Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

axilla, groin, and skin folds. Radiation sensitivity in other areas of the body decreases in
the following order:
• Inner neck.
• Antecubital, popliteal, flexor surface of extremities.
• Chest.
• Abdomen.,
• Face.
• Back.
Least sensitive areas are the nape of the neck, scalp, palms, and soles. Dry desquamation
usually leads to complete recovery. However, recovery from moist desquamation
depends on the extent of injury.
Subacute stage. The subacute stage is characterized by initiation of progressive dermal
and subcutaneous fibrosis leading to a second ulcerative phase and cutaneous ischemia in
affected areas.
Chronic stage. Onset is usually from 16 weeks to 2 years after initial irradiation with
epidermal atrophy and erosions associated with dermal and subcutaneous fibrosis being
the main clinical manifestations. Concomitant inflammation tends to progress indefinitely
with no endpoint. As such, long-term evaluation and management may be required.
Late stage. This occurs 10–30 years after irradiation in the exposed field with
development of “spontaneous” angiomas, keratoses, ulcers, and squamous and basal cell
carcinomas.
Treatment and Management Issues
There are no specific protocols published to guide treatment. However, treatment of past
victims provides a valuable point of reference for treating future victims. The clinical
situation helps guide whether the treatment approach should be conservative or surgical,
based on the following guidelines:
• Radiation ulcer and localized necrosis without signs of regeneration is the primary
and most often encountered indication for surgical intervention, as well as severe
pain. The more rapid the progression of the pathologic process, the more severe
the injury is, and the earlier the intervention should be performed.
• Resection of injured and dead tissue must be accomplished to permit an effective
engraftment. Erythematous tissue surrounding frank ulcers is likely to ulcerate if
traumatized.
• Antihistamines and topical antipruritic agents may be used for the relief of
symptoms. Antihistamines may also prevent or weaken the subsequent
inflammatory process.
• Use of high-dose systemic glucocorticoids, combined with topical class III or IV
steroids, should be considered.
• Potential opportunistic pathogens (i.e., bacteria, fungi, and viruses) should be
treated.
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