Damage to sebaceous gland and the efficacy of moisturizer after whole breast radiotherapy: a randomized controlled trial

Abstract

BackgroundWe conducted a randomized trial to evaluate the efficacy of heparinoid moisturization for radiation dermatitis. We report the time-course of sebum content after whole breast radiotherapy (WBRT) and the efficacy of heparinoid moisturizer.MethodsPatients receiving adjuvant breast RT were randomly assigned into three groups; prophylaxis, post-WBRT and control groups. Patients used moisturizer on the irradiated breast from the beginning of RT in the prophylaxis group, 2 weeks post-RT in the post-WBRT group, and no moisturizer in the control group. Sebum content of the irradiated and non-irradiated breast was measured to assess sebaceous gland damage. Sebum composition was also analyzed.ResultsA total of 76 patients were analyzed; 30 in the post-WBRT group, 32 in the control group, 14 in the prophylaxis group. The sebum content in the irradiated breast significantly decreased after WBRT in the post-WBRT and control groups. The decrease was sustained in the control group. In the non-irradiated breast, sebum content also decreased after WBRT in the post-WBRT and control groups. After moisturizer application, sebum content by sebumeter returned to pre-RT level in the post-WBRT group, while the decrease was sustained in the control group. Sebum content measured by evaporative light scattering detector and sebumeter was similar in the control group, but the dissociation was observed after moisturizer application in the post-WBRT group. The proportion of wax esters decreased in the irradiated breast after WBRT.ConclusionsRadiotherapy significantly reduced sebum content in both irradiated and non-irradiated breast, indicating that RT caused quantifiably persistent sebaceous gland damage in irradiated sites and the surrounding tissue. Combined with the results from our previous study, heparinoid moisturizer treatment effectively prevents water loss by retaining oil contents on the skin surface.Trial registrationUMIN, UMIN000005532. Registered 1 April 2011.Electronic supplementary materialThe online version of this article (10.1186/s12885-019-5334-9) contains supplementary material, which is available to authorized users.

Impact of Breast Reconstruction on Biophysical Parameters of Mammary Skin in Patients Receiving Postmastectomy Radiotherapy for Breast Cancer

“…In contrast to this report, another study observed that sebum content is significantly reduced with radiotherapy. This study further reported that the application of a moisturizer could increase sebum levels in patients undergoing radiotherapy [ 26 ]. Both reports, like our study, used a photometric method for sebum measurement, evaluating the amount of sebum by analyzing the degree of light transmission in the measured area.…”

“…As radiotherapy damages the sebaceous gland and impairs the function of the stratum corneum [ 24 ], the amount of skin surface lipids may be altered by radiotherapy. Nonetheless, data regarding changes in sebum content during radiotherapy remain inconsistent [ 25 26 ]. In a study measuring the biophysical parameters before and after radiotherapy for breast cancer, sebum levels were not significantly altered following radiotherapy [ 25 ].…”

Effect of Heparinoid Moisturizer on Quality of Life in Patients with Acute Radiation Skin Damage Following Hypofractionated Radiation Therapy After Breast-Conserving Surgery: A Randomized Controlled Study

“… 32 Hirudoid Ⓡ is one of several available moisturizers that contain heparinoid, along with other ingredients such as white petrolatum, which are known to supplement stratum corneum water content and sebum. 4 , 6 Pain reduction following HP application has also been reported, although the relief was temporary. 4 , 5 Such effects of HP might contribute to shorten the period of “Symptoms and feelings” subscore worsening.…”

English version of guidelines for the management of asteatosis 2021 in Japan

“…The clinical course of radiation dermatitis begins with edematous erythema, then progresses to dry, desquamation plaque with pigmentation 104 . Several studies reported that irreversible disturbance of sebaceous glands occurs at the site of irradiation 104,105 . The major complications of radiation dermatitis are pruritus and skin tightness caused by asteatosis, requiring continuous treatment.…”