Moist desquamation is a description of the clinical pattern seen as a consequence of radiation exposure

Radiation exposure

The term radiation exposure commonly has several uses:* Absorption of high-energy ionizing radiation by an object. In living beings a high absorbed dose can lead to radiation poisoning.* Absorption by an object of non-ionizing radiation...

 where the skin

Skin

-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...

 thins and then begins to weep because of loss of integrity of the epithelial barrier and decreased oncotic pressure. Typically this occurs at doses of 15 - 20 Gray

Gray (unit)

The gray is the SI unit of absorbed radiation dose of ionizing radiation , and is defined as the absorption of one joule of ionizing radiation by one kilogram of matter ....

, far higher than any diagnostic scan and more typical of levels seen radiotherapy or deployment of nuclear armament. Historically, this was a common phenomenon in Hiroshima

Hiroshima

is the capital of Hiroshima Prefecture, and the largest city in the Chūgoku region of western Honshu, the largest island of Japan. It became best known as the first city in history to be destroyed by a nuclear weapon when the United States Army Air Forces dropped an atomic bomb on it at 8:15 A.M...

 and Nagasaki

Nagasaki

is the capital and the largest city of Nagasaki Prefecture on the island of Kyushu in Japan. Nagasaki was founded by the Portuguese in the second half of the 16th century on the site of a small fishing village, formerly part of Nishisonogi District...

 during World War II

World War II

World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...

 with the atomic bomb attacks from the United States

United States

The United States of America is a federal constitutional republic comprising fifty states and a federal district...

.

The phenomenon was famously described by John Hersey

John Hersey

John Richard Hersey was a Pulitzer Prize-winning American writer and journalist considered one of the earliest practitioners of the so-called New Journalism, in which storytelling devices of the novel are fused with non-fiction reportage...

 in his novel Hiroshima.

Clinical Characteristics

Sloughing of the epidermis and exposure of the dermal layer clinically characterize moist desquamation. Outside of medical therapy, when moist desquamation is seen in the setting of nuclear warfare, the condition is generally thought to be fatal.

Treatment

Management of these partial-thickness wounds has been influenced by the Winter principle of moist wound healing, which suggests that wounds heal more rapidly in a moist environment. Hydrocolloid dressings applied directly to these wounds prevent the evaporation of moisture from the exposed dermis and create a moist environment at the wound site that promotes cell migration.

In a randomized prospective trial , hydrocolloid dressings were compared with gentian violet, a compound with antifungal and antiseptic properties used in some institutions to treat moist desquamation. Unlike the hydrocolloid dressings, gentian violet produces a dry wound bed. Thirty-nine patients who developed a total of 60 wounds during radiotherapy were randomized to treatment with either a hydrocolloid dressing or gentian violet. There were no significant differences in wound healing time. However, patients reported higher satisfaction with the hydrocolloid dressing based on its comfort and aesthetic factors. Gentian violet produced skin discoloration and drying affects that limited mobility.