H01: After the blast: a skin perspective

Orals

Natalie King Stokes

Sandwell and West Birmingham NHS Trust, Birmingham, UK

On 6 August 1945, an atomic bomb, ‘Little Boy’, was dropped on Hiroshima, instantly killing 80 000 people. Three days later a second atomic bomb was dropped on Nagasaki. The catastrophic effects were amplified by the destruction of services and personnel, with 90% of Hiroshima’s medical professionals injured or killed. The hibakusha, ‘bomb-affected people’, who survived the blast, subsequently developed a myriad of radiation-related conditions and cancers, in addition to lifelong psychological trauma and stigma. This study aimed to explore the acute and delayed effects of the Hiroshima and Nagasaki atomic bombs on the skin. Literature searches were conducted using the Wellcome Collection Library, PubMed and Radiation Effects Research Foundation Library. Instant effects to the skin were flash burns due to heat rays. Sharply demarcated burns appeared on skin facing towards the hypocentre, affecting those within 3·5 km. Burns were modified by the colour and type of clothing, with shadows cast by intervening objects. Later, keloid scars commonly developed, postulated to have resulted from lack of available treatment, malnutrition, infection and delayed healing, rather than due to radiation. In the following weeks, a mysterious illness began affecting apparently uninjured survivors. At this point, the true nature of the bombs remained unknown. Petechiae and sudden hair loss became markers among the hibakusha of imminent death. As more information was gained about the atomic bombs, in addition to Japanese and US pathological studies, this became understood as genshi-byou (atomic disease), now termed acute radiation syndrome. Additional cutaneous effects included prolonged wound healing, with halted granulation, and increased risk of erysipelas and abscesses. Based on evidence of skin cancers acquired following medical X-ray treatment, researchers expected skin cancers to develop approximately 20 years after the blasts. Surprise was therefore expressed in a 1969 report, which identified no skin cancers in 10 650 survivors. An increased risk of skin cancer in survivors was first reported in 1991 and confirmed in a study of 80 158 ‘Life Span Study’ cohort members from 1958 to 1996. Increased risk of basal cell carcinoma (BCC), with a significant radiation dose response was found, but not for squamous cell carcinoma or melanoma. Younger age at exposure significantly increased the risk of BCC development. (Sugiyama H, Misumi M, Kishikawa et al. Skin cancer incidence among atomic bomb survivors from 1958 to 1996. Radiat Res 2014; 181: 531–9). While the physical scars of the atomic bombs are increasingly understood through long-term epidemiological studies, we may never truly comprehend the psychological scars.