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Radiation – Cutaneous Radiation Injury


 
Route Of Exposure
  • Injury to the skin and underlying tissues from acute exposure to a large external dose of radiation is referred to as cutaneous radiation injury (CRI). Acute radiation syndrome (ARS) will usually be accompanied by some skin damage; however, CRI can occur without symptoms of ARS.

 

Clinical
  • Early signs and symptoms of CRI are itching, tingling, or a transient erythema or edema without a history of exposure to heat or caustic chemicals.
  • Exposure to radiation can damage the basal cell layer of the skin and result in inflammation, erythema, and dry or moist desquamation. In addition, radiation damage to hair follicles can cause epilation.
  • The visible skin effects depend on the magnitude of the dose as well as the depth of penetration of the radiation.
  • Unlike the skin lesions caused by chemical or thermal damage, the lesions caused by radiation exposures do not appear for hours to days following exposure, and burns and other skin effects tend to appear in cycles.
  • The key treatment issues with CRI are infection and pain management.

 

Stages Of Cutaneous Radiation Injury
  • Prodromal stage (within hours of exposure)—This stage is characterized by early erythema (first wave of erythema), heat sensations, and itching that define the exposure area. The duration of this stage is from 1 to 2 days.
  • Latent stage (1–2 days postexposure)—No injury is evident. Depending on the body part, the larger the dose, the shorter this period will last. The skin of the face, chest, and neck will have a shorter latent stage than will the skin of the palms of the hands or the soles of the feet.
  • Manifest illness stage (days to weeks postexposure)—The basal layer is repopulated through proliferation of surviving clonogenic cells. This stage begins with main erythema (second wave), a sense of heat, and slight edema, which are often accompanied by increased pigmentation.
  • Third wave of erythema (10–16 weeks postexposure, especially after beta exposure)—The exposed person experiences late erythema, injury to blood vessels, edema, and increasing pain. A distinct bluish color of the skin can be observed. Epilation may subside, but new ulcers, dermal necrosis, and dermal atrophy (and thinning of the dermis layer) are possible.
  • Late effects (months to years postexposure; threshold dose ~10 Gy or 1000 rads)—Symptoms can vary from slight dermal atrophy (or thinning of dermis layer) to constant ulcer recurrence, dermal necrosis, and deformity.

 

Diagnosis
The signs and symptoms of CRI are as follows:
  • Intensely painful burn-like skin injuries (including itching, tingling, erythema, or edema) without a history of exposure to heat or caustic chemicals
    Note : Erythema will not be seen for hours to days following exposure, and its appearance is cyclic.
  • Epilation
  • A tendency to bleed
  • Possible signs and symptoms of ARS

 

Exposure/Contamination

 

Treatment
  • Localized injuries should be treated symptomatically as they occur, and radiation injury experts should be consulted for detailed information.
  • Supportive care in a clean environment (a burn unit if one is available)
  • Prevention and treatment of infections
  • Use of the following:
    • Medications to reduce inflammation, inhibit protealysis, relieve pain, stimulate regeneration, and improve circulation
    • Anticoagulant agents for widespread and deep injury
  • Pain management
  • Psychological support
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