[Clinical diagnosis and treatment of five occupational acute radiation-induced skin injury patients from an X-ray radiation incident].

In July 2025, the Guangdong Prevention and Treatment Centre for Occupational Disease admitted 5 patients with occupational acute radiation-induced skin injury caused by an X-ray radiation accident. Through occupational field investigation, clinical data collection, combined with chromosome aberration analysis, micronucleus assay, bilateral hand magnetic resonance imaging (MRI), tumor markers, immunological indicators, endocrine indicators, as well as on-site physical dose estimation, a systematic clinical diagnosis and treatment analysis was conducted for the 5 patients. All 5 patients presented with numbness, pain, and erythema with swelling in the irradiated fingers. The severity of skin injuries ranged from erythema, hyperpigmentation, and darkening to fissures, desquamation, and blister formation, with 1 case developing large blisters on the right index, middle, and ring fingers. MRI examination revealed inflammatory changes in the soft tissues as well as subcutaneous and interosseous fluid accumulation in 2 cases. Immunological examination showed decreased peripheral NK cell/lymphocyte ratios (0.06) in 2 cases, and decreased CD3+CD4+T cell/lymphocyte ratio (0.22) and CD3+CD4+T cell/CD3+CD8+ T cell ratio (0.007) in 1 case. Physical dose estimation yielded a minimum hand skin absorbed dose of 4.64-9.28 Gy and a maximum of 14.82-29.64 Gy, with cumulative whole-body effective doses ranging from 1.8 to 4.6 mSv. The 5 patients were diagnosed with occupational acute radiation skin injury grade Ⅳ (3 cases), grade Ⅱ (1 case), and grade Ⅰ (1 case), respectively, and were treated with comprehensive therapy including local anti-inflammation, tissue healing promotion, infection prevention, microcirculation improvement, antioxidant therapy, and hyperbaric oxygen therapy. The clinical manifestations of acute radiation skin injury caused by external X-ray exposure are primarily correlated with the absorbed dose, and biological and physical dose estimations serve as essential early diagnostic tools, with comprehensive therapy remaining the mainstay of current treatment.