Weapons of War and Dermatology: A Comprehensive Review of Cutaneous Manifestations From Chemical Warfare Agents, Part II: Nerve Agents, Cyanides, and Riot Control Agents.

Abstract

This second installment in a two-part comprehensive review explores chemical warfare agents that primarily cause systemic toxicity with secondary cutaneous manifestations: nerve agents, cyanides, and riot control agents (RCAs). While these agents are primarily known for their systemic effects, their dermatological manifestations can provide critical diagnostic clues in exposure scenarios. Part II examines the G-series, V-series, GV-series, and Novichok nerve agents; various cyanide compounds; and both historical and modern RCAs. For each agent class, the review details their historical contexts, physicochemical properties, mechanisms of action, dermatological manifestations, and current treatment approaches. The widespread use of RCAs in civilian law enforcement underscores the practical relevance of understanding these compounds. Additionally, despite international prohibitions, some of these agents continue to pose threats in modern conflicts and targeted assassinations. The review highlights the crucial role dermatologists can play in multidisciplinary response teams, as recognizing characteristic cutaneous changes may facilitate rapid diagnosis and life-saving intervention. Future preparedness efforts should incorporate specialized training for health care providers, emphasizing the distinct dermatological presentations of these agents.