cutan Ocul Toxicol. 2007;26:73-81 pubmed
    ..Also this agent is causes of chronic and delayed destructive lesions in the ocular surface and cornea, leading to progressive visual deterioration and ocular irritation. ..
  14. Hefazi M, Attaran D, Mahmoudi M, Balali Mood M. Late respiratory complications of mustard gas poisoning in Iranian veterans. Inhal Toxicol. 2005;17:587-92 pubmed
    b>Mustard gas or sulfur mustard (SM) is an alkylating chemical warfare agent that was widely used during the World War I and in the Iran-Iraq conflict...
  15. Beheshti J, Mark E, Akbaei H, Aslani J, Ghanei M. Mustard lung secrets: long term clinicopathological study following mustard gas exposure. Pathol Res Pract. 2006;202:739-44 pubmed
    ..Two out of 14 cases showed changes suggestive of OP. Inhalation of SM can lead to persistant and clinically significant lung disease, including bronchial mucosal injury and OP, many years after exposure. ..
  16. Gholamrezanezhad A, Saghari M, Vakili A, Mirpour S, Farahani M. Myocardial perfusion abnormalities in chemical warfare patients intoxicated with mustard gas. Int J Cardiovasc Imaging. 2007;23:197-205 pubmed
    ..Based on the results, the pattern of myocardial perfusion in these patients is significantly different from normal controls, which could resemble either coronary artery disease or mild cardiomyopathic changes. ..
  17. Medvedeva N, Polyak Y, Kuzikova I, Orlova O, Zharikov G. The effect of mustard gas on the biological activity of soil. Environ Res. 2008;106:289-95 pubmed
    A special group of substances that are very dangerous for the biosphere includes war gases such as mustard gas (bis(2-chloroethyl)sulphide)...
  18. Ghabili K, Agutter P, Ghanei M, Ansarin K, Shoja M. Mustard gas toxicity: the acute and chronic pathological effects. J Appl Toxicol. 2010;30:627-43 pubmed publisher
    Ever since it was first used in armed conflict, mustard gas (sulfur mustard, MG) has been known to cause a wide range of acute and chronic injuries to exposure victims...
  19. Naderi M, Jadidi K, Falahati F, Alavi S. The effect of sulfur mustard and nitrogen mustard on corneal collagen degradation induced by the enzyme collagenase. Cutan Ocul Toxicol. 2010;29:234-40 pubmed publisher
    ..The main result of this study confirms the hypothesis that SM inhibits the effect of collagenase on corneal collagen. ..
  20. Shohrati M, Ghanei M, Shamspour N, Babaei F, Abadi M, Jafari M, et al. Glutathione and malondialdehyde levels in late pulmonary complications of sulfur mustard intoxication. Lung. 2010;188:77-83 pubmed publisher
    ..These findings encourage us to examine therapeutic measures to correct such imbalances in future studies. ..
  21. Ghanei M, Akbari Moqadam F, Mohammad M, Aslani J. Tracheobronchomalacia and air trapping after mustard gas exposure. Am J Respir Crit Care Med. 2006;173:304-9 pubmed
    b>Mustard gas primarily affects the eyes, skin, and particularly the respiratory tract...
  22. Ghasemi H, Ghazanfari T, Ghassemi Broumand M, Javadi M, Babaei M, Soroush M, et al. Long-term ocular consequences of sulfur mustard in seriously eye-injured war veterans. Cutan Ocul Toxicol. 2009;28:71-7 pubmed publisher
    ..Although many descriptive studies about SM-induced ocular injuries are present in the medical literature, few of them have been conducted over a large group with serious ocular involvement...
  23. Balali Mood M, Hefazi M. Comparison of early and late toxic effects of sulfur mustard in Iranian veterans. Basic Clin Pharmacol Toxicol. 2006;99:273-82 pubmed
    ..Being suggested as the main cause ofassociated with malignancies and recurrent infections, natural killer cells were significantly lower 16 to 20 years after intoxication. ..
  24. Ghanei M, Shohrati M, Jafari M, Ghaderi S, Alaeddini F, Aslani J. N-acetylcysteine improves the clinical conditions of mustard gas-exposed patients with normal pulmonary function test. Basic Clin Pharmacol Toxicol. 2008;103:428-32 pubmed publisher
    ..It also prevents sulfur mustard-induced oxidative stress, and can be used in the treatment of sulfur mustard-induced pulmonary disease. ..
  25. Paromov V, Brannon M, Kumari S, Samala M, Qui M, Smith M, et al. Sodium pyruvate modulates cell death pathways in HaCaT keratinocytes exposed to half-mustard gas. Int J Toxicol. 2011;30:197-206 pubmed publisher
    2-Chloroethyl ethyl sulfide (CEES) or half-mustard gas, a sulfur mustard (HD) analog, is a genotoxic agent that causes oxidative stress and induces both apoptotic and necrotic cell death...
  26. Laskin J, Black A, Jan Y, Sinko P, Heindel N, Sunil V, et al. Oxidants and antioxidants in sulfur mustard-induced injury. Ann N Y Acad Sci. 2010;1203:92-100 pubmed publisher
    ..These data indicate that drugs that target oxidative stress pathways may represent important candidates for reducing SM-induced tissue injury. ..
  27. Ghanei M, Tazelaar H, Chilosi M, Harandi A, Peyman M, Akbari H, et al. An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients. Respir Med. 2008;102:825-30 pubmed publisher
    ..Fifteen patients with chronic respiratory disease from mustard gas exposure were divided into severe (6 cases) and mild exposure (9 cases)...
  28. Etezad Razavi M, Mahmoudi M, Hefazi M, Balali Mood M. Delayed ocular complications of mustard gas poisoning and the relationship with respiratory and cutaneous complications. Clin Exp Ophthalmol. 2006;34:342-6 pubmed
    ..Late complications of SM poisoning in the eyes, respiratory system and skin are mainly due to SM's local irritant effects. ..
  29. Attaran D, Khajedaloui M, Jafarzadeh R, Mazloomi M. Health-related quality of life in patients with chemical warfare-induced chronic obstructive pulmonary disease. Arch Iran Med. 2006;9:359-63 pubmed
    ..This study showed that lower lung functions as assessed by the St George Respiratory Questionnaire worsen the quality of life in patients with chemical warfare-induced chronic obstructive pulmonary disease. ..
  30. Mukhopadhyay S, Rajaratnam V, Mukherjee S, Smith M, Das S. Modulation of the expression of superoxide dismutase gene in lung injury by 2-chloroethyl ethyl sulfide, a mustard analog. J Biochem Mol Toxicol. 2006;20:142-9 pubmed
    b>Mustard gas exposure causes inflammatory lung diseases. Many inflammatory lung diseases are associated with oxidative stress. Reactive oxygen species (ROS) are involved in the maintenance of physiological functions...
  31. Jowsey P, Williams F, Blain P. DNA damage, signalling and repair after exposure of cells to the sulphur mustard analogue 2-chloroethyl ethyl sulphide. Toxicology. 2009;257:105-12 pubmed publisher
    ..Finally, CEES was found to induce the phosphorylation of p53 and Chk2 and these events were mediated by both the ATM ataxia telangiectasia mutated and ATR (ATM and Rad-3 related) protein kinases. ..
  32. McNutt P, Hamilton T, Nelson M, Adkins A, Swartz A, Lawrence R, et al. Pathogenesis of acute and delayed corneal lesions after ocular exposure to sulfur mustard vapor. Cornea. 2012;31:280-90 pubmed publisher
    ..Although lesions resulting from ocular exposure often resolve clinically, an idiopathic delayed mustard gas keratopathy (MGK) can develop after a moderate or severe exposure...
  33. Ghassemi Broumand M, Aslani J, Emadi S. Delayed ocular, pulmonary, and cutaneous complications of mustards in patients in the city of Sardasht, Iran. Cutan Ocul Toxicol. 2008;27:295-305 pubmed publisher
    ..In this case study, we evaluated 600 warfare patients aged 19 to 80 years whose mustard gas injury dated back to 19 years before evaluation in Sardasht. Our results showed that 5...
  34. Graham J, Stevenson R, Mitcheltree L, Hamilton T, Deckert R, Lee R, et al. Medical management of cutaneous sulfur mustard injuries. Toxicology. 2009;263:47-58 pubmed publisher
    ..Of the 12 treatment adjuncts examined, the most promising included Vacuum Assisted Closure, Amino-Plex Spray, and ReCell Autologous Cell Harvesting Device. ..
  35. Ghabili K, Agutter P, Ghanei M, Ansarin K, Panahi Y, Shoja M. Sulfur mustard toxicity: history, chemistry, pharmacokinetics, and pharmacodynamics. Crit Rev Toxicol. 2011;41:384-403 pubmed publisher
    ..In the present article we review this knowledge and relate the molecular-biological basis of SM toxicity, as far as it has been elucidated, to the pathological effects on exposure victims. ..
  36. Davoudi S, Keshavarz S, Sadr B, Shohrati M, Naghizadeh M, Farsinejad K, et al. Skin hydration and transepidermal water loss in patients with a history of sulfur mustard contact: a case-control study. J Eur Acad Dermatol Venereol. 2009;23:940-4 pubmed publisher
    ..Contact with sulfur mustard agent can alter biophysical properties of the skin--especially the function of stratum corneum as a barrier to water loss-several years after exposure. ..
  37. Minsavage G, Dillman J. Bifunctional alkylating agent-induced p53 and nonclassical nuclear factor kappaB responses and cell death are altered by caffeic acid phenethyl ester: a potential role for antioxidant/electrophilic response-element signaling. J Pharmacol Exp Ther. 2007;321:202-12 pubmed
  38. Steinritz D, Emmler J, Hintz M, Worek F, Kreppel H, Szinicz L, et al. Apoptosis in sulfur mustard treated A549 cell cultures. Life Sci. 2007;80:2199-201 pubmed
    ..In summary, our studies demonstrate that AChE activity may be a potential marker of apoptosis in A549 cells after SM injury. To what extent AChE is involved in apoptosis regulation during SM poisoning has to be further investigated. ..
  39. Black A, Joseph L, Casillas R, Heck D, Gerecke D, Sinko P, et al. Role of MAP kinases in regulating expression of antioxidants and inflammatory mediators in mouse keratinocytes following exposure to the half mustard, 2-chloroethyl ethyl sulfide. Toxicol Appl Pharmacol. 2010;245:352-60 pubmed publisher
    ..Inhibiting the capacity of keratinocytes to generate eicosanoids may be important in limiting inflammation and protecting the skin from vesicant-induced oxidative stress and injury. ..
  40. Jafari M, Ghanei M. Evaluation of plasma, erythrocytes, and bronchoalveolar lavage fluid antioxidant defense system in sulfur mustard-injured patients. Clin Toxicol (Phila). 2010;48:184-92 pubmed publisher
    ..The data suggest that oxidative damage might have an important role for patients exposed to SM. SM may induce an oxidative stress response by depleting the antioxidant defense systems and increasing lipid peroxidation in lung cells. ..
  41. Milhorn D, Hamilton T, Nelson M, McNutt P. Progression of ocular sulfur mustard injury: development of a model system. Ann N Y Acad Sci. 2010;1194:72-80 pubmed publisher
  42. Naraghi Z, Mansouri P, Mortazavi M. A clinicopathological study on acute cutaneous lesions induced by sulfur mustard gas (yperite). Eur J Dermatol. 2005;15:140-5 pubmed
    ..Clinical and laboratory findings of these 32 adult patients exposed to mustard gas were determined...
  43. Tewari Singh N, Agarwal C, Huang J, Day B, White C, Agarwal R. Efficacy of glutathione in ameliorating sulfur mustard analog-induced toxicity in cultured skin epidermal cells and in SKH-1 mouse skin in vivo. J Pharmacol Exp Ther. 2011;336:450-9 pubmed publisher
    ..Together, these results highlight GSH efficacy in ameliorating CEES-caused skin injury and further support the need for effective antioxidant countermeasures against skin injury by HD exposure. ..
  44. Jain A, Tewari Singh N, Orlicky D, White C, Agarwal R. 2-Chloroethyl ethyl sulfide causes microvesication and inflammation-related histopathological changes in male hairless mouse skin. Toxicology. 2011;282:129-38 pubmed publisher
  45. Jain A, Tewari Singh N, Gu M, Inturi S, White C, Agarwal R. Sulfur mustard analog, 2-chloroethyl ethyl sulfide-induced skin injury involves DNA damage and induction of inflammatory mediators, in part via oxidative stress, in SKH-1 hairless mouse skin. Toxicol Lett. 2011;205:293-301 pubmed publisher
    ..This study could help in identifying countermeasures that alone or in combination, can target the unveiled pathways for reducing skin injury in humans by SM. ..
  46. Ghanei M, Panahi Y, Mojtahedzadeh M, Khalili A, Aslani J. Effect of gamma interferon on lung function of mustard gas exposed patients, after 15 years. Pulm Pharmacol Ther. 2006;19:148-53 pubmed
    Bronchiolitis has been known to be among the main the pathological features of lung lesions in Mustard Gas (MG) exposed patients...
  47. Attaran D, Lari S, Khajehdaluee M, Ayatollahi H, Towhidi M, Asnaashari A, et al. Highly sensitive C-reactive protein levels in Iranian patients with pulmonary complication of sulfur mustard poisoning and its correlation with severity of airway diseases. Hum Exp Toxicol. 2009;28:739-45 pubmed publisher
    ..001). Our findings suggest that the serum hs-CRP level is increased in SM patients with COPD and may have a direct correlation with disease severity. It may then be used as a marker for the severity of COPD in patients with SM poisoning. ..
  48. Javadi M, Yazdani S, Sajjadi H, Jadidi K, Karimian F, Einollahi B, et al. Chronic and delayed-onset mustard gas keratitis: report of 48 patients and review of literature. Ophthalmology. 2005;112:617-25 pubmed
    To report the clinical features of 93 eyes of 48 patients with chronic and delayed-onset mustard gas keratitis. Clinicopathologic correlation in 5 eyes and a review of related literature are presented...
  49. Panahi Y, Davoodi S, Khalili H, Dashti Khavidaki S, Bigdeli M. Phenol and menthol in the treatment of chronic skin lesions following mustard gas exposure. Singapore Med J. 2007;48:392-5 pubmed
    ..This randomised, double-blinded clinical trial was performed in chemical warfare-injured veterans with mustard gas-induced pruritus. 80 subjects were selected randomly and divided into two equal groups...
  50. Qabar A, Nelson M, Guzman J, Corun C, Hwang B, Steinberg M. Modulation of sulfur mustard induced cell death in human epidermal keratinocytes using IL-10 and TNF-alpha. J Biochem Mol Toxicol. 2005;19:213-25 pubmed
    ..We, therefore, identify IL-10 and TNF-alpha signal transduction pathways and their components as possible candidates for early therapeutic intervention against sulfur mustard induced cell injury. ..
  51. Kehe K, Thiermann H, Balszuweit F, Eyer F, Steinritz D, Zilker T. Acute effects of sulfur mustard injury--Munich experiences. Toxicology. 2009;263:3-8 pubmed publisher
    ..3 patients needed tracheotomy. Chest X-ray did not yield abnormal observations. This presentation summarizes the experience of treating SM victims in Munich and discusses therapeutic implications. ..
  52. Mukherjee S, Stone W, Yang H, Smith M, Das S. Protection of half sulfur mustard gas-induced lung injury in guinea pigs by antioxidant liposomes. J Biochem Mol Toxicol. 2009;23:143-53 pubmed publisher
    The purpose of this study was to develop antioxidant liposomes as an antidote for mustard gas-induced lung injury in a guinea pig model...
  53. Javadi M, Baradaran Rafii A. Living-related conjunctival-limbal allograft for chronic or delayed-onset mustard gas keratopathy. Cornea. 2009;28:51-7 pubmed publisher
    ..the long-term outcomes of living-related stem cell transplantation in patients with delayed or chronic mustard gas keratopathy (MGK)...