A radiation ulcer is a chronic wound that develops in skin previously exposed to radiation therapy. As a delayed side effect, it can appear months or even years after treatment has concluded. This type of ulcer forms because radiation, while targeting cancer, causes lasting damage to healthy skin and underlying tissue, impairing their ability to heal.
How Radiation Therapy Leads to Ulcers
Radiation therapy affects healthy tissues in its path, setting off biological changes that can lead to ulceration. The primary mechanism involves damage to small blood vessels, which impairs blood flow and reduces the supply of oxygen and nutrients to the area. Radiation also harms fibroblasts, the cells responsible for producing collagen and creating the structural framework for tissues.
This damage impairs their ability to regenerate, leading to a progressive loss of tissue integrity. Unlike acute skin reactions like redness that resolve shortly after treatment, this underlying damage can persist and worsen. This long-term fragility is what makes the area susceptible to breaking down and forming a non-healing ulcer, often triggered by minor trauma or tension.
Recognizing a Radiation Ulcer
A radiation ulcer presents as a persistent sore that fails to heal and is located within the original radiation treatment field. The surrounding skin often shows signs of chronic radiation damage, appearing thin, pale, and waxy. One of the tell-tale signs in the adjacent tissue is the presence of telangiectasias, which are small, dilated blood vessels that look like fine red or purple lines.
These are indicators of the underlying microvascular damage caused by the radiation. The ulcer itself may be painful and tender to the touch. The ulcer may produce a clear or yellowish fluid, and if it becomes infected, this drainage might become thicker, discolored, or develop a foul odor.
Treatment and Management Strategies
Diagnosing a radiation ulcer begins with a physical examination of the wound and surrounding tissue. A healthcare provider will assess the ulcer’s characteristics and the skin’s condition. To confirm the diagnosis and rule out a cancer recurrence, a biopsy may be performed, which involves taking a small tissue sample for laboratory analysis.
Initial treatment focuses on conservative wound care. This involves keeping the wound clean to prevent infection and using specialized dressings to create a moist healing environment. Debridement, the medical removal of dead or unhealthy tissue from the wound bed, may be necessary to promote the growth of new, healthy tissue.
For ulcers that do not respond to basic wound care, more advanced therapies may be considered. Hyperbaric oxygen therapy (HBOT) is one option where a patient breathes pure oxygen inside a pressurized chamber. This process increases the oxygen dissolved in the blood, which flows to the damaged area, stimulating new blood vessel formation and enhancing natural healing.
When conservative measures fail, surgical intervention is often the most effective solution. The goal is to remove the damaged tissue and cover the defect with healthy, well-vascularized tissue. This is accomplished through tissue transfer procedures, such as a skin graft or a tissue flap, which moves skin, fat, and sometimes muscle with its original blood supply to the wound site.
Risk Reduction and Proactive Skin Care
Patients can take proactive steps to lower their risk. During and after radiation therapy, it is important to follow the oncology team’s skin care instructions, as the skin remains vulnerable for life. This includes gentle cleansing, avoiding harsh soaps or products with alcohol, and using recommended moisturizers to maintain the skin’s barrier function.
Protecting the treated skin from friction from clothing and direct sun exposure is also a standard recommendation. Lifelong sun protection is necessary, which means applying a broad-spectrum sunscreen and wearing protective clothing over the area when outdoors.
Certain factors can elevate the risk of developing a radiation ulcer:
- High total doses of radiation or large treatment areas.
- Lifestyle factors like smoking, which constricts blood vessels.
- Medical conditions such as diabetes or vascular disease that compromise blood flow.
- Receiving certain types of chemotherapy concurrently with radiation.