(X-ray burn; Roentgen-ray dermatitis)
An inflammatory condition of the skin was quite common in the early days of the employment of X-rays and at the present time, in spite of all precautions and a much improved technic, it is sill occasionally developed in the work of careful and experienced operators. Erythema, followed by slight pigmentation, is the mildest form. Vesiculation may occur and, in severer types, a dry superficial slough forms which takes months to separate and may result in an ulcer, which in turn takes months or years to heal. These serious lesions are surrounded by an inflammatory border and are always accompanied by pain. When a scar eventually forms it is usually accompanied with telangiectases. A chronic form may occur on the face and hands of X-ray operators and is characterized by scaliness, atrophy, obliteration of the normal lines of the skin, alopecia, and at times loss of the nails. Keratoses may develop and lead to cancerous degeneration.
Etiology and Pathology. Long exposure, too frequent applications, unknown quality of a tube, or personal idiosyncrasy, all play casual parts. Even after erythema develops, and treatment is discontinued, dermatitis may yet ensue, at times weeks after the discontinuance of the treatment. The effects of X-ray are cumulative. This fact should never be forgotten. Although it may be necessary to cause an X-ray dermatitis to insure the best results, it is wise to warn the patient. It is always my custom, in treating case of onychomycosis, psoriasis of the nails, epithelioma and lupus vulgaris to tell the patient that such a dermatitis may be necessary to insure the best results.
Pathological, there is a destruction of the cell protoplasm and of its nucleus, which involves not only the epidermis and its appendages, but also the corium. McLeod has summarized the condition as follows: (1) the X-ray in small doses has a stimulating effect; (2) in large doses, by long exposure, close proximity of the tube, or the employment of soft tubes, the rays may devitalize the tissue elements; (3) that the hair-follicles, glands, nails and blood vessels are more readily and severely affected by the rays; (4) that cells which have become pathologically affected are far less resistant to the rays than healthy cells; (5) action of the rays is cumulative.
Prognosis and Treatment. a favourable outcome may be expected in all mild cases. Improved methods of technic have lessened the frequency and intensity of attacks. The prognosis of severe cases is bad because epitheliomatous degeneration, constant pain and possible destruction of tissue may be expected. The milder forms of erythema need protection and possibly a cooling lotion of lead and opium with or without the addition of glycerin or boric acid. Ointments containing acetanilid, cocain, menthol or opiates may be used to relieve the pain and promote healing. I have seen good results follow the use of a 2 to 5 per cent. creolin in glycerin, carron oil (made with olive oil), or orthoform (1 to 2 drams to an ounce of simple cerate). Calendula in liquid or ointment form is also used. Surgical treatment including subsequent skin grafting may be needed in cases of ulceration. Solidified carbon dioxid may be used to remove warty or keratotic growths. Arsenicum, Nat. mur., Radium brom., and Silicea may be studied.