Cutaneous and local radiation injuries

Abstract

The threat of a large-scale radiological or nuclear (R/N) incident looms in the present-day climate, as noted most recently in an editorial in Scientific American (March 2021). These large-scale incidents are infrequent but affect large numbers of people. Smaller-scale R/N incidents occur more often, affecting smaller numbers of people. There is more awareness of acute radiation syndrome (ARS) in the medical community; however, ionising radiation-induced injuries to the skin are much less understood. This article will provide an overview of radiation-induced injuries to the skin, deeper tissues, and organs. The history and nomenclature; types and causes of injuries; pathophysiology; evaluation and diagnosis; current medical management; and current research of the evaluation and management are presented. Cutaneous radiation injuries (CRI) or local radiation injuries (LRI) may lead to cutaneous radiation syndrome, a sub-syndrome of ARS. These injuries may occur from exposure to radioactive particles suspended in the environment (air, soil, water) after a nuclear detonation or an improvised nuclear detonation (IND), a nuclear power plant incident, or an encounter with a radioactive dispersal or exposure device. These incidents may also result in a radiation-combined injury; a chemical, thermal, or traumatic injury, with radiation exposure. Skin injuries from medical diagnostic and therapeutic imaging, medical misadministration of nuclear medicine or radiotherapy, occupational exposures (including research) to radioactive sources are more common but are not the focus of this manuscript. Diagnosis and evaluation of injuries are based on the scenario, clinical picture, and dosimetry, and may be assisted through advanced imaging techniques. Research-based multidisciplinary therapies, both in the laboratory and clinical trial environments, hold promise for future medical management. Great progress is being made in recognising the extent of injuries, understanding their pathophysiology, as well as diagnosis and management; however, research gaps still exist.

Overlapping Science in Radiation and Sulfur Mustard Exposures of Skin and Lung: Consideration of Models, Mechanisms, Organ Systems, and Medical Countermeasures: Overlapping science in radiation and sulfur mustard injuries to lung and skin

“…Clinical manifestation of CRI results from cellular damage including death of epidermal stem cells, DNA damage, ROS/ RNS, and an inflammatory response cycle. 45 The resulting pathophysiology of this injury can include vascular dilation, increased capillary permeability, microhemorrhage, and platelet consumption. 42 Neutrophil and lymphocyte infiltrates can result in perivascular edema, cell hypoxia, and cell death.…”

“…Recruitment of these cells can also lead to sustained TFG-β1 release that can result in fibrosis, which depending on injury severity, can extend into the blood vessels and deeper tissues. 45 Clinical assessment of CRI severity is done with scenario history including dosimetry or dose reconstruction along with patient history/ physical exam and serial photographs of the injury. 46 Imaging is another essential tool used to assess radiation injury, including magnetic resonance imaging (MRI), magnetic resonance angiography, and ultrasound.…”

Autologous i‐PRF promotes healing of radiation‐induced skin injury

“…Chronic skin injury presents as chronic fibrosis of skin tissue, dermal necrosis/atrophy, delayed ulceration and skin cancer, usually occurring months to years after exposure and eventually forming intractable wounds over time 3 . Compared with traumatic skin injury, RSI is prone to infection and progression and has a longer latency and persistence, which irreversibly damages skin capillaries and leads to long‐term non‐healing wounds, eventually leading to skin tissue fibrosis or even cancers, and thus seriously affecting patients' quality of life 4 . In terms of the pathophysiology and mechanism of RSI, ionising radiation can either directly induces sustained DNA double‐strand breaks and necrosis in skin tissue, or indirectly generates reactive oxygen species (ROS) and reactive nitrogen intermediates (RNI), thereby causing cell apoptosis, tissue fibrosis, vascular necrosis and release of inflammatory mediators such as interleukin‐1 (IL‐1), interferon‐γ (IFN‐γ), tumour necrosis factor‐α (TNF‐α) and IL‐6 in skin cells, inducing further damage to skin tissues and redox imbalance, and resulting in the difficult healing of the wounds 5 .…”

Long-term functional regeneration of radiation-damaged salivary glands through delivery of a neurogenic hydrogel

“…Despite substantial improvements in the targeted delivery of ionizing radiation (IR) for the treatment of tumors, numerous neighboring organs, including the skin ( 1 ), heart ( 2 ) and salivary glands ( 3 ), are inadvertently damaged by off target effects. With IR being the primary treatment option for the elimination of head and neck cancers (67,000/yr in USA ( 4 )), salivary glands represent one of the organ systems routinely injured, often resulting in permanent hyposalivation and related dry mouth condition xerostomia ( 5 ).…”