28 LFFECTS ob LON A [T'we, RADIATION Neariv all of the lesions were spotty and de- were absent until tae vieitle lesions developed During the eary staves of ievelopment of the ~ejoped on exposed parts of the body not cov- lesions, itching ered by clothing during the fallout. burrong and sheht pain were experienced wil the more superficiai lesions With deeperlesions pout “was more severe. The deeper foot lesions were ihe most painful ana caused some of the people to walk on then heels for several dav~ during the acute stayes Some of the more severe lesions of the neck and axilla were painful when turning the (eau or raising the APTS, The lesions ified peat produce any constitunicial avinptoms. 3.3, 3.31 Description of Skin Lesions* Gross Appearame The time of Uppearance ind the severity of the lesions varied with the degree of skin on tamination inthe different groups. The Ronvelap group, which showed greatest radioactive contamination of the skin ¢according te instru ment readings) were the first to develop Jesionand epilation at about 12 re 14 days after tae aceident. They also had the most severe lesions Skin lesions i: the vesser exposed Adlinginae and Rongerik groups developed approximate! one week after those in tue Rongelap group. and were less severe and extensive The fot ris group did not leveion any lesions which «ould be attributed to irradiation of the skin ‘The incidence of uleerating lesions inp the ditferen: wroups reflected the relative severity of the sias injury. Twenty percent of the Rongelap people developed ulcerative vesions while only five pet eent of the Allinginae and none of the Rongerrs people developed uicerative lesions. Ninets percent of the Rongeiap und Adinginae groupe developed lesions, compared to only forty et cent of the Rongermk group. There were swore lesions per individnal on the Rongelap eran than in the Aginginae or Rongertk groups 4 comparison of he snerdence and time of apperu ance of epilation ad eek lesions in the o« groups is illustrated cru easly ay Froure | * The deseriptiim of deste us ci fers tarhe Voarsta lee unless otherwise indica ed The ma- ority of madividuals developed multiple lesions particalar vy the Rongelap group), most of which were superficial. There was a difference of several days in the latent period before ce- velopment of lesions on various skin areas. The urder ef appearance was roughly as follows: sealp owith epilation). neck, axillary region, aurecubital fossae. feet. arms, legs, and trunk. Lesions on the flexor surfaces in general pre‘eded those on the extensor surfaces. Tables PE and 3.2 show inetdence aceording to age and Time ot appearance of lesions in the various LTOUDS Ir. the early stages all lesions were character- ized by hyperpigmented macules, papules, or inised plagues. (Plate 1.) These frequently were small, 1-2 mm. areas at first, but tended to ‘oalesce ina few days into larger lesions, with iolry, leathery rexture. The pigmented stage of the superticial lesions within several days was followed by dry, scaly ‘tesquamation which proceeded from the cenler part of the lesion outward, leaving a pink ro white thonned epithelium. As the desquamaion proceeded outward, a characteristic appearinee of a central depigmented area fringed with an irreguiar hvperpigmented zone was -een (]'lates Zand 3). Repigmentation began in the central area and spread outward over the hext few weeks leaving skin of relatively nornal appearance. Plates 3. 4, 11, and 12 show ~uperticial jesions as thev appeared initially and ~Ix months later The midest mantfestation of ~kin injury was the development of a blotchy nereased tigmentation of the skin with barely verceptible desquamation, Such lesions were nost often noted on the face and trunk. EF pilition was usually necompanied by scalp esrons > Plates 13, 17 and 19}. Some indi- cidath developed new sealp lesions over a per od of about a month. Neck lesions usually lida neeklace’ distribution, beginning anteri- ly and spreading posteriorly. « pore oeWece oT women in whom These were thiek hair sey