Moist desquamation is a description of the clinical pattern seen as a consequence of radiation exposure where the skin 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, far higher than any diagnostic scan and more typical of levels seen in radiotherapy or deployment of nuclear armament. Historically, this was a common phenomenon in Hiroshima and Nagasaki during World War II with the atomic bomb attacks from the United States.[1]
The phenomenon was famously described by John Hersey in his novel Hiroshima.
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.
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.