Radiation Burns: Symptoms, Types, Causes and Treatment

Radiation burns are a unique and challenging form of skin and tissue injury, distinct from burns caused by heat or chemicals. They can result from exposure to a range of radiation sources, from medical procedures to accidents and environmental factors. Understanding the symptoms, types, causes, and latest treatments is critical for patients, caregivers, and healthcare providers. This article offers a comprehensive look at the landscape of radiation burns, synthesizing current research and clinical findings.

Symptoms of Radiation Burns

Radiation burns can be deceptive. Unlike thermal burns, symptoms may appear hours, days, or even weeks after exposure. Recognizing the telltale signs early can be crucial for timely intervention and improved outcomes.

Symptom	Description	Severity Progression	Source(s)
Erythema	Reddening of the skin	Early, mild	3, 5
Desquamation	Peeling/flaking (dry or moist)	Intermediate	5
Ulceration	Development of open sores or ulcers	Late, severe	4, 5
Necrosis	Tissue death, blackened areas	Advanced	5, 6, 7
Hair Loss	Loss of body hair in affected region	Early to mid	5
Pigmentation	Loss or darkening of skin color	Late	1
Pain	Ranges from mild discomfort to severe	Varies throughout	6, 7
Poor Healing	Delayed wound repair, chronic wounds	Persistent	3, 9

Table 1: Key Symptoms of Radiation Burns

The Spectrum of Symptoms

Radiation burns can manifest in a variety of ways, often evolving through several stages:

• Erythema: One of the earliest signs, characterized by redness and warmth due to inflammation. This can appear within hours or days after exposure, depending on the dose and type of radiation 5.
• Desquamation: As the damage progresses, skin may begin to peel. Dry desquamation is less severe, while moist desquamation involves blistering and weeping, signaling deeper tissue involvement 5.
• Ulceration and Necrosis: In severe cases, radiation burns progress to open sores (ulcers) and even tissue death (necrosis). These changes may take weeks to months to fully develop and are often accompanied by severe pain and risk of infection 4,5,6,7.
• Hair Loss and Pigmentation Changes: Hair in the affected area may fall out, and the skin may lose its normal color, becoming either pale (depigmented) or dark (hyperpigmented) 1,5.
• Pain and Poor Healing: Pain can be intense and persistent, especially as ulcers and necrosis develop. The damaged area is prone to poor healing due to compromised blood supply and ongoing inflammation 3,7,9.

Factors Influencing Symptom Severity

• Radiation Dose and Type: Higher doses and ionizing radiation (X-rays, gamma rays) typically result in more severe symptoms 2,5.
• Patient Factors: Genetic susceptibility, skin type, and pre-existing conditions can modify the severity of burns 1.
• Latency Period: There may be a significant delay between exposure and the appearance of symptoms, particularly with high-dose or fractionated exposures 5.

Types of Radiation Burns

Radiation burns are not one-size-fits-all. They vary depending on the type and energy of radiation involved, as well as the pattern and duration of exposure. Understanding these distinctions is vital for diagnosis and management.

Type	Source/Mechanism	Common Features	Source(s)
Ionizing	X-rays, gamma rays, nuclear	DNA damage, ulceration, necrosis	2, 5
Non-ionizing	UV, laser, infrared, microwave	Erythema, blistering, local pain	2, 3
Acute Localized	High-dose, focused exposure	Severe skin damage, ulcers	3, 4, 5
Chronic/Cumulative	Repeated low/moderate exposure	Atrophy, fibrosis, cancer risk	1, 2

Table 2: Main Types of Radiation Burns

Ionizing vs. Non-Ionizing Radiation Burns

Ionizing Radiation Burns

• Causes: Medical X-rays, radiotherapy, nuclear accidents, radioactive contamination.
• Mechanism: Ionizing particles (such as photons and electrons) penetrate tissue, causing direct DNA and cellular damage.
• Features: Higher risk of ulceration, necrosis, atrophy, and even secondary cancers due to genetic mutations 2,5.
• Special Cases: Cutaneous radiation syndrome (CRS) is a severe outcome following high-dose, localized exposure, marked by persistent ulcers and deep tissue destruction 5.

Non-Ionizing Radiation Burns

• Causes: Ultraviolet (UV) sunlight, lasers, infrared heat, microwaves, radiofrequency energy.
• Mechanism: Lower energy, causes surface tissue damage without altering DNA directly.
• Features: Erythema, skin peeling, blistering, and occasionally pigmentation changes. Chronic exposure to UV, especially UVB, can still induce DNA mutations and lead to skin cancers 1,2.

Acute vs. Chronic Radiation Burns

Acute Localized Burns

• Result from a single, high-dose exposure (e.g., radiotherapy accidents or fluoroscopic procedures).
• Characterized by rapid onset of severe symptoms, including deep ulcers and necrosis 4,5.

Chronic/Cumulative Burns

• Develop over time due to repeated or prolonged lower-dose exposures.
• Can lead to skin thinning (atrophy), fibrosis (scarring), pigment changes, and a significantly increased risk of skin cancer (basal cell and squamous cell carcinoma) many years after exposure 1,2.

Special Considerations

• Burn Scarring: Radiation burns may result in atrophic, hypertrophic, or keloidal scars, depending on depth and individual healing response 1.
• Secondary Malignancy: Chronic radiation-damaged skin is at increased risk for developing cancers, sometimes decades later 1.
• Other Types: Vesicant burns, though primarily chemical, can mimic radiation burns in appearance and treatment challenges 3.

Causes of Radiation Burns

Radiation burns have a variety of causes, ranging from accidental exposures to necessary medical treatments. Recognizing these sources can help in prevention, early detection, and tailored intervention.

Cause Category	Examples	Risk Context	Source(s)
Medical	Radiotherapy, fluoroscopy, X-rays	Cancer treatment, diagnostics	2, 4, 5
Accidental	Nuclear accidents, war, mishaps	Occupational, environmental	2, 6, 7
Environmental	Solar UV, tanning beds	Leisure, outdoor work	1, 2
Industrial	Radioactive material, lasers	Manufacturing, research	2, 6

Table 3: Common Causes of Radiation Burns

Medical Causes

• Radiotherapy: Used in cancer treatment, can inadvertently damage surrounding healthy skin and tissue, especially at high doses or with repeated treatments 2,5.
• Fluoroscopic Procedures: High-dose fluoroscopy, common in cardiology and interventional radiology, can cause deep skin burns if proper precautions are not taken 4.
• Diagnostic Imaging: While rare, repeated or high-intensity X-rays for diagnostic purposes can cause skin injury 2.

Accidental Exposures

• Nuclear Accidents: Events like Chernobyl or industrial mishaps can expose workers and populations to dangerous levels of ionizing radiation, leading to severe, often life-threatening burns 2,6.
• Radiological Warfare: Exposure to radioactive contamination during war or terrorism can cause acute and chronic radiation injuries 2.

Environmental Sources

• Solar Ultraviolet (UV): Sunburn from UVB and UVA radiation is a common, though usually less severe, form of non-ionizing radiation burn. Chronic exposure increases the risk of actinic keratosis and skin cancer 1.
• Tanning Beds: Artificial UV exposure can similarly cause burns and long-term skin damage 1.

Industrial & Occupational

• Radioactive Materials: Mishandling of radioactive sources in research, manufacturing, or medical settings can result in accidental burns 2,6.
• Lasers and Microwaves: High-intensity lasers and microwave devices in industrial or research contexts can cause localized non-ionizing burns 2.

Factors Affecting Risk

• Protective Measures: Adherence to radiation safety protocols dramatically reduces the risk of accidental burns 2,4.
• Genetic Susceptibility: Some individuals are more prone to radiation-induced skin damage and subsequent complications 1.
• Dose and Exposure Duration: The risk and severity of burns increase with higher doses and longer exposure times 2,5.

Treatment of Radiation Burns

Treating radiation burns is complex, requiring both general wound care and specialized interventions. New therapies, including cellular treatments, are changing the landscape of care for severe cases.

Treatment	Approach/Method	Main Benefits	Source(s)
Supportive Care	Dressings, infection control	Promotes healing, comfort	3, 4
Surgery	Excision, skin graft, flaps	Removes necrotic tissue	6, 7
Cell Therapy	Mesenchymal stem cells (MSC)	Enhances regeneration, reduces inflammation	5, 6, 7, 8, 9
Gingival Fibroblasts	Local injection into wounds	Accelerates epidermal healing	8

Table 4: Key Treatments for Radiation Burns

Supportive and Conventional Treatments

• General Wound Care: Includes gentle cleansing, sterile dressings, and careful monitoring for infection. Pain management is essential, as radiation burns can be intensely painful 3,4.
• Infection Prevention: Burned, irradiated skin is more susceptible to infection and sepsis, so strict hygiene and sometimes prophylactic antibiotics are necessary 3.
• Surgical Interventions:
  • Excision: Removal of necrotic or non-healing tissue.
  • Skin Grafts and Flaps: Used to cover large wounds and promote healing, though results can be unpredictable due to ongoing tissue damage 6,7.

Advanced and Emerging Therapies

Mesenchymal Stem Cell (MSC) Therapy

• What is it?: Injection of autologous (patient’s own) bone marrow-derived mesenchymal stem cells directly into the wound.
• Benefits:
  • Promotes tissue regeneration and healing.
  • Modulates inflammation, reducing secondary damage.
  • Improves vascularization of the affected area, leading to better outcomes 5,6,7,9.
• Clinical Evidence: Multiple case studies and animal models have demonstrated improved healing, reduced pain, and prevention of recurrent inflammatory “waves” with MSC therapy, especially when combined with surgery and skin grafts 5,6,7,9.

Gingival Fibroblast (GF) Therapy

• What is it?: Injection of cultured gingival fibroblasts into the wound.
• Benefits:
  • Promotes rapid epidermal regeneration.
  • Alters the wound environment to favor healing and reduces scarring.
  • Easier to collect and grow than MSCs 8.

Other Considerations

• Dosimetry-Guided Surgery: Using advanced imaging and dose-mapping to precisely excise only the tissue that has received damaging levels of radiation, sparing healthy tissue 6.
• Plastic Surgery and Flap Reconstruction: Sometimes required for extensive wounds, especially where joints or critical anatomic structures are involved 7.

Challenges and Future Directions

• Unpredictable Progression: Radiation-induced necrosis can extend unpredictably, complicating both surgical and medical management 6,7.
• Long-term Follow-up: Chronic ulcers and secondary malignancies require ongoing surveillance.
• Protocol Development: There is a need for standardized, hospital-ready clinical protocols for advanced therapies like MSC and GF injection 9.

Conclusion

Radiation burns are complex injuries that demand careful attention and innovative care. From early symptoms like erythema and hair loss to advanced necrosis and ulceration, the clinical presentation can be varied and deceptive. Causes range from medical treatments to environmental and accidental exposures, with both ionizing and non-ionizing radiation capable of inflicting serious harm.

In summary:

• Symptoms range from early redness and pain to late-stage necrosis, ulceration, and poor healing 1,3,4,5,6,7,9.
• Types include ionizing and non-ionizing burns, with acute and chronic forms, each carrying its own risks and complications 1,2,3,4,5.
• Causes span medical, accidental, environmental, and industrial settings, highlighting the importance of strict safety protocols 1,2,4,5,6.
• Treatment is evolving, with stem cell-based therapies and gingival fibroblast injections offering new hope for deep, chronic wounds where conventional methods often fail 5,6,7,8,9.

Key Takeaways:

• Early recognition and intervention are crucial for better outcomes.
• Advanced therapies like MSC and GF injections are promising but require further development.
• Prevention through safety and protective measures remains the best strategy against radiation burns.

Staying informed and proactive—whether as a patient, provider, or policy-maker—can help reduce the burden of these challenging injuries and improve healing for those affected.