Do Syrian conflict survivors show novel chronic cutaneous sequelae from chlorine gas exposure: A case report and literature review

During the Syrian conflict, chlorine gas has increasingly been used as a chemical weapon, primarily causing acute respiratory injuries. However, chronic dermatological sequelae remain poorly documented, complicating long-term healthcare planning. A 70-year-old Syrian man developed pruritic ulcerative lesions on the scalp and exposed skin areas following chlorine gas exposure during a December 2016 airstrike. These lesions persisted for months after the initial exposure. Initial symptoms included ocular irritation, coughing, and dyspnea. These respiratory symptoms resolved within 48 hours; however, progressive skin changes developed. Physical examination revealed well-defined, erythematous, hyperkeratotic lesions exhibiting epidermal necrosis on the scalp and extremities. Associated findings included alopecia and hair follicle atrophy. Histopathological examination demonstrated epidermal hyperkeratosis, hypergranulosis, and dermal fibrosis with chronic perivascular inflammation. Based on clinical presentation, exposure history, exclusion of alternative etiologies, and histopathological findings, a diagnosis of chlorine-induced chronic dermatitis due to chemical warfare agent exposure was established. Treatment included oral cetirizine, prednisolone, and topical corticosteroids. At the 3-month follow-up, the chronic disease remained stable, with persistent hyperkeratotic lesions showing no significant improvement in size, erythema, or morphology. Clinicians should recognize chronic dermatopathology as an integral component of chemical warfare injuries. International health agencies should develop comprehensive registries to document long-term effects of gas exposure and to guide therapeutic strategies in conflict-affected populations.