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Chemical agents have been used as weapons on a large scale in World War I, in the Iraq-Iran War, by Iraq against Kurdish civilians, and in the Sarin attacks in Japan. Industrial hazardous materials (HAZMATs) produced in chemical plants could also be used as weapons in chemical terrorism.

Table C-2 lists potential agents for such attacks and the symptoms they elicit. Of these, the blistering agent sulfur mustard is one of the most likely agents to be used in a terrorist attack scenario, and it also induces skin lesions (see

TABLE C-2Recognizing and Diagnosing Health Effects of Chemical Terrorism

Following exposure and an asymptomatic latent period, erythema, pruritus, burning, and pain may present; initial blistering of the skin will start on the second day after exposure and will progress for up to 2 weeks. Vesicles coalesce, forming large blisters, and wound healing is considerably slower than for a comparable thermal burn. Differential diagnoses are thermal burn or scalding, toxic epidermal necrolysis, and staphylococcal scalded skin syndrome. (See also W R Heymann: Threats of biological and chemical warfare on civilian populations. J Am Acad Dermatol 2004, 51:452.)

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