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Dermal NecrosisDermal Necrosis – General InformationDermal Necrosis or cutaneous injury is a medical condition caused by exposure to a large external dose of radiation that affects the skin and the underlying tissues. The disease is known to generally appear after exposure to beta radiation or low energy X-rays due to the fact that beta radiation and X-rays are less penetrating and less likely to damage the internal organs of the patient than the beta radiations. Dermal Necrosis is a condition that progresses over time in various stages and can be classified by grade; the stages of this disorder include the prodermal stage, the latent stage and the manifest illness stage. The prodermal stage is characterized by early erythema, heat sensations, and itching that defines the exposure site. In most cases this stage lasts from one to two days. In the latent stage no injury is evident. Depending on which part of the patient’s body has been affected, the larger the dose is, and the shorter the period of progression lasts. In most cases, the skin on the patient’s face, chest, and neck presents a shorter latent stage that the skin on the palms of the hands or the soles of the feet. In the manifestation stage of Dermal Necrosis, the basal layer is repopulated through proliferation of surviving clonogenic cells. Usually, the stage starts with anerythema, a sensation of heat, and slight edema, which are, in most cases accompanied by increased skin pigmentation. The signs and symptoms that appear vary from dry desquamation or ulceration to necrosis, depending on the severity of the condition.Dermal Necrosis – SymptomsIn most cases, the early signs and symptoms of this condition - Dermal Necrosis are itching, tingling, or a transient erythema or edema without a history of exposure to heat or caustic chemicals. There are also cases in which the exposure to radiation can damage the basal layer of the patient’s skin causing the appearance of inflammation, erythema, and dry or moist desquamation. In severe cases of Dermal Necrosis, radiation damages the hair follicles and it can lead to depilation. Transient and inconsistent erythema, accompanied by itching, can appear several hours after the exposure and be followed by a latent phase without any signs and symptoms that can last for two to three weeks. After this stage has passed, the patient starts to experience intense reddening, blistering, and ulceration of the irradiated site. Depending on each organism and radiation dose, a third and fourth presence or erythema can appear over several months or even years. In most cases, the healing process takes place by regenerative means. Usually, large doses of radiation can cause permanent hair loss, damaged sebaceous and ulceration or necrosis of the exposed area of the patient’s body. If the patient suffers from Dermal Necrosis it is very important for him to know the following facts: the visible effects depend on the magnitude of the dose but also on the depth of penetration of the radiation; unlike the skin injuries provoked by the chemical or thermal damage, the injuries caused by radiation exposures are not visible for hours and even days after exposure.Dermal Necrosis – TreatmentIn cases in which the patient is suffering from this medical condition called Dermal Necrosis or he has other trauma, the first thing to be done is to immediately try to close the present wounds, covering the burns, reducing the fractures, performing a surgical stabilization, and applying definitive treatment within the first two days after the injury. Any surgical procedures must be delayed at least a couple of days until the patient has a hematopoietic recovery. Due to the fact that cutaneous injury is cyclic, sites of early erythema should be noted and recorded. In performing these procedures, doctors should consider certain steps such as supportive care in clean environment, prevention and treatment of infections, medications to reduce the present inflammation, inhibit proteolysis, relieve pain, stimulate regeneration, and improve circulation using anticoagulant agents for widespread and deed injury, pain management and psychological support. In most cases, doctors can apply certain treatments depending on the stage of the Dermal Necrosis disease, including prodermal stage, latent stage, and manifestation stage. For the prodermal stage, doctors commonly use antihistamines and topical antipruriginous compounds that can act against itching and can also prevent and attenuate initiation of the cycle that leads to the manifestation stage of Dermal Necrosis. There are cases in which doctors can also use anti inflammatory drugs such as corticosteroids, topical creams and slight sedative medicines. For the latent stage, doctors use anti inflammatory drugs and sedative agents. There are some cases in which, at midst age, doctors apply proteolysis inhibitors such as Gordox. For the manifestation stage, doctors use repeated swabs, antibiotic treatment, and anti inflammatory drugs, such as Lioxasol, used to reduce bacterial, fungal, and viral infections. In treating this disorder that affects the skin (Dermal Necrosis), doctors should follow certain steps in order to assure improvement; such steps include applying topical ointments containing corticosteroids in addition with local antibiotics and vitamins; stimulating regeneration of DNA by using Lioxasol, and after the regeneration has begun, using biogenic medicines such as Actovegin and Solcoseril; stimulating blood supply after three to four weeks using Pentoxifylline - this is not indicated for individuals who suffer from atherosclerotic heart disease; puncturing the blisters if they are sterile, but not removing them as long as they are intact; staying alert for wound infection using antibiotic treatment according to the patient’s condition; treating the pain, because pain relief is very difficult and is the most demanding step of the treatment; debriding areas of necrosis thoroughly but cautiously. There is a second major step in treating Dermal Necrosis, and that is treatment of later effects. After an immediate treatment of the patient’s injury, doctors must apply a long and painful process of healing. The most important facts in treating the disease are: pain management, fibrosis and late ulcers; it is very important to use medication to stimulate vascularization, inhibit the present infection, and reduce fibrosis, such as Pentoxifylline, vitamin E and interferon gamma; necrosis, plastic and reconstructive surgery are usually the most common procedures required and are more efficient in early stages of the treatment, post traumatic stress disorder. |
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