Chronic Occupational Radiodermatitis

Chronic radiodermatitis or radiation dermatitis makes skin dry, fine, and hairless -due to atrophy of the epidermis, and vulnerable to minor trauma, discolored, with areas pigmented, organized hematomata, wart-like formations and ulcers.

Definition of radiodermatitis: Degenerative changes in the skin following excessive exposure to ionizing radiation.

Also known as radiation dermatitis.

Alternative names: Dermatitides, Radiation-Induced; Dermatitis, Radiation Induced; Dermatitis, Radiation-Induced; Radiation Induced Dermatitis; Radiation-Induced Dermatitides; Radiation-Induced Dermatitis; Radiodermatitides. - Dermatitis due to exposure to x-rays or gamma rays causing ionization of tissue water with acute changes resembling thermal injury.

Radiation therapy has been associated with a range of tissue damage occurring both acutely, within hours of therapy, and chronically many years following completion. Acute tissue damage includes erythema, edema, vesicular eruptions, erosions, and ulcerations commonly referred to as radiodermatitis. Chronic tissue damage includes radiodermatitis as well as persistent skin atrophy, ulceration (either new or recurrent), and cutaneous malignancies.

Late ulceration, developing years after radiation exposure, is more common than acute ulcerations and may persist indefinitelyRadiation therapy has been associated with a range of tissue damage occurring both acutely, within hours of therapy, and chronically many years following completion. Acute tissue damage includes erythema, edema, vesicular eruptions, erosions, and ulcerations commonly referred to as radiodermatitis. Chronic tissue damage includes radiodermatitis as well as persistent skin atrophy, ulceration (either new or recurrent), and cutaneous malignancies. Late ulceration, developing years after radiation exposure, is more common than acute ulcerations and may persist indefinitely.

Radiation-induced skin malignancies have been reported to occur between 5 and 65 years after exposure.Basal Cell Carcimoma are more commonly associated with post-irradiation malignancies than squamous cell carcinoma and they usually arise in areas of radiodermatitis, specifically chronic ulceration. Radiation therapy increases the risk for chronic ulceration and cutaneous malignancy. Patients with a history of radiation therapy need careful long-term observation to detect early forms of skin cancer. Chronic radiation ulcers must be distinguished from malignant ulcerations with a biopsy.

Chronic occupational radiodermatitis has three stages: simple, progressive, and malignant.

With simple chronic radiodermatitis, the skin becomes dry, fine, and hairless due to atrophy of the epidermis, and is easily vulnerable to minor trauma. It is also discolored, with areas of increased pigmentation, hemorrhage areas and organized hematomata (black spots). The epidermis presents areas of desquamation, fissuring (linear ulcers) and micro-ulcers. The ridges of epidermis which form the fingerprints also disappear.

With progressive chronic radiodermatitis wart-like formations and ulcers appear, which continue to worsen even after exposure to radiation has ceased. Hyperkeratotic plaques and painful keratoses form on the sides of the fingers and fingertips. At this stage the hands lose their flexibility. Around the edges of the ulcers caused by radiodermatitis, pseudoepitheliomatous hyperplasia may occur. The skin develops telangiectases, and areas of epidermal atrophy and dermal fibrosis. Progressive chronic radiodermatitis frequently gives rise to a painful burning sensation.

With malignant chronic radiodermatitis, neoplastic transformation develops in the ulcers or the keratoses. The commonest histological types are Bowen's disease (squamous cell carcinoma in situ), squamous cell carcinoma, and basal cell carcinoma (rodent ulcer). These tend to appear at a much later stage, often as much as twenty or thirty years after exposure to radiation. From a clinical point of view malignant chronic radiodermatitis is apparent as areas of ulceration with poor wound healing.

At a later stage, the disease may metastasize via the lymphatic system to local lymph nodes and also, via the blood, to organs.

Both the development of the disease locally, and any localized or distant metastases that may occur, are very difficult to treat. In general, to prevent the localized disease from spreading, drastic surgery is recommended, such as amputation of the affected fingers or even of the hand or forearm, and irradiation or dissection of the epitrochlear or axillary nodes on the affected side. As a rule, even patients in the localized stage of the illness do not get better.

In the medical bibliography available, no references can be found to the spontaneous remission of radiodermatitis or of malignant or pre-malignant developments which had occurred more than ten years after the onset of the disease. The same is true of recent clinical literature, where not a single case can be found of spontaneous remission in patients who have suffered from advanced chronic radiodermatitis produced by prolonged diagnostic radiation, or who have developed epidermal carcinoma following radiodermatitis.

Chronic radiodermatitis is a disease most commonly found in doctors whose hands have been exposed over the years to the ionizing radiation used in radiodiagnostic procedures. Acute tissue damage includes erythema, edema, vesicular eruptions, erosions, and ulcerations.

Chronic radiation dermatitis is permanent, progressive, and irreversible. Squamous cell carcinoma (SCC) may develop in 4 to 39 years, with a median of 7 to 12 years, almost exclusively from the chronic repeated types of exposures. SCC always develops within the area of radiodermatitis, never in normal skin. The tumors are often multiple and metastasize late in about 25%; despite extensive surgery (excision, grafts, etc.), the prognosis is poor, and recurrences are common. In recent years there has been about an equal incidence of SCC and basal cell carcinoma (BCC). BCC appears mostly in patients formerly treated with x-rays for acne vulgaris and acne cystica or epilation (tinea capitis). The tumors may appear 40 to 50 years after exposure. Excision and grafting is often possible before the cancer develops.

Topical application of Helix Aspersa Müller Glycoconjugates will ease distress and hardship associated with dry skin and free radicals during and after radiation and with erythema, edema, vesicular eruptions, erosions, and ulcerations. The use of this natural skin care product addresses the effects by arousing the natural renewal and protective mechanisms of the body. The snail serum works naturally to battle the painful side effects of radiotherapy as it has the prophylactic property of preventing acute radiation side effects in skin tissue.

Last modified: November 30, 2008

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