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Radiation Burns

A radiation burn is a type of damage to the skin, other biological tissues, or organs. It is most often caused by ultraviolet rays, X-rays, or radiation therapy to treat cancer. Radiation burns are also known as radiodermatitis, radiation dermatitis, radiation skin damage, or x-ray dermatitis. Sunburn is the most common type of radiation burn, and while many cases are simple, prolonged exposure to UV rays can result in severe sunburn, skin cancer, and other medical issues.

Even though the radiation from the sun is harmful, different types of radiation are used in the medical field to diagnose and treat illnesses. X-rays, PET scans, and CT scans emit small amounts of radiation, but they help doctors to understand what’s happening inside the patient’s body. Radiation is also used to treat various forms of cancer. Despite its usefulness, there are times when it can be harmful.

The most common type of medical radiation burn is radiation dermatitis, and it is usually mild. It occurs to some extent in most patients receiving radiation therapy whether or not they get chemotherapy. However, this condition can also result from exposure to radiation during certain procedures such as coronary angiography, indwelling catheter placement, and embolization procedures.

Some people are more at risk of radiation dermatitis than others. Risk factors include malnutrition, obesity, skin disease, overlapping skin folds, HIV, and diabetes. Individuals who receive individual doses of radiation that are larger than 3 to 5 Gy per dose or total radiation doses amounting to more than 55 Gy are also more at risk. In addition, patients who get radiation for head and neck tumors along with concurrent cetuximab therapy are more likely to get radiation dermatitis.

Unlike thermal burns, it is not always readily apparent when a radiation burn occurs. This is because the individual doesn’t feel a sensation when they’re exposed, and there may be no visible signs immediately. This contrasts with thermal burns where heat warns the individual that they could be hurt, and fire or hot objects can be easily recognized. However, even though skin affected by a radiation burn often appears normal on the surface at first, the immune response has already started.

Symptoms of Radiation Dermatitis

Radiation dermatitis typically shows up a few days to weeks after an individual starts to get radiotherapy. The time of onset depends on the intensity of the dose and how sensitive the patient’s tissues are. The burn is restricted to the areas that have been irradiated.  Radiation dermatitis can be either acute or chronic.

Acute Radiation Dermatitis

Acute cases occur within 90 days of exposure, and depending on the severity of the reaction, the patient’s skin may simply redden, or skin cells may die. The National Cancer Institute categorizes acute radiation dermatitis into four grades.

In Grade 1, there’s just a slight reddening of the skin. In Grade 2, moderate, patchy reddening is evident, and the skin peels near skin folds and creases. There’s also moderate swelling. Grade 3 radiation dermatitis is characterized by the peeling off sections of the skin that are bigger than 1.5 cm in diameter and not confined to the skin folds. Swelling is severe.

A patient with Grade 4 radiation dermatitis experiences full-thickness necrosis and/or ulcerations. The necrosis goes into the dermis. This is the internal layer of the skin that contains hair follicles, sweat glands, capillaries, and nerve endings.

Chronic Radiation Dermatitis

Chronic radiation dermatitis can begin anywhere from 15 days to 10 years or even more after the start of radiation therapy. It is a continuation of the acute form of the injury, and it involves additional inflammatory changes in the skin. This condition is characterized by:

  • Fragile surface skin
  • The disappearance of pores
  • A rise in collagen and damage to the elastic fibers in the dermis
  • Prominent blood vessels

Indicators of Radiation Burns

Radiation burns look similar to thermal burns. Therefore, superficial burns result in dry, red skin. The site of the injury may itch, and the victim may be in moderate pain. Partial-thickness burns are moist, and the skin is red with blisters. The skin may also slough off in small pieces. Victims experience moderate to severe pain.

With full-thickness burns, the skin is generally charred, white, black, or brown, and it may appear leathery in appearance. Dry, black dead tissue forms around the wound. Since these burns involve the destruction of nerve endings, victims usually don’t feel pain. The most severe injuries are usually due to a very high dose of radiation.

Treatment

Radiation burn is not a particularly well-researched area, and there are no precise guidelines for managing it. However, there are ways that patients can find relief. Skin that’s burned is usually very sensitive, and it is more likely to tear than healthy skin. Therefore, the damaged area needs to be kept without causing further harm.

Treatment usually takes the form of both topical and oral solutions, but a lot depends on how the injury occurred. A topical steroid may be prescribed for radiation dermatitis, while oral or topical antibiotics are often used to treat burns associated with radiotherapy.

Doctors have to carefully monitor patients with acute radiation dermatitis. They need to ensure that both the dose and the distribution of the radiation are correct. If medication is contributing to the patient’s condition, healthcare professionals should consider discontinuing it.

Prevention

Patients who are scheduled to have radiation therapy can take steps to prevent injury or further injury to the skin. Before each session, they should wash the area with a gentle soap-free cleanser and dry it with a soft towel. However, they should avoid using creams immediately before treatment. After the session, they can apply gels, emollients, and dressings to reduce discomfort. Patients should avoid scratching the skin, exposing the treated area to the sun, and using perfumes and alcohol-based lotions.

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