reee CHAPTER 3 SKIN LESIONS, EPILATION, AND NAIL PIGMENTATION 3.1 INTRODUCTION. EARLY SYMPTOMATOLOGY REFERABLE TO THE SKIN The Marshallese on Rongelap saw a visible fallout of powdery material that began approxi- mately five hours after the initial flash was seen. The powder whitened the hair and adhered to their skin as a salt-like film. The Marshallese on Ailinginae reported a similar but less strik~ ing fallout. The Americans on Rongerik also saw a fallout and described it as “mist-like.” The Marshallese on Utirik did not see a fallout. The early symptoms were limited to the Rongelap, Ailinginae, and to a lesser cxtent the Americans on Rongerik. The early symptoms consisted of a generalized itching and burning of the skin, limited almost exclusively to the exposed parts of the body. A less consistent symptom was burning of the eyes accompanied by tears. The symptoms began the night of the fallout and continued into the next day. A few individuals had symptoms lasting as long as two or three days. Decontamination of the skin of the exposed individuals was initiated either aboard the destroyers while they were beingevacuated or upon their arrival at the naval base on Kwajalein. The classical initial erythema of radiation injury to the skin was not noticed by the observers who examined these individuals during the first 10 days. H aninitial erythema developed in the native Marshallese, it was masked by their dark skin. An erythema was not seen in the white skinned Americans exposed on Rongerik. 3.2 3.2.1 SKIN LESIONS General Description Skin lesions first appeared in the Rongelap group after 12 to 15 days and in the Ailinginae and Rongertk groups after 20 days. There were no skin lesions in the Utirik group. There was considerable difference in (he length of time necessary for the development of the various le- sions. However, it was found that there was a consistent patlern in the sequential development of lesions on various exposed parts of the body. The principal lesions occurred roughly in the following sequential order: scalp (with epilation); neck, axillary region, antecubital fossac, feet, arms, legs, and trunk. Lesions on the flexor surfaces tended to precede those on the extensor surfaces (see Table 3.1 for the time of appearance of various lesions). A clear cut primary erythema was not seen, nor was a late erythema. In a few cases, there was considerable scratching of the skin due to intense itching prior to development of gross lesions. In these cases, an erythema of questionable etiology was observed. This erythema may well have been due to the scratching. Erythema was likewise not observed preceding developmentof lesions in the white and Negro Americans of the Rongerik group. The first indication of a developing lesion was an increase in pigmentation. These pig- mented areas appeared in the form of macules, papules, raised plaques, or larger areas of 34