Radiation dermatitis (radiation or X—ray dermatitis) is an inflammatory change that occurs in the skin as a result of exposure to ionizing radiation. Clinical manifestations of radiation dermatitis depend on the radiation dose. In the acute period, redness, the appearance of blisters and the formation of poorly healing ulcers are possible. In the later period, dryness and atrophic changes occur, skin cancer may develop. The characteristic clinical picture and the clear connection of the occurrence of the disease with ionizing radiation usually does not cause doubts in the diagnosis.
Nowadays, radiation dermatitis can occur in connection with professional activities (in radiologists) and in emergency situations. It can also be therapeutic, that is, developed as a result of radiation therapy, which is used in the treatment of malignant tumors and some skin diseases.
Skin damage by ionizing radiation is divided into early and late. The early ones appear during the irradiation period or within 3 months after it. Late skin lesions can develop years after radiation exposure. There is an intermediate period between early and late radiation injuries lasting from several months to many years.
Acute radiation dermatitis refers to early skin lesions. At an irradiation dose of 8-12 Gy, an erythematous form of acute radiation dermatitis occurs. It is characterized by redness of the skin at the irradiation site, the appearance of itching and soreness. Peeling and hair loss are noted. After 3-4 months, hair growth is restored. The erythematous form is considered an acceptable skin reaction to radiation, since it does not lead to the appearance of late complications.
Irradiation of the skin at a dose of 12-20 Gy leads to the development of a bullous form of radiation dermatitis. It occurs against the background of redness, itching, soreness, swelling of the skin and is characterized by the appearance of serous blisters. When the bubbles are opened, erosions form in their place, which are covered with crusts and heal within 2-3 months. Bullous radiation dermatitis is accompanied by an increase in regional lymph nodes, an increase in body temperature and hair loss.
With an irradiation dose of more than 25 Gy, a necrotic form of radiation dermatitis develops. It is accompanied by severe pain, high fever, weakness, insomnia. The severity of the patient’s condition depends on the area of the affected area of the skin. Skin manifestations go from the stage of redness and blisters to the formation of long-term non-healing ulcers. Moreover, ulcers can occur bypassing the bullous stage.
Chronic radiation dermatitis can be a consequence of acute or develops primarily as a result of repeated exposure to small doses of ionizing radiation on the skin. Its occurrence is facilitated by increased insolation, diabetes mellitus, exposure to chemical irritants on the skin, vascular pathology, purulent infection, etc. The manifestations of chronic radiation dermatitis include: dry skin, cracking, hyperkeratosis, areas of hypo- and hyperpigmentation, atrophic radiation ulcers.
Treatment of erythematous form of radiation dermatitis is carried out with corticosteroid creams. In bullous and necrotic forms, relief of pain syndrome and anti-inflammatory therapy are indicated. Bubbles are opened or their contents are sucked out. To improve the healing of erosions and ulcers, corticosteroid ointments and 10% methyluracil ointment are used. Necrotic dermatitis often requires surgical excision of the necrotic area.
Chronic radiation dermatitis with unexpressed skin atrophy does not need active treatment. It is necessary to exclude irritating factors and the use of nourishing creams. With severe symptoms, anti-inflammatory and epithelizing agents are prescribed (corticosteroid ointments, preparations from the blood serum of dairy calves, etc.). With the formation of a long-term non-healing radiation ulcer, its excision is indicated.
Against the background of chronic radiation dermatitis, the development of basal cell carcinoma or squamous cell carcinoma of the skin may begin. In about half of the cases, this occurs 7-12 years after repeated and prolonged exposure. However, the occurrence of such complications can be observed after decades.