![]() A distinct bluish color of the skin can be observed. 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. ![]() The symptoms that follow vary from dry desquamation or ulceration to necrosis, depending on the severity of the CRI (see Table 1). This stage begins with main erythema (second wave), a sense of heat, and slight edema, which are often accompanied by increased pigmentation. Manifest illness stage (days to weeks postexposure)-The basal layer is repopulated through proliferation of surviving clonogenic cells. 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. Depending on the body part, the larger the dose, the shorter this period will last. Latent stage (1–2 days postexposure)-No injury is evident. The duration of this stage is from 1 to 2 days. 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. Appendix A gives a detailed description of the various skin responses to radiation, and Appendix B provides color photographs of examples of some of these responses. 3ĬRI will progress over time in stages and can be categorized by grade, with characteristics of the stages varying by grade of injury, as shown in Table 1. The key treatment issues with CRI are infection and pain management.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 visible skin effects depend on the magnitude of the dose as well as the depth of penetration of the radiation.With CRI, it is important to keep the following things in mind: In most cases, healing occurs by regenerative means however, large radiation doses to the skin can cause permanent hair loss, damaged sebaceous and sweat glands, atrophy, fibrosis, decreased or increased skin pigmentation, and ulceration or necrosis of the exposed tissue. Depending on the radiation dose, a third and even fourth wave of erythema are possible over the ensuing months or possibly years. After the latent phase, intense reddening, blistering, and ulceration of the irradiated site are visible. Transient and inconsistent erythema (associated with itching) can occur within a few hours of exposure and be followed by a latent, symptom-free phase lasting from a few days to several weeks. In addition, radiation damage to hair follicles can cause epilation. Exposure to radiation can damage the basal cell layer of the skin and result in inflammation, erythema, and dry or moist desquamation. In addition, cases of CRI have occurred in people who were overexposed to x-radiation from fluoroscopy units.Įarly signs and symptoms of CRI are itching, tingling, or a transient erythema or edema without a history of exposure to heat or caustic chemicals. Most cases of CRI have occurred when people inadvertently came in contact with unsecured radiation sources from food irradiators, radiotherapy equipment, or well depth gauges. CRI can occur with radiation doses as low as 2 Gray (Gy) or 200 rads 2 and the severity of CRI symptoms will increase with increasing doses. This is especially true with acute exposures to beta radiation or low-energy x-rays, because beta radiation and low-energy x-rays are less penetrating and less likely to damage internal organs than gamma radiation is. Acute radiation syndrome (ARS) 1 will usually be accompanied by some skin damage however, CRI can occur without symptoms of ARS. 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). Information on cutaneous radiation injury (CRI) for members of the public can be found at If you are a patient, we strongly advise that you consult with your physician to interpret the information provided as it may apply to you.
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