os,
AKIN LEMONS AND EPILATION
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The early symptoms of itching and burning
of the skin and eves were prohably due mainly te
kin irradiation frew the falleet material.
However, the chemical nature of this material
may have contributed to the irmtation. It has
Leen noted (12) that irritating chemicals applied during or shortly after irradiation on-
hanre the effects of radiatica.
The lack cf prumiinence of an erythema wan
wetable, particularly in view of the severity of
vnme of the lesions that developed. Wilhelmy
(13) states that erythema only occurs when the
dove reaching the papillary layer exceeds a cer-
ee EE
tain level. Perhaps due to the low energy of
the beta radiation the dose to the dermis was in-
+2 are
Ne AP gS GER
the lew wrere lesons occurring ele here on
the body. it ix kagneal to assume that the feet
received a higher done of radiation becaine of
proximuty to the growad and thin amy explain
the seventy of thew lesions. The longer laten
period (desipte higher dene of radiation) may
he related to thicknem of the epedermin, cif
ferences in length of mitotic evelen or other
inherent characterinticn of xkin in diferent
areas of the body.
The histopatholagical changes noted, such as
tleructive and atrophic changes of the epidermix, disturbances in’ keratinization, and
atrophy of hair follicles, when taken together
are consistent with radiation injury to the skin
sufficient to evoke the response. On the other
hand, the darkness of the skin and the development of hyperpigmentation may have masked
an erythema. Microscopically, a superficial
hyperemia was not prominent.
Wirth and Raper (10) point out that they
were inipressed in their studies on P * radiation
of the human skin with the difficulty of distinguishing between true erythema and tanning,
particularly in the skin of brunette individuals.
It was unfortunate that color filters were not
available to aid in distinguishing an erythema
us suggested by Harris ¢¢ a/. (14).
(9, 12, 17, 18, 19, and 20). Severe injury to
the dermis and blood vessels was not observer.
The minimal dermal injury with severe epidermal injury is in keeping with the large component of low energy betx material present, re-
before development of lesions of the skin is considered to be roughly inversely proportional
to the dose of radiation (14, 16). In the present series of cases the relatively long latent pe-
trating radiation, but may be more typical of
the response to ultra soft roentgen or “Crrenz
rays(21).
There is no satixfactory explanation for the
darker dusky-yray color that appesred in some
of the skin lesions as healing progressed. Vascular changes or pigment aberrations might
have been responsible. The return to near normalin this prygmentation by 6 months showed
the transient nature of this change. The continued absence of pigmentation at the site of
the deeper foot lesions at 6 months and 1 vear
later sugyests that the pigment-producing elements im these areas were permanently cam,
In general, the length of the latent period
+
ae
nod is suggestive of a low dose of radiation.
Due to the wide spectrum of beta energies and
particulate distribution of radioactive material,
strict comparisons cannot be made with previous experience. However, the later development of less severe Jesions in the Ailinginae and
Rongerik groups as contrasted with earher deVelopment of more serrous lesions in the Kongelap group isin keeping with a lower skin dose
in the former, and a higher skin dose in the
latter. tis of interest, however, that the latent
period was dependent to some extent on
anatomical location. The foot lesions, which
were yenerally the most severe lesions encountered, had a longer latent period than tid
Fe ln ig RO lla ae RG a meee ay Feereiememe ein
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sulting in absorption of the greater portion of
the energy in the epidermis.
Hyperpigmentation of injured areas was a
consistent: finding in the Marshallese and the
American Negroes. Pigmented lesions were
also obverved to a lesser extent in the white
Americans. Such pronounced pigmentation ix
not characteristic of the usual lesions as de-
scribed following exposure to beta or pene-
nged.
The unique features of the lesions sich as
the marked pigmentation, the shsence of obvious Mmultiphasic response. the long latent period,