Radiation Burns Symptoms And Treatment

Introduction

Radiation is the release of energy in the form of electromagnetic waves or the movement of subatomic particles. In nature, radiation is sourced from numerous naturally occurring radioactive materials that are present in the soil, water, air, and even within the human body itself. It's a part of our daily lives, as individuals routinely breathe in and consume various types of radiation from the surrounding atmosphere, the food we eat, and the water we drink.

A radiation burn refers to the harm inflicted on the skin or living tissues resulting from exposure to either radiofrequency energy or ionizing radiation. The most prevalent form of radiation burn is sunburn, which arises from excessive exposure to ultraviolet radiation from the sun. This type of radiation burn occurs when the skin absorbs an excess of ultraviolet (UV) rays, primarily from sunlight, leading to a range of symptoms and discomfort. Sunburn is a well-known example of radiation burn caused by UV radiation.¹

Radiation burns typically arise as a complication following therapeutic treatments and stem from the creation of free oxygen radicals within the body. In the present day, the most prevalent artificial origins of human exposure to radiation primarily arise from the utilization of X-ray machines and radiopharmaceuticals, which serve essential roles in diagnostic procedures, radiotherapy treatments, and various other medical devices employed in healthcare. 

The degree of radiation burns and the approach to addressing them are contingent upon various factors, including the dosage, frequency, total affected surface area, and the specific site exposed to radiation. 

Injury to the epithelial layers of the skin can lead to a process known as desquamation. When fibroblasts, crucial for collagen production and effective wound healing, are directly damaged, this can result in reduced collagen synthesis and impaired wound recovery. Moreover, there is a possibility of vascular fibrosis, leading to reduced blood flow and subsequent tissue hypoxia, which can ultimately result in the necrosis of deeper tissues.

Symptoms of radiation burns

The intensity of symptoms can vary depending on factors such as dosage, fractionation, and the energy of the radiation beam. In a general sense, the progression of the injury can be divided into early and late phases. 

In the initial phase, patients typically exhibit symptoms like redness (erythema) and swelling of the skin (cutaneous edema), followed by hair loss (epilation), dry skin peeling (dry desquamation), and darkening of the skin (hyperpigmentation). As the injury advances, individuals may begin to experience sensations like itching (pruritus), tingling, and heat, subsequently leading to the formation of blisters (vesiculation), moist skin peeling (moist desquamation), erosion, ulceration, and/or tissue death (necrosis) affecting the epidermis, dermis, or both layers of the skin.

Following these more visible and severe symptoms, patients often encounter what is referred to as late effects, which encompass issues like hair loss (epilation), thinning of the skin (skin atrophy), visible blood vessels near the skin's surface (telangiectasia), changes in skin pigmentation (hypopigmentation and hyperpigmentation), and additional long-term skin-related concerns.

Grading radiation burns

• Grade 1 radiation injury manifests as a subtle occurrence, presenting with slight reddening of the skin (erythema) or minor skin peeling (desquamation).
• Grade 2 radiation injury signifies a more noticeable reaction, with a moderate to pronounced redness (erythema) or irregular, damp skin peeling (moist desquamation) primarily occurring in skin folds and creases. There is also moderate swelling associated with this grade.
• Grade 3 radiation injury is characterized by a widespread and extensive occurrence of moist skin peeling (moist desquamation), with areas exceeding 1.5 cm in diameter, and this condition is not limited to skin folds. Additionally, there may be the development of pitting edema, which refers to severe swelling.
• Grade 4 radiation injury represents the most severe level, involving skin necrosis or ulceration that extends through the entire thickness of the dermis, which is the middle layer of the skin. This is an extremely critical and grave form of radiation injury.⁴

Treatment and management for radiation burns

There are several options for managing radiation burns, although the effectiveness of these treatments can vary. 

• Corticosteroid cream, which is a topical steroid, is often prescribed for radiation dermatitis. However, its efficacy remains a subject of debate in clinical studies. 
• Antibiotics, whether administered orally or applied topically, have shown their effectiveness in addressing burns caused by radiation. 
• Silver leaf nylon dressing has gained recognition as one of the most beneficial treatments for radiation burns. This dressing is notable for its antimicrobial and anti-infective properties, with silver ions rapidly relieving discomfort, aiding in recovery, and alleviating symptoms such as pain, itching, infection, swelling, and burning. 
• Zinc, renowned for its role in immune function, can be applied topically to treat radiation burns and various other skin conditions. While not universally endorsed by medical professionals, zinc offers numerous benefits for improving skin health when used topically.

Furthermore, amifostine, a medication designed to counteract free radicals and reduce radiation toxicity, has demonstrated promise in clinical trials. Patients undergoing chemotherapy who used amifostine experienced a significant 77 percent reduction in the risk of radiation dermatitis compared to those who did not use this medication. The injectable form of amifostine has obtained approval from the U.S. Food and Drug Administration (FDA), but it is only available with a prescription, necessitating a discussion with your healthcare provider to explore this treatment option.

When caring for skin subjected to radiation therapy, a gentle and considerate approach is paramount. Start by cleaning the treated skin daily using warm water and a low-pH cleanser to effectively remove bacteria without causing further irritation; it's advisable to avoid washcloths or loofahs and instead gently splash water onto the skin.

Harnessing the natural anti-inflammatory properties of aloe vera, applying fresh aloe vera juice to the affected skin on a daily basis can assist in mitigating skin damage resulting from radiation therapy. Additionally, calendula cream, renowned for its antibacterial, anti-inflammatory, and antioxidant effects, has shown promise in both preventing and treating radiation-induced burns. 

For mild itching and burning sensations, over-the-counter (OTC) hydrocortisone cream can provide relief, but be sure to apply it thinly to the affected area up to three times a day, avoiding use within an hour of radiation treatment. In cases of more severe skin issues, prescription creams provided by your healthcare provider may be necessary, and it's crucial to diligently adhere to their instructions for application to achieve the best possible outcomes in skin care during radiation therapy.

Conclusion 

Radiation-induced skin reactions can vary widely in severity, encompassing mild, temporary discomfort to severe and long-lasting damage. Managing these reactions effectively requires the collaborative engagement of not only the radiation oncologist but also the radiation safety officer and the patients themselves. Their collective vigilance and cooperation play a vital role in minimizing the adverse effects of radiation on the skin.

The pathology of radiation-induced skin damage is intricate, and clinical management can be challenging. Given this complexity, there is a pressing need for ongoing research and efforts to enhance the treatment of radiation burns. By advancing our understanding of the underlying mechanisms and refining therapeutic approaches, we can strive to ameliorate the impact of radiation on the skin, ultimately improving the quality of life for individuals undergoing radiation therapy.