31
SKIN LESIONS AND EPILATION
touched the nape of the neck.
Neck lesions are
ve eee
ihastrated in Plate 1-4. Axillary lesions ( Plate
11) usually consisted of coalescing papules.
Antecubital fossa lesions were characterised by
formation of thickened pleques. Several
babies and one woman developed lesions in the
anal region which, though not deep, were pein-
fel due to excoriation of the epidermis. Thess
healed rapidly.
Deeper
were seen on the scalp, neck,
fee:
ae
. vaseontheear. They were char-
by trensepidermal necrosis with wet
,amation leaving weeping, crusting ulcera-
tions. Vesiculation was not observed except
with foot lesions which developed bullae, fre-
quently several ce. ‘meters in diameter, beneath
thickened
pigmen.
plaques.
These foot
lesions occurred un the dorsum of the feet and
between the toes. (Only one case showed des-
quamation on the soles of the feet.)
After
several days the builae ruptured and desquamated leaving raw ulcers. Some of these
lesions, particularly of the feet, became second-
arily infected requiring antibiotics. However,
most of the lesions healed rapidly and new
epithelium covered the ulcerated areas within
a week to 10 days.
in Plates 5-10.
Foot lesions are illustrated
Ome ear lesion (Plates 13-16)
took several months to heal.
The repigmentation of some deeper lesions
presented abnormalities.
Neck lesions often
developed a dusky. grayish brown pigmentation
associated with a thickened “orange peel" appearance.
Histological appearance of epidermal rugosity was also noted in these lesions
(yee section on histopathology). In addition,
the deeper lesions of the feet failed to repigment, remaining pink or white.
At examina-
tion 6 months and | year after the exposure, the
skin appeared normal with no residual changes
in the vast majority of cases.
However, some of
the deeper lesions continued to show evidence of
year pigmentation changes were mild.
Foot
lesions had not repigmented at sites of deepest
involvement and some strophy of the skin in
these areas was apparent.
3.32 Microscopic Appearance
Biopeies were taken of seven neck, aad one
axillary lesion in the Rongelap group during
the third to fourth week after exposure. At
the time of biopsy these lesions were in the hyperpigmented stage with little or no desquamation. Most of the biopsies were taken from in-
dividuals with lesions of average severity. A
second series of biopsies (repeats in three individuals) were taken from this group, 4 st
the seventh week and 5 at the eighth week postexposure. These were taken from the neck and
antecubital fousme. All of these lesions had
desquamated and the depigmented akin had repigmented to « dusky, gray color with some
thickening of the akin (“orange-peel” appearance), plates 25 and 27.
Hiopsies were not
taken from ulcerative lesions or from the feet
because of the danger of infection.
<A third
series of 11 biopsies were taken from the Rongelap group at 6 months along with several con-
trol biopsies from unexposed natives. Material
was obtained in many cases adjacent to sites of
previous biopsies.
Al) biopsy wounds healed rapidly within a
week to 10 days with no secondary complications.
The microscopic findings are summarized as
follows:
First seriee—ird to $th week. Fpidermis.
Transepidermal damage was noted with a few
intervening
arcades showing
(Plates 21 and 22).
less damage
The epidermis in the nost
extensively involved nreas showed considerable
Foremost among these was
atrophy with flattening of the rete pegs and in
places the epidermis was reduced to a thickness
able scarring, atrophy, scaling of the epidermis
of 2to 3 cella ( Plates 21, 23, and 24). The cells
residual damage.
the ear lesion which had healed with consider-
and gross telangiectasis.
By 6 months the hy-
perpigmentation and thickening of the akin of
the neck lesions had greatly subsided and by 1
of the malpighian layer showed pleomorphic
nuclei, pyknosis and cytoplasmic halos, giant
cells and in a few instances multinucleated cells.