Radiation dermatitis

Published on 18/03/2015 by admin

Filed under Dermatology

Last modified 18/03/2015

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Radiation dermatitis

Joshua A. Zeichner

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

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Radiation dermatitis is a potential complication of cutaneous radiation exposure, most commonly from interventional radiologic procedures or treatment of malignancies. Appendageal structures and basal layer cells are the most sensitive to radiation exposure. Their damage leads to acute skin changes, including pruritus, desquamation, erythema, epilation, edema, and blistering. Atrophy, dyspigmentation, telangiectasia, fibrosis, ulceration, and necrosis are later effects resulting from dermal and vascular damage. Radiation recall is a dermatitis developing at sites of previous radiation exposure, usually induced by chemotherapeutic drugs such as doxorubicin or dactinomycin.

Management strategy

Severity of skin changes correlates with the cumulative dose of ionizing radiation, therefore minimizing exposure is important. While exposure to high levels of radiation is important in some cancer treatment algorithms, treatment of the skin consists of supportive care, pain control, and prevention of infection. Maintaining skin integrity, improving patient comfort, and reducing infection risk and skin trauma are keys to improving outcomes. Cornstarch and emollient creams treat dry desquamation (painless peeling of the skin), while moist desquamation (painful, full-thickness loss of the epidermis) should be treated with occlusive dressings and care to prevent infections. Topical corticosteroids control pruritus and reduce inflammation. Patients should also avoid friction from tight-fitting clothing. Topical antifungal ointments treat and may provide prophylaxis against fungal infections, especially in the intertriginous areas. Patients may gently wash the skin with water and mild soap. In addition, a topical trolamine-containing cream (Biafine) has been shown to improve wound healing and has been used in acute radiation dermatitis.

Like acute changes, chronic radiation dermatitis is treated symptomatically. Topical emollient creams and corticosteroids can be employed as needed. Skin necrosis or ulceration must be carefully monitored for signs of infection. Some recommend physical massage of the skin to improve fibrosis.

First-line therapies

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Prevention
image Avoidance of excessive ionizing radiation exposure  
Acute radiation dermatitis
image Emollient creams E
image Topical corticosteroids A
image Topical trolamine-containing emulsion A
image Topical calendula A
image Dexpanthenol A
image Topical silver sulfadiazine B
Chronic radiation dermatitis