JRSM >
Volume 96, Number 8 >
Pp. 423-424
Hollyoaks, 20 Haven Gardens, Crawley Down RH10 4UD, UK
Karagama and co-workers (April 2003 JRSM1) looked for physical sequelae in thirty-four individuals exposed to CS spray within the confines of a single decked 72-seat coach. Usefully, they divided the cohort into individuals with exposure directly onto the face and individuals with indirect exposure within the confined environment. They recorded the symptoms experienced one hour, one month, and ten months after exposure. As might have been expected,2 the main symptoms were ocular (10 out of 10 exposed directly and 22 out of 24 exposed indirectly) followed by respiratory (10 out of 10 for the direct group and 13 out of 24 for the indirect group). Only 1 of the indirect group reported a rash whereas 3 out of 10 of the direct group reported rashes. This would concur with the report of Schmutz et al.3 regarding cutaneous accidents with CS and CN: these workers concluded that, when properly suspended in air, these agents mainly affect the eyes and have only minor effects on the skin, whereas when applied directly onto the skin they produce extreme irritation with erythema and vesicles. The effects seem to develop in two stages. First there is redness and a burning sensation on the face; then, next day, oedema ensues with swelling of the eyelids. Oozing rapidly turns to crusts and, in the absence of treatment, infection is the rule. In a recent case I was supplied with dated serial colour photographs that fitted the above description. The lesions were unilateral, indicating use at very short range (also reported by Schmutz). In two previous cases, photographic evidence was lacking but the general practitioner's description in the medical records was similar and he had prescribed antibiotics prophylactically.
In their follow-up examinations at 8-10 months, Karagama et al. found no differences between the directly and indirectly exposed groups for respiratory or other effects, and they conclude that there was no convincing evidence of long-term physical sequelae. However, the possibility of long-term respiratory damage cannot always readily be dismissed. In 1992 Hu and Christiana4 reported a case in which a previously healthy woman aged 21 with no wheezing or asthma or family history of asthma or atopy was inadvertently exposed to CS gas in a nightclub. From the results of spirometry over time and the response to treatment with the appropriate medication together with monitored symptoms they diagnosed the development of RADS (reactive airways dysfunction syndrome), a non-specific form of asthma that typically follows a single massive exposure to an irritant.
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