CHRONIC CUTANEOUS DAMAGE AFTER ACCIDENTAL EXPOSURE TO IONIZING-RADIATION - THE CHERNOBYL EXPERIENCE

Background: The hazards of acute radiation exposure are well known. Bo ne marrow failure from total body gamma or neutron irradiation is the most clinically relevant aspect of acute radiation disease. With nonho mogeneous exposure, as is characteristic in accidents, other organ sys tems, such as the skin, may be more important in determining clinical prognosis. This became obvious in the two worst radiation accidents si nce 1945, the Chernobyl accident in April 1986 and the Goiania acciden t in September 1987. Objective: Our purpose was to describe the charac teristic chronic sequelae of accidental cutaneous radiation in a group of patients who survived the Chernobyl nuclear power plant accident. Methods: Fifteen patients with the delayed type of the cutaneous radia tion syndrome were examined between September 1991 and January 1992. A ll patients had a history of acute radiation disease. The exposure pat tern was characterized by partial body exposure with high doses of bet a and gamma irradiation from radioactive water, steam, or dust. Result s: Radiation-induced lesions were confined primarily to the legs and d istal arms, but sometimes involved up to 50% of the total body surface . In addition to telangiectases, radiation keratoses, and radiation ul cers, hemangiomas, hematolymphangiomas, splinter hemorrhages in the di stal nail bed, lentiginous hyperpigmentation, and severe subcutaneous fibrosis were noted. No malignant transformation could be detected. As sociated diseases included cataracts, chronic hepatitis, and recalcitr ant bacterial and herpesvirus infections. Conclusion: After accidental partial body exposure to high doses of beta and gamma irradiation, th e predominant involvement of the skin, described as the cutaneous radi ation syndrome, can become the characteristic feature. This causes lon glasting, serious diagnostic and therapeutic problems.