Do Syrian Conflict Survivors Show Novel Chronic Cutaneous Sequelae From Chlorine Gas Exposure: A Case Report and Literature Review

This case report and literature review document a 70-year-old Syrian man who developed chronic dermatological sequelae, including pruritic ulcerative lesions and alopecia, following chlorine gas exposure during a 2016 airstrike. Despite initial respiratory symptoms resolving within 48 hours, the skin lesions persisted for months, showing no significant improvement after 3 months of treatment with oral cetirizine, prednisolone, and topical corticosteroids. Histopathological examination revealed epidermal hyperkeratosis, hypergranulosis, and dermal fibrosis with chronic inflammation. This case highlights the potential for chlorine gas to cause long-term skin damage, expanding the recognized clinical spectrum of chemical weapon-induced injuries. The report emphasizes the need for international health agencies to document long-term effects of gas exposure to guide therapeutic strategies in conflict-affected populations. This case report presents the first documented evidence of chronic dermatological sequelae following chlorine gas exposure in a conflict setting, highlighting a significant gap in existing literature. The patient developed persistent ulcerative plaques, hyperkeratosis, alopecia, and perivascular inflammation, challenging the prevailing view that chlorine causes only transient skin irritation. The findings suggest that sublethal concentrations of chlorine can induce significant cutaneous injury, necessitating long-term monitoring of survivors. The report emphasizes the need for systematic documentation and long-term dermatological surveillance protocols for chemical weapon survivors, as current guidelines focus primarily on acute respiratory effects and lack protocols for chronic skin conditions.