Das kutane Strahlensyndrom

Abstract

Accidental exposure to ionizing radiation may occur during such catastrophic events as the Chernobyl accident in 1986 or over days to weeks as in Goiania in 1987 and in the military camp during the training of soldiers in Lilo/Georgia in 1997, as well as in medical institutions. The cutaneous symptoms after radiation exposure are based on a combination of inflammatory processes and alteration of cellular proliferation as a result of a specific pattern of transcriptionally activated proinflammatory cytokines and growth factors. They follow a time course consisting of prodromal erythema, latency period, acute stage, chronic stage and late stage. The entire complex is referred to as cutaneous radiation syndrome. The time course depends on several factors such as the radiation dose, radiation quality, individual radiation sensitivity, the extent of contamination and absorption and amount of skin exposed. For the diagnosis of the cutaneous radiation syndrome the following procedures are used: 7.5 MHz to 20 MHz-B-scan sonography, thermography, capillary microscopy, profilometry, nuclear magnetic resonance imaging, bone scintigraphy and histology. Based on the results of experimental and clinical research, today treatment may include topical or systemic corticosteroids, gamma-interferon, pentoxifylline, vitamin E and superoxide dismutase. The treatment depends on the stage of the cutaneous radiation syndrome. Due to the complexity of the clinical manifestations of radiation disease, most patients require interdisciplinary treatment in specialized centres. Dermatologists are essential partners in the life-long follow-up and therapy of such patients.

Treatment of chronic radiation ulcers with recombinant platelet‐derived growth factor and a hydrophilic copolymer membrane

“…6 The treatment of (chronic) radiation dermatitis is a great challenge. 2,7 As shown by animal studies and uncontrolled observations in accidental radiation patients, subcutaneous interferon-γ improves radiation-induced fibrosis. 8 Pentoxyphyllin (3 × 400 mg /d p.o.)…”

“…or copper-zinc-superoxide dismutase have been used in combination for long-term treatment of radiation-induced fibrosis as well. 2 Topical treatment of radiation ulcers with hydrocolloids alone showed a better patient's satisfaction than gentian violet solution, but failed to accelerate wound healing. 9 Further studies are necessary to evaluate the optimal wound dressing for radiation ulcers.…”

“…Angiomatous changes with frequent bleedings and skin tumours have been observed in the late phase of chronic radiation dermatitis. [1][2][3] Among others, the development of painful and easily bleeding ulcers is a major factor contributing to the impact of quality of life in those patients. There is no standardized treatment for chronic radiation ulcers available.…”

Therapy with Ionizing Radiation

“…The high dose rate of up to 15 Gy/min at the outlet window rarely, but repeatedly, leads to serious accidents in which the skin organ is regularly exposed to single doses of 60-90 Gy or more. Because of unintended exposure to the substances used in the construction of pipelines, 137 Cs emitters cause dozens of accidents worldwide each year, resulting in the loss of hands, or even more serious injuries, in industrial workers, due to the consequences of cutaneous radiation syndrome (Gottlöber et al 2000). In recent years, highly targeted devices for the selective elimination of brain tumors and brain metastases have been developed (gamma-knife therapy).…”

Radiation-induced basal cell carcinoma

“…The cutaneous symptoms after radiation exposure are based on a combination of inflammatory processes and alteration of cellular proliferation as a result of a specific pattern of transcriptionally activated pro-inflammatory cytokines and growth factors. The entire complex is referred to as cutaneous radiation syndrome and its severity depends on several factors such as the radiation dose, radiation quality, individual radiation sensitivity, the extent of contamination and absorption and amount of skin exposed [ 6 ]. Clinical manifestations usually include a combination of hyper- and hypopigmentations, epidermal thinning and sclerosis ( Figure 3 ).…”