Burns and the effects of exposure to radiation: Clinic, diagnosis and treatment

Treating lesions caused by UV rays

• Limit further UV exposure. If re-exposure cannot be avoided, ensure that the burned area is covered with loose cotton clothing and protect areas that cannot be covered with SPF 50 sunscreen.
• Cool the burned area with a cold compress or by running the affected burned area under tap water at 15°C to 25°C^3,4.
• Local treatment with hydrocortisone or dermocorticoids⁵ or oral NSAIDs³. These treatments should not be continued for more than three days without medical advice. Protective or non-protective topical treatments can also be applied (Biafine, aloe vera...), but be careful with sun exposure.
• Avoid vaseline for more severe sunburns. Also refrain from treatments containing local anaesthetics because of the risk of allergic contact dermatitis.
• If blisters are present (superficial 2^nd-degree burn), do not puncture them and be sure to clean the area with soap and a dermal antiseptic product.
• Monitor the patient's temperature.

Treating Radiation Dermatitis

• The following treatments will only be curative.
• Indeed, there is no preventive treatment to date that has been proven to be truly effective.
• Some studies seem to show a certain effectiveness in the use of a calendula cream to prevent the appearance of radiodermatitis and to reduce the pain linked to irradiation⁶.
• Moreover, there is no real consensus to date that proves the superiority of a curative treatment^2,7.
• However, there is some guidance on the management of different types of radiation dermatitis².
• In addition, after radiotherapy treatment, local hygiene is very important, and it is recommended to wash with a mild soap and warm water⁸.

Regarding the various types of Cutaneous Radiation Injury (CRI), the recommendations made by the French Speaking Cancer Care Support Association are²:

• Grade I: Continuation of hygiene care. Dermocosmetic emollient creams or vaseline. Possible use of dermocorticoids depending on medical advice.
• Grade I very erythematous: The same advice applies. Possible application of topical creams: hyaluronic acid cream, dermocorticoids. Possible application of an absorbent and protective dressing (e.g., hydrogel⁹, hydro-balance...).
• Grade II: topical management (hyaluronic acid cream) or use of an absorbent dressing as advised for a very erythematous grade I radiation dermatitis. A hydrocolloid or hydrocellular dressing can also be considered, depending on the exudates. Dressings must be changed every 24 hours.
• Grade III: temporary interruption of radiotherapy treatment should be considered. Clean the wound with saline solution and apply an oil emulsion dressing every day or every other day. An aggravating factor may be involved. Absorbent dressings such as irrigo-absorbent or hydrocellular dressings, preferably non-adhesive, should automatically be used. They can be combined with alginate if the lesion is haemorrhagic or hydrofiber if it is exudative.
• Grade IV: permanent interruption of treatment. An aggravating factor must be sought. Refer the patient to a specialized plastic and reconstructive surgery department.

• The main complications that can be triggered by UV radiation exposure are deep second-degree burns that can leave scars and increase the risks of infection.
• In the long term, these burns can induce skin ageing and skin cancers.

• Consult a dermatologist: if healing is delayed or abnormal, s/he can eliminate local treatment errors (such as the use of aggressive antiseptics, the application of unsuitable dressings) and set up a preventive treatment for hypertrophic and keloid scars.
• Reassure the patient: superficial burns always have an excellent prognosis.
• Explain:
  • Immediate management of a burn: cooling should occur as soon as possible in thermal burns and neutralization with an appropriate antidote in chemical burns.
  • Initial care: no alcoholic antiseptics or sprays that contribute to skin damage. Instead, use local products for analgesic and healing purposes.
  • For extensive burns: the need for pressotherapy (dressings and compression garments that limit abnormal scarring, which is frequent in the case of burns). Some therapies can prove useful, such as physical therapy (mobilization of joints) and crenotherapy (spa treatment), particularly the use of thread-like showers that allow for significant softening of scars.
  • Annual dermatological check-ups are essential in the long term for acute radiation syndrome, to detect early signs of cancer.

How do we treat a burn in a pregnant woman?

• Treatment must be based on the severity of the burn.

Are there any complications for the baby? What are the implications for the pregnancy? Are there any contraindications for a cesarean section?

• Complications for the baby and impact on pregnancy are related to the symptoms associated with shock or trauma. If a C-section is necessary, it is up to the surgeon to determine whether it can be carried out.

Should I use a different cream on sunburn and stretch marks?

• Recommend the application of a level 2 corticosteroid cream, mornings and evenings for 3 days.

In pregnant women: Are scars from recent burns in the epidural injection areas a problem?

• No, not if the wound is closed; open wounds are a contraindication to an epidural.

Are there ways to recover sensitivity after a burn?

• In some cases, physical therapy and massage can help restore sensitivity.

What should I do if I have telangiectasias?

• Telangiectasias can be associated with certain burns such as radiation burns.

1. Les effets connus des UV sur la santé. https://www.who.int/fr/news-room/questions-and-answers/item/the-known-health-effects-of-uv (consulted on 17/02/2023).
2. Altschuler C, Bensadoun R-J, Bigeard-Chevallay C. Toxicité cutanée radio induite, AFSOS. 2014.
3. Coup de soleil - Troubles dermatologiques. Edition Prof. Man. MSD. https://www.msdmanuals.com/fr/professional/troubles-dermatologiques/r%C3%A9actions-%C3%A0-la-lumi%C3%A8re-solaire/coup-de-soleil?query=Coups%20de%20soleil (consulted on 21/02/2023).
4. Coup de soleil : que faire ? https://www.ameli.fr/assure/sante/themes/coup-soleil/bons-reflexes-consultation-medicale (consulted on 21/02/2023).
5. Comment traite-t-on les coups de soleil. VIDAL. https://www.vidal.fr/maladies/peau-cheveux-ongles/coup-soleil-erytheme-solaire/traitements.html (consulted on 21/02/2023).
6. Pommier P, Gomez F, Sunyach MP, D’Hombres A, Carrie C, Montbarbon X. Phase III randomized trial of Calendula Officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol 2004; 22: 1447–1453.
7. Benomar S, Boutayeb S, Lalya I, Errihani H, Hassam B, El Gueddari BK. Traitement et prévention des radiodermites aiguës. Cancer/Radiothérapie 2010; 14: 213–216.
8. Rosenthal A, Israilevich R, Moy R. Management of acute radiation dermatitis: A review of the literature and proposal for treatment algorithm. J Am Acad Dermatol 2019; 81: 558–567.
9. Rehailia Blanchard A, Orliac H, Morel A, Benetreau-Grand P, Clavère P, Saidi N. Prise en charge des radiodermites aiguës : comparaison de deux stratégies au centre hospitalier universitaire de Limoges. Cancer/Radiothérapie 2015; 19: 661.