Weapons of War and Dermatology: A Comprehensive Review of Cutaneous Manifestations from Chemical Warfare Agents, Part I—Caustics, Vesicants, and Choking Agents

This comprehensive review, the first in a 2-part series, examines chemical warfare agents (CWAs) that primarily cause direct tissue damage, with emphasis on dermatologic manifestations. Despite international prohibitions through the Chemical Weapons Convention, CWAs continue to pose significant threats in contemporary conflicts. Part I focuses on caustics (corrosive agents), vesicants (including mustards, arsenicals, and halogenated oximes), and choking agents (ammonia, bromine, chlorine, phosphorus, and others), exploring their history, chemistry, pathophysiology, and clinical presentations. The review synthesizes current literature to identify knowledge gaps in recognizing and treating CWA-related cutaneous disorders, highlighting the limitations of conventional treatment protocols and the need for specialized dermatological expertise. Key findings include variability in clinical presentations and treatment protocols across different agents, with evidence suggesting that early intervention may significantly improve outcomes. Health care systems remain inadequately prepared for mass casualties from these weapons, necessitating improved clinician training, particularly for dermatologists who may play crucial roles in diagnosis and treatment. Future management strategies should explore novel decontamination approaches and targeted therapies. This first installment sets the foundation for Part II, which will examine nerve agents, cyanides, and riot control agents that primarily cause systemic toxicity with secondary cutaneous manifestations.