Proteomics analysis of chronic skin injuries caused by mustard gas.

Sulfur mustard (SM) is an alkylating and forming chemical that was widely used by Iraqi forces during the Iran-Iraq wars. One of the target organs of SM is the skin. Understanding the mechanisms involved in the pathogenesis of SM may help better identify complications and find appropriate treatments. The current study collected ten SM-exposed patients with long-term skin complications and ten healthy individuals. Proteomics experiments were performed using the high-efficiency TMT10X method to evaluate the skin protein profile, and statistical bioinformatics methods were used to identify the differentially expressed proteins. One hundred twenty-nine proteins had different expressions between the two groups. Of these 129 proteins, 94 proteins had increased expression in veterans' skins, while the remaining 35 had decreased expression. The hub genes included RPS15, ACTN1, FLNA, HP, SDHC, and RPL29, and three modules were extracted from the PPI network analysis. Skin SM exposure can lead to oxidative stress, inflammation, apoptosis, and cell proliferation.

Atopic dermatitis: molecular, cellular, and clinical aspects.

Atopic dermatitis (AD) is a complicated, inflammatory skin disease, which numerous genetic and environmental factors play roles in its development. AD is categorized into different phenotypes and stages, although they are mostly similar in their pathophysiological aspects. Immune response alterations and structural distortions of the skin-barrier layer are evident in AD patients. Genetic makeup, lifestyle, and environment are also significantly involved in contextual factors. Genes involved in AD-susceptibility, including filaggrin and natural moisturizing, cause considerable structural modifications in the skin's lipid bilayer and cornified envelope. Additionally, the skin's decreased integrity and altered structure are accompanied by biochemical changes in the normal skin microflora's dysbiosis. The dynamic immunological responses, genetic susceptibilities, and structural modifications associated with AD's pathophysiology will be extensively discussed in this review, each according to the latest achievements and findings.

A Randomized Clinical Trial on Therapeutic Effects of Myrtus communis L. Cream on Chronic Skin Lesions and Quality of Life of Sulfur Mustard-exposed Veterans

Abstract: Sulfur mustard is one of the chemical warfare agent. It rapidly reacts with the cutaneous tissues and other tissues, leading to various devastating long-term effects on human health. Mustard-exposed veterans suffer from its chronic skin problems, including itching, burning sensation, and eczema. We aimed to evaluate the protective effects of Myrtus communis L. (myrtle) on chronic skin lesions and quality of life of sulfur mustard-exposed veterans. In this randomized, double-blind clinical trial, 60 sulfur mustard-exposed patients were evaluated. Thirty patients received myrtle essence 5% cream (case group) and 30 patients received Eucerin cream (placebo group) twice in a day for one month. Then, We assessed the chronic skin problems and itching-related parameters (such as the itching time, severity, distribution, frequency, and calculated itching score), duration of sleep, number of waking up at night, and quality of life in the both groups. Our analysis of data revealed that application of myrtle cream effectively decreased skin problems including; itching and burning sensation. Additionally, myrtle markedly decreased skin lesion symptoms such as excoriation in the case group as compared with before treatment. Noticeably, myrtle cream significantly improved quality of life of the patients in the case group. The present study provides more in-depth information regarding the protective role of myrtle on the sulfur mustard-induces skin complication. Also, myrtle effectively improved quality of life of the sulfur mustard-exposed veterans.

"Coffee plus honey" versus "topical steroid" in the treatment of chemotherapy-induced oral mucositis: a randomised controlled trial.

BACKGROUND: Oral mucositis is one of the common complications of cancer chemotherapy and about 40% of the patients who take chemotherapy protocols, experience this irritating problem. The purpose of this study was to draw comparison between the therapeutic effects of our treatment modalities (topical steroid, honey, honey plus coffee) in patients suffering from oral mucositis. METHODS: This was a double blinded randomised clinical trial of a total of 75 eligible adult participants which they randomly fell into three treatment groups. For all the participants a syrup-like solution was prepared. Each 600 grams of the product consisted of "20 eight-mg Betamethasone solution ampoules" in the Steroid (S) group, "300 grams of honey plus 20 grams of instant coffee" in the Honey plus Coffee (HC) group, and "300 grams of honey" for the Honey (H) group. The participants were told to sip 10 ml of the prescribed product, and then swallow it every three hours for one week. Severity of lesions was clinically evaluated before the treatment and also one week after the initiation of the intervention. This study adhered to the principles of the Declaration of Helsinki and guidelines of Good Clinical Practice. RESULTS: This study showed that all three treatment regimens reduce the severity of lesions. The best reduction in severity was achieved in HC group. H group and S group took the second and third places. In other words, honey plus coffee regimen was the most effective modality for the treatment of oral mucositis. CONCLUSION: Oral mucositis can be successfully treated by a combination of honey and coffee as an alternative medicine in a short time. Further investigations are warranted in this field. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT: 201104074737N3, (9 May 2011).

Serum levels of interleukins 2, 4, 6, and 10 in veterans with chronic sulfur mustard-induced pruritus: a cross-sectional study.

Inflammation is a key component in the pathogenesis of sulfur mustard (SM)-induced skin complications. Here, the levels of interleukin (IL) -2, IL-4, IL-6, and IL-10 were evaluated in patients with chronic SM-induced complications. Seventy-four serum samples were collected from SM-injured veterans (SM group; n = 37) and nonchemically injured patients (control group; n = 37) with skin pruritus. The levels of IL-2, IL-4, IL-6, and IL-10 were evaluated by sandwich enzyme-linked immunosorbant assay technique in both nil and mitogen medium. No significant difference was found in pruritus score between SM (74.16 +/- 5.93) and control (74.48 +/- 6.15) groups (P > .05). The mean serum concentrations of IL-2 and IL-6 were found to be significantly elevated in the control compared with the SM group (P < .05). However, no significant difference was observed between the study groups regarding serum levels of IL-4 and IL-10 (P > .05). Serum IL-2 (in both SM and control groups) and IL-6 (in the control group) concentrations were significantly correlated with pruritus score while no significant association was found for IL-4 and IL-10. Serum concentrations of IL-2, IL-6, and IL-10 are significantly decreased in SM-exposed patients with chronic pruritus. Such alterations might represent a plausible mechanism for tissue damage and skin itching following SM exposure. Therefore, variation of ILs may also contribute to skin pruritus induced by SM.

Pro-inflammatory cytokines among individuals with skin findings long-term after sulfur mustard exposure: Sardasht-Iran Cohort Study.

Sulfur mustard (SM) is a potent alkylating vesicant warfare chemical agent which causes severe damages to the interface organs, skin, lungs and eyes. The most common chronic skin lesions are mustard scars, xerosis, eczema, seborrheic dermatitis, cherry angioma and hyperpigmentation. This study is part of Sardasht-Iran Cohort Study (SICS) which was performed to compare the serum levels of inflammatory cytokines in SM-exposed individuals (n=372) with long-term relevant skin findings versus unexposed controls (n=128). Serum levels of pro-inflammatory cytokines including IL-1α, IL-1ß, IL-1Ra, IL-6, and TNF (tumor necrosis factor) were titrated using ELISA method, 79.9% (n=290) of the exposed group and 60.5% (n=98) of the control group showed skin findings. In the exposed group, 52.1% (n=189) had only skin findings (OSFE) and in the control group, 32% (n=41) had no problem (NC, normal). Median serum levels of cytokines IL-1α, IL-1ß, IL-1Ra, IL-6 and TNF-α in the OSFE group were: 1.077, 1.745, 25.640, 0.602 and 12.768 pg/ml, respectively. These values in normal controls were 1.889, 1.896, 32.190, 1.022 and 23.786 pg/ml, respectively which are higher than the corresponding values in the OSFE group, the differences were statistically significant only for IL-1α and TNF-α. This may be due to a damage incurred upon precursors of cytokine producing cells or failure of their functions, increase in suppressive mediators or other mechanisms which are not well known. More studies are needed in molecular dimensions of the immune and cytokine responses in the SM-exposed patients.

Relationship between levels of IFNγ, TNFα, and TGFß and pruritus in sulfur mustard-exposed veterans.

One of the foremost negative effects of sulfur mustard (SM) is chronic pruritus, which affects the quality-of-life. In the present study, pruritus was assessed in relation with inflammatory factors in the blood. Seventy-two blood samples were collected from SM-injured veterans of the Iran-Iraq War (Case Group; n = 36) and non-exposed patients (Control Group; n = 36) suffering from skin pruritus. Pruritus severity in all subjects was assessed, as were levels of IFNγ, TGFß, and TNFα. The results indicated that total pruritus severity did not significantly differ between the two groups. While WBC counts in Control patients were significantly higher than among the exposed veterans, there were no significant differences in levels of any specific WBC sub-classes. Levels of serum IFNγ and TGFß in the control subjects were significantly greater than those in the exposed veterans. In contrast, serum TNFα in the SM-exposed group appeared to be in the normal range, albeit significantly higher than that of the control group. A positive correlation between pruritus and each of the evaluated cytokines was noted in the Case Group. As for the non-SM-exposed veterans, correlations were significant only in the cases of IFNγ (stimulated) and TGFß. The results of the present study suggested that there might be a relationship between cytokine alterations and pruritus in SM-exposed veterans. Based on these studies, designing of new treatments to modulate blood levels of mediators might be helpful to decrease the problem of SM-induced pruritus, thereby improving the quality-of-life in exposed veterans.

Efficacy and safety of immunotherapy with interferon-gamma in the management of chronic sulfur mustard-induced cutaneous complications: comparison with topical betamethasone 1%.

The present trial investigated the efficacy of immunotherapy with interferon-gamma (IFN-γ) in the treatment of sulfur mustard (SM)-induced chronic skin complications. Forty subjects who were suffering from chronic skin complications of SM and were diagnosed to have severe atopic dermatitis, were assigned to IFN-γ (50 µg/m(2)) subcutaneously three times per week (n = 20) or betamethasone valerate topical cream 0.1% (n = 20) every night for 30 days. Extent and intensity of cutaneous complications was evaluated using scoring atopic dermatitis (SCORAD) index, and quality of life using dermatology life quality index (DLQI) at baseline and at the end of trial. SCORAD-A and SCORAD-B scores were significantly decreased in both IFN-γ and betamethasone. However, SCORAD-C score was decreased only in the IFN-γ group. There were significant reductions in overall as well as objective SCORAD scores in both groups. As for the magnitude of changes, treatment with IFN-γ was associated with greater reductions in overall, objective and segmented SCORAD scores compared to betamethasone. DLQI reduction was found to be significantly greater in the IFN-γ group. Promising improvements in quality life and clinical symptoms that was observed in the present study suggest the application of IFN-γ as an effective therapy for the management of SM-induced chronic skin complications.

Efficacy of Aloe vera/olive oil cream versus betamethasone cream for chronic skin lesions following sulfur mustard exposure: a randomized double-blind clinical trial.

BACKGROUND: Chronic pruritic skin lesions are among the common late complications of sulfur mustard intoxication. In the present randomized double-blind clinical trial, therapeutic efficacy of Aloe vera/olive oil combination cream in the alleviation of these lesions was evaluated and compared to that of betamethasone 0.1% cream. METHODS: Sixty-seven Iranian chemical warfare-injured veterans were randomized to apply A. vera/olive oil (n=34, completers=31) or betamethasone 0.1% (n=33, completers=32) cream twice daily for 6 weeks. Evaluation of pruritus severity was performed using a pruritic score questionnaire and visual analogue scale (VAS). RESULTS: Both treatments were associated with significant reductions in the frequency of pruritus (p<0.05), burning sensation (p<0.01 and p<0.001 in A. vera/olive oil and betamethasone group, respectively), scaling (p<0.01 and p<0.05) and dry skin (p<0.001) at the end of trial. Fissure and excoriation were only reduced in the A. vera group (p<0.05). The change in the frequency of hyper- and hypopigmentation lesions, blisters, erythema and lichenification did not reach statistical significance in any of the groups (p>0.05). Mean pruritus (p<0.05) and VAS scores (p<0.01 and p<0.05) were significantly decreased by the end of trial in both groups. The rate of improvement in the pruritus severity [defined as being classified in a less severe category (mild, moderate and severe)] was found to be comparable between the groups (p>0.05). CONCLUSION: A. vera/olive oil cream was at least as effective as betamethasone 0.1% in the treatment of sulfur mustard-induced chronic skin complications and might serve as a promising therapeutic option for the alleviation of symptoms in mustard gas-exposed patients.

Improvement of sulphur mustard-induced chronic pruritus, quality of life and antioxidant status by curcumin: results of a randomised, double-blind, placebo-controlled trial.

Skin is among the first and most heavily damaged organs upon sulphur mustard (SM) exposure. Pruritus is the most common chronic skin complication of SM, which adversely affects the quality of life (QoL). However, current therapies for the management of SM-induced pruritus are very limited and associated with side effects. The present trial investigated the efficacy of curcumin in the alleviation of SM-induced chronic pruritic symptoms. A total of ninety-six male Iranian veterans (age 37-59 years) were randomised to receive either curcumin (1 g/d, n 46) or placebo (n 50) for 4 weeks. Serum concentrations of substance P and activities of antioxidant enzymes were measured at baseline and at the end of the trial. Assessment of pruritus severity was performed using the pruritus score, visual analogue scale (VAS) and scoring atopic dermatitis (SCORAD) index. QoL was evaluated using the Dermatology Life Quality Index (DLQI) questionnaire. Serum concentrations of substance P (P<0·001) as well as activities of superoxide dismutase (P=0·02), glutathione peroxidase (P=0·006) and catalase (P<0·001) were significantly reduced in the curcumin group, while no significant change was observed in the placebo group. Curcumin supplementation was also associated with significant reductions in measures of pruritus severity including the pruritus score (P<0·001), VAS score (P<0·001), overall (P<0·001) and objective SCORAD (P=0·009), and DLQI's first question (P<0·001). None of these measures was significantly changed in the placebo group. As for the QoL, although DLQI scores decreased in both groups (P<0·001 and P=0·003 in the curcumin and placebo groups, respectively), the magnitude of reduction was significantly greater in the curcumin group (P<0·001). In conclusion, curcumin may be regarded as a natural, safe, widely available and inexpensive treatment for the management of SM-induced chronic pruritus.

Recombinant human interferon gamma (Gamma Immunex) in treatment of atopic dermatitis.

Atopic dermatitis (AD) is a chronic, inflammatory skin disease which is characterized by severe pruritus and affects patients' quality of life. In recent years gamma interferon (IFN-gamma) has been accepted as a novel treatment for severe AD, however, its mechanism of action is not clearly identified. Present study evaluated the effect of recombinant human interferon gamma (rIFN-gamma: Gamma Immunex, Exir Pharmaceutical Company, Iran) on severity of AD (SCORAD), dermatology life quality index (DLQI) as well as serum levels of IL-4, IgE and IL-6 in AD patients. Twenty AD patients were entered in to a study in Baqiyatallah outpatient clinics and received rIFN-gamma (50 µg/m(2) body area, 3 times per week, subcutaneously) for 1 month. SCORAD and DLQI were assessed at beginning and end of the treatment period. IL-4, IL-6 and IgE were measured in blood samples before and after 1 month treatment with rIFN-gamma. DLQI mean value before treatment was 20.80 ± 3.95, which decreased to 8.20 ± 2.14 after treatment (P < 0.001). SCORAD-A (percentile of the body surface involved in AD), SCORAD-B (the severity of clinical features) and SCORAD-C (patients' scaling of itching and somnolence) significantly decreased after treatment (P < 0.001, P < 0.001 and P < 0.01). Total SCORAD at the end of treatment period was less than basal value (27.83 ± 8.48 vs. 70.04 ± 8.48; P < 0.001). Treatment with rIFN-gamma decreased serum levels of IL-4 and IL-6 (P < 0.05), but IgE remained unchanged. Results suggested the controlling effect of rIFN-gamma treatment on clinical symptoms of AD, which involves suppression of IL-4 but not IgE production.

Doxepin cream vs betamethasone cream for treatment of chronic skin lesions due to sulfur mustard.

Oral doxepin was shown to reduce chronic pruritus due to sulfur mustard. The present study compared the effects of topical doxepin 5% with betamethasone 1% for the treatment of pruritus in veterans exposed to sulfur mustard. This investigator-blinded, randomized, clinical trial was conducted in an outpatient dermatology clinic. Seventy-five men who were exposed to sulfur mustard 23 to 28 years ago during the Iran-Iraq war who complained of pruritus were randomized to receive doxepin cream 5% (n = 40) or betamethasone cream 0.1% (n = 35) twice a day for 6 weeks. Pruritus severity and Dermatology Life Quality Index (DLQI) were evaluated before and after each treatment. Both groups showed significant improvement regarding pruritus (P < .05), burning sensation, skin dryness (P < .001), and skin scaling (P < 0.05). The lesions of all regions significantly reduced after treatments (P < .05), except those on the head, face, and genitalia. Pruritus, visual analog scores, and DLQI significantly decreased (P < .01, P < .01, and P < .001, respectively) in doxepin- and betamethasone-treated groups, and there was no difference between groups. All DLQI subscores decreased after both type of treatments (P < .01). Equal efficacy of doxepin cream and betamethasone suggest that doxepin is a potential alternative to control pruritus caused by sulfur mustard in exposed veterans.

Comparative study of skin sebum and elasticity level in patients with sulfur mustard-induced dermatitis and healthy controls.

BACKGROUND: Sulfur mustard (SM) - a chemical agent - has both acute and chronic effects on skin. Xerosis, which is deemed to be due to the damage of hydrolipidic barrier of the skin, is the most common complaint of veterans exposed to the chemical. This study was designed to evaluate skin sebum and elasticity in veterans with a history of SM contact. METHODS: Three hundred and ten subjects were enrolled in this study and were divided into four groups: SM-exposed patients with current skin lesions (n=87); SM-exposed patients without skin lesions (n=71); patients with dermatitis (n=78); and normal controls (n=74). The skin sebum and elasticity were measured in four areas (forehead, suprasternal, palm and back of the hands) using a Sebumeter and a Reviscometer. RESULTS: Skin sebum was higher in participants who presented with dermatitis and had history of contact with SM than others; the difference was only statistically significant on the forehead. There was no significant difference in the skin elasticity between the four groups. CONCLUSION: While SM may increase skin sebum in long term, there is no evidence that it has a substantial effect on skin elasticity.

Skin hydration and transepidermal water loss in patients with a history of sulfur mustard contact: a case-control study.

BACKGROUND: Skin lesions are among the most common complications of contact with sulfur mustard. OBJECTIVE: This study was aimed to measure skin water content and transepidermal water loss (TEWL) in patients with a history of sulfur mustard contact. METHODS: Three hundred ten male participants were included in this study: 87 (28.1%) sulfur mustard-exposed patients with current skin lesions (group 1), 71 (22.9%) sulfur mustard-exposed patients without skin lesions (group 2), 78 (25.2%) patients with dermatitis (group 3) and 74 (23.8%) normal controls (group 4) The water content and TEWL of skin was measured at four different locations of the body: forehead, suprasternal, palm and dorsum of hand. Nonparametric statistical tests (Kruskal-Wallis) were used to compare the four groups, and P < 0.05 was considered statistically significant. RESULTS: The mean age of participants were 44.0 +/- 6.7, 41.9 +/- 5.9, 43.8 +/- 9.3 and 44.8 +/- 8.9 years in groups 1 to 4, respectively (P = 0.146). Xerosis, post-lesional hyperpigmentation and lichenification were significantly more common in either sulfur mustard-exposed participants or non-exposed participants with dermatitis (P < 0.05). Skin hydration was higher in subjects with sulfur mustard contact than in non-injured participants (P < 0.05) in the dorsum and palm of hands and forehead. TEWL was significantly higher in participants only in suprasternal area and dorsum of hand. CONCLUSION: 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.

Sardasht-Iran cohort study of chemical warfare victims: design and methods.

BACKGROUND: Insights into long-term clinical consequences of sulfur mustard have emerged from some investigations but less is known about the basic and molecular mechanisms of these complications. Sardasht-Iran Cohort Study is a comprehensive historical cohort study on Sardasht chemical victims' population which was designed to find out the long-term complications of sulfur mustard exposure and the basic mechanisms underlying clinical manifestations. This paper describes the design and methodology of Sardasht-Iran Cohort Study. METHODS: In Sardasht-Iran Cohort Study, 500 individuals including 372 subjects from Sardasht, as the exposed group, and 128 subjects from Rabat, as the unexposed age-matched control group were evaluated. The exposed group was divided into two groups based on the severity of clinical complications at the time of exposure. Different samples including blood, sputum, saliva, tear, urine, and semen were collected for immunologic, hematologic, biochemical, and other laboratory analysis. Data were gathered from medical records, clinical examinations, laboratory tests, and questionnaires for psychological and lifestyle situations. CONCLUSION: The important distinctions setting this study apart from the previous ones are discussed. The Sardasht-Iran Cohort Study provides important information on various aspects of long-term consequences of sulfur mustard exposure. This database will provide a better position to suggest guidelines for the diagnosis, treatment, and prevention of delayed complications in the patients exposed to sulfur mustard.

Comparison of topical capsaicin and betamethasone in the treatment of chronic skin lesions due to sulfur mustard exposure.

Chronic pruritic skin lesions are considered to be one of the late complications of sulfur mustard exposure. The purpose of this study was to compare the efficacy of topical capsaicin with that of betamethasone in the treatment of these lesions. In this investigator-blinded, randomized clinical trial, patients applied capsaicin cream 0.025% (n=32) or betamethasone cream 0.1% (n=32) 2 times a day for 6 weeks. Efficacy was based on a dermatologist assessment. The severity of the pruritus was assessed by pruritic score questionnaire and a visual analog scale before and after treatment. All patients complained of pruritus. Both groups showed a significant decrease in pruritus, scaling, and skin dryness (p<0.05), but burning sensation was not improved significantly in the capsaicin group. The mean (+/- standard deviation [SD]) baseline pruritic scores in the capsaicin and betamethasone groups were 29.4 (13.1) and 33.6 (7.2), respectively (p=0.1). The mean (SD) pruritus score change from baseline to after the treatment was significantly higher (p<0.001) in the betamethasone group than in the capsaicin group, 12.7 (6.4) vs. 6.9 (5.6). Fourteen (35%) patients in the capsaicin group reported a burning sensation and intolerable odor, but these effects were not serious enough to necessitate discontinuing the treatment. Topical capsaicin cream 0.025% was much less well tolerated than betamethasone and inferior to betamethasone in reducing chronic skin lesions and symptoms from sulfur mustard exposure.

Comparison of long-pulsed alexandrite and Nd:YAG lasers, individually and in combination, for leg hair reduction: an assessor-blinded, randomized trial with 18 months of follow-up.

OBJECTIVE: To compare the long-term effectiveness and safety of long-pulsed Nd:YAG and alexandrite lasers, individually and in combination, in long-term leg hair reduction. DESIGN: Randomized, single-center, within-participant, investigator-blinded, active-controlled clinical trial. SETTING: Private skin laser center. PARTICIPANTS: Twenty individuals aged 16 to 50 years with skin phototypes III and IV. INTERVENTIONS: The medial and lateral sides of each participant's legs were randomly assigned to receive 1 of the following laser treatments: (1) long-pulsed 1064-nm Nd:YAG laser (12-mm spot size); (2) long-pulsed 755-nm alexandrite laser (12-mm spot size); (3) long-pulsed 755-nm alexandrite laser (18-mm spot size); and (4) a combination of long-pulsed 1064-nm Nd:YAG laser and long-pulsed 755-nm alexandrite laser (treatments 1 and 2). Identified areas were treated for a total of 4 sessions at 8-week intervals. MAIN OUTCOME MEASURES: Hair reduction from baseline based on hair counting with digital photography by 2 blinded assessors, 8 and 18 months after the last treatment session. RESULTS: Fifteen participants completed the trial. The mean (SD) hair reduction 18 months after the last treatment, as measured by the assessors from digital photographs, were 75.9% (19.0%) for the 12-mm spot size alexandrite laser, 84.3% (12.4%) for the 18-mm spot size alexandrite laser, 73.6% (11.4%) for the Nd:YAG laser, and 77.8% (15.9%) for the combination therapy (analysis of variance, P > .05). The incidence of adverse effects (hyperpigmentation) and pain severity were significantly greater in areas that received combination therapy (P = .001). CONCLUSIONS: After 18 months of follow-up, alexandrite and Nd:YAG lasers were efficacious for leg hair removal. Combination therapy did not have any additional benefit and caused more adverse effects.

Impact of pruritus on quality of life in sulfur mustard-exposed Iranian veterans.

BACKGROUND: Sulfur mustard, a chemical warfare agent, has various verified chronic effects on the skin. One of the foremost negative impacts of this agent is chronic pruritus, which plagues chemically injured veterans for life and can downgrade their quality of life. AIM: To assess the association between the quality of life and pruritus severity in chemically injured veterans. METHODS: One hundred and twenty-five consecutive chemically injured veterans suffering from pruritus were assessed via the Dermatology Life Quality Index (DLQI) and pruritus score. Pruritus scores less than 15, between 16 and 30, and more than 30 were considered as mild, moderate, and severe pruritus, respectively. Patients with different levels of pruritus were compared with respect to their DLQI and its subscores. RESULTS: All subjects were male with a mean age of 44.3 +/- 8.0 years; 11.2% had mild, 35.2% moderate, and 53.6% severe itching. The DLQI median scores in the mild, moderate, and severe cases were 16, 20, and 21, respectively (P = 0.014). The DLQI subscores of symptoms and feelings (P = 0.015), personal relationships (P = 0.002), and daily activities (P = 0.036) were worst in patients with severe itching. CONCLUSION: Chemically injured veterans suffering from severe itching have a significantly poorer quality of life than do patients with milder symptoms.