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Dermatitis radiologica chronica professionalis Radiodermatitis bullosa acuta Ulcus radiologicum acutum


The increase in use of high dose and long fluoroscopically guided interventional procedures in the last twenty years has put physicians at a greater risk, as far as chronic exposure of the hands to radiation is concerned. Radiodermatitis appears after a threshold dose of radiation is obtained.

Whether chronic dermatitis develops depends on a number of factors, including the type of equipment and radiation used, the duration of exposure, the configuration of the beam and the number of procedures carried out per year.

The first signs of chronic occupational radiodermatitis may appear after some years of cumulative exposure. The usual parts affected are the hands, especially the left hand, due to the position it takes when carrying out operations. The fingers most commonly affected are the dorsum and medial side of the index, middle and ring fingers.

Initially the clinical features are not very marked. The skin on the dorsum of the fingers becomes dry, shiny and hairless and the nails become brittle and develop longitudinal lines.

Chronic radiodermatitis has three stages: simple, progressive and malignant.

With simple chronic radiodermatitis, the skin becomes dry, fine and hairless due to atrophy of the epidermis and is easily vulnerable to minor trauma. It is also discoloured with areas of increased pigmentation, haemorrhage areas and black spots. The epidermis presents areas of desquamation, fissuring (linear ulcers) and micro-ulcers. The ridges of the epidermis which form the fingerprints also disappear.

Progressive chronic radiodermatitis shows in the appearance of wart-like formations and ulcers, which continue to worsen even after exposure to radiation has ceased. It can lead to hyperkeratotic plaques and painful keratoses on the sides of the fingers and fingertips. Around the edges of the ulcers caused by radiodermatitis pseudoepitheliomatous hyperplasia may occur. The skin develops telangiectases and areas of epidermal atrophy and dermal fibrosis. Progressive chronic radiodermatitis frequently gives rise to a painful burning sensation.

With malignant chronic radiodermatitis, neoplastic transformation develops in the ulcers or the keratoses. The commonest histological types are Bowen’s disease (squamous cell carcinoma in situ) , squamous cell carcinoma and basal cell carcinoma. These tend to appear at a much later stage, often as much as twenty or thirty years after exposure to radiation. From a clinical point of view malignant chronic radiodermatitis is apparent as areas of ulceration with poor wound healing.

Radiaxon® Radiation Protection Gloves reduce the amount of scattered and secondary radiation exposure to the hand from primary X-ray beams during diagnostic procedures, angiography, cardiovascular, orthopaedic and urologic interventions, pain management, fluoroscopic procedures and where a C-arm is used.





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