are completely consistent with known effects of skin damage. Despite data highly suggestive of a link between skin diseases and arsenic exposure, very little data exist that can be directly extrapolated to exposure to the organic arsenical Lewisite and its consequences in the skin.
The evidence indicates a causal relationship between exposure to mustard agents and bone marrow depression and immune system dysfunction. These acute effects would render individuals highly susceptible to infections, including pneumonia, rheumatic fever, and tuberculosis, which in severe cases may cause permanent damage to vital organs. There is insufficient evidence with which to draw conclusions regarding the effects of Lewisite on immune system function.
Animal studies clearly demonstrate a causal relationship between exposure to mustard agents and immunotoxicity. Evidence from observations in humans indicates a causal relationship between mustard agent exposure and acute bone marrow toxicity expressed as leukopenia, pancytopenia, and aplastic or hypoplastic bone marrow. However, underrepresented in human studies is information on chronic or delayed effects. The data examined, however, indicate that clinical studies as a whole support a close parallelism between animal experiments and observations in humans regarding the immunosuppressive properties of mustard agents.
There is insufficient evidence to demonstrate a causal relationship between exposure to mustard agents and the development of long-term gastrointestinal, hematologic, or neurological diseases or dysfunctions, other than those secondary to other conditions related to exposure to mustard agents. In addition, there is insufficient information to link Lewisite with long-term health effects on the hematological, gastrointestinal, and neurological systems.
Gastrointestinal, hematological, and neurological effects are common after acute high exposures to mustard agents and can be attributed primarily to the known toxicological effects of these agents and secondarily to effects on other organ systems (e.g., from shock or burns). However, effects on these organ systems have not been a focus of any follow-up studies of humans exposed to mustard agents or Lewisite.
There is insufficient evidence to demonstrate a causal relationship between exposure to mustard agents or Lewisite and toxicity to the reproductive system.
The database is too small and uncertain to allow a clear understanding of human reproductive risk from exposure to sulfur mustards.