Soot penetrated the dermis of this firefighter 30-days following the Thomas wildfire in California. Dr. James Brown, PhD reviewed the photographs and shared the following thoughts.
My first impression of the pictures and the symptoms (skin irritations) described by other firefighters, is this crew is lucky to have survived such an exposure. Unfortunately, they are likely to experience adverse effects for some time.
Concerns regarding prognosis:
The sweating of soot is good as it helps remove materials trapped in the skin, and that should subside, but expect it to continue to a lesser extent for a very long time - possibly years. The dermatitis should subside, and is likely a result of all the particulate matter embedded in the skin. As the majority of the soot leaves the body, the skin will become less irritated. There may be significant variability among crew members due to differing sensitivities to the invading materials. I would make sure the firefighters inspect these areas regularly, looking (and feeling) for nodule development. The skin may start encapsulating some of the foreign material. If that happens, they should seek the attention of a physician, preferably a dermatologist, immediately.
Considering wildland firefighters do not wear respiratory protection, my greatest concern is inhalation exposure. Look at the soot on the skin. That is exactly what the conducting airways of the lungs looked like after this incident. I am sure a lot of black sputum has been coughed up since. The severity of the asthma induced by the exposure will likely subside, but may persist for an extended period with some possibility of a permanent airway sensitivity. Depositing particulates deep in the lung can have long and dire consequences.
It is impossible to predict to whom, or to what extent, these consequences may manifest themselves, but all involved will have an increased risk of developing interstitial lung diseases, COPD, and even lung cancer. Additionally, because of the lung's access to the bloodstream, toxic and possibly carcinogenic compounds, we're likely delivered to the circulation. The consequence of that situation, again, is impossible to predict and will vary among individuals (from no observed effect to some disease manifestation). It is vital that these firefighters be monitored by appropriate physicians (pulmonologists, internists, etc.) and that those physicians be fully aware of the exposure history.
This may seem like a lot of gloom and doom, but the reality is you are regularly exposed to these toxic environments. And, because of regular and long-term exposures, you are at a higher risk of all the adverse outcomes mentioned here. This severe exposure just further increased the risk of seeing those adverse at some time in the future..
See also, Firefighter Cancers and Other Diseases