CUTANEOUS RADIATION INJURY

Cutaneous radiation injury (CRI) is also known as local radiation injury and is the sequela of skin exposure to large doses of radiation. The threshold dose to cause CRI is highly variable due to both patient factors and the properties of the radiation (dose, dose rate, and radiation quality). CRI can occur in the absence of ARS. When it occurs with ARS, it is known as CRS. The extent of cutaneous injury is an important determinant of survival. Immediate erythema typically indicates a thermal or chemical burn. Erythema that occurs within 2 hours of gamma exposure indicates very high local exposure. Most skin changes will occur more than one week after exposure.29,30 If acute radiation skin exposure is suspected, cool water may decrease inflammation. Conservative treatments adapted from non-radiation skin injury such as topical steroids, antihistamines, and antibiotics may be useful.20,31 Systemic antibiotic therapy is not recommended. Pain control and fluid replacement is an important part of therapy. One can expect lower fluid requirements than with thermal burns, but fluid therapy should be tailored to the clinical condition of the patient.30

Advanced skin care in the form of skin grafts or even amputation to control necrotic tissue may be necessary in those with severe exposure.30,31 Other therapies (likely only available at higher echelons of care), such as pentoxifylline, α-tocopherol, transforming growth factor-β, fibroblast growth factor, interferon-γ, and estradiol may be considered in consultation with radiation and burn or skin care specialists.32-35

Figure 8. Timeline of CRI
Figure 9. Cutaneous injury from fluoroscopy
Table 12. Cutaneous Radiation Injury (CRI) Therapies