Post-Irradiation Morphea: Case report and review of the literature

Alhathlool, Ammar; Hein, Rüdiger; Andrés, Christian; Ring, Johannes; Eberlein, Bernadette

doi:10.3315/jdcr.2012.1106

Cited by 24 publications

(31 citation statements)

References 36 publications

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“…In comparison, the annual and age‐adjusted incidence of morphea (in the general population not related to radiotherapy) is 2.7 per 100 000 . Because of its non‐characteristic appearance (erythematous plaques, indurated papular lesions), it is mistakenly diagnosed as recurrence of breast cancer or another malignancy . Morphea connected with ionizing radiation has been described under many names: RIM, radiation post‐scleroderma, breast‐associated morphea, post‐irradiation morphea .…”

Section: Epidemiology and Clinical Datamentioning

confidence: 99%

“…There was no clear connection between the radiotherapy total dose, fractionation scheme, the use of a boost and the incidence of RIM. Age and acute post‐radiation skin side‐effects did not seem to be important risk factors for predicting development of RIM …”

Section: Analysis Of Clinical Datamentioning

confidence: 99%

“…Various agents, similar to those used in the treatment for idiopathic morphea, including steroids, calcineurin inhibitors, systemic immunosuppressants, are used in this condition with poor effects . However, some authors report improvement after topical or oral steroids, antibiotics and methotrexate . As an important therapeutic target in RIM seems induration of the skin, which may be reduced by heparin, hyaluronidase, phototherapy (UVA, UVA1, PUVA) or systemic antibiotics (penicillin, tetracyclines).…”

Section: Treatment and Outcomementioning

confidence: 99%

“…9 Because of its non-characteristic appearance (erythematous plaques, indurated papular lesions), it is mistakenly diagnosed as recurrence of breast cancer or another malignancy. 10,11 Morphea connected with ionizing radiation has been described under many names: RIM, radiation post-scleroderma, breast-associated morphea, post-irradiation morphea. 11,12 RIM is a painful and disfiguring disease, which may impair patient's quality of life.…”

Section: Epidemiology and Clinical Datamentioning

confidence: 99%

“…Age and acute post-radiation skin sideeffects did not seem to be important risk factors for predicting development of RIM. 10…”

Section: Analysis Of Clinical Datamentioning

confidence: 99%

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Radiation‐induced morphea – a literature review

Spałek

Jońska-Gmyrek

Gałecki

2014

Acad Dermatol Venereol

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Radiation-induced morphea (RIM) is a rare and under-recognized skin complication of radiotherapy. It is commonly wrongly diagnosed as other dermatological conditions or malignancy because of similar clinical characteristics. This literature review analyses 66 cases that have been reported in the literature since 1989. The clinical appearance often includes pain and disfiguration of affected area, which may influence the patient's quality of life. There is no clear connection between the radiotherapy dose, the fractionation scheme, the use of a boost, age, the presence of other dermatological conditions or other connective tissue diseases and the occurrence of RIM. Its pathogenesis is still unclear, but several theories are proposed to explain this phenomenon. The available data suggest that the abnormally high secretion of some cytokines (interleukin 4, interleukin 5, transforming growth factor) induced by radiation causes an extensive fibrosis after an activation of fibroblasts. Histological confirmation is crucial in distinguishing RIM from similar-looking diseases, such as chronic radiation dermatitis, cancer recurrence, radiation, recall dermatitis, new carcinoma or cellulitis. There is no clear treatment regimen for this condition. Clinical outcome after therapy is often unsatisfactory. The commonly used methods and agents include: topical and systemic steroids, calcineurin inhibitors, systemic immunosuppressants including methotrexate, tacrolimus, heparin, hyaluronidase, phototherapy (UVA, UVA1, UVB, PUVA), systemic antibiotics, imiquimod, mycophenolate mofetil, photophoresis. The differential diagnosis is challenging and requires a multidisciplinary approach to avoid misdiagnosis and to plan appropriate treatment.

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Section: Epidemiology and Clinical Datamentioning

confidence: 99%

Section: Analysis Of Clinical Datamentioning

confidence: 99%

Section: Treatment and Outcomementioning

confidence: 99%

Section: Epidemiology and Clinical Datamentioning

confidence: 99%

“…Age and acute post-radiation skin sideeffects did not seem to be important risk factors for predicting development of RIM. 10…”

Section: Analysis Of Clinical Datamentioning

confidence: 99%

See 3 more Smart Citations

Radiation‐induced morphea – a literature review

Spałek

Jońska-Gmyrek

Gałecki

2014

Acad Dermatol Venereol

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Morphoea (Localized Scleroderma)

Orteu

2016

Rook's Textbook of Dermatology, Ninth Edition

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Morphoea encompasses a group of related conditions characterized by varying degrees of sclerosis, fibrosis and atrophy in the skin and subcutaneous tissues, sometimes extending deeply into the muscle, bone, eye and brain. Extracutaneous manifestations occur in up to 25% of cases but in contrast to systemic sclerosis (SSc), no internal organ fibrosis or vascular changes occur. Antinuclear antibody positivity is common but the specific autoantibodies seen in SSc are rarely present. There is no increased mortality, but substantial morbidity may occur as a result of joint contractures, facial and limb asymmetry, extracutaneous manifestations and the psychological impact of the condition. Although previously considered self‐limiting, there is now emerging evidence that a protracted, relapsing–remitting course may be common. The key to successful treatment is the involvement of a multidisciplinary team and the initiation of therapy during the active inflammatory stage, before significant damage has occurred. Topical and phototherapies are appropriate in superficial forms of morphoea, whilst a majority of linear, generalized and deep forms require systemic therapy.

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Morphoea and Allied Scarring and Sclerosing Inflammatory Dermatoses

Orteu

2024

Rook's Textbook of Dermatology

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Post-Irradiation Morphea: Case report and review of the literature

Cited by 24 publications

References 36 publications

Radiation‐induced morphea – a literature review

Radiation‐induced morphea – a literature review

Morphoea (Localized Scleroderma)

Morphoea and Allied Scarring and Sclerosing Inflammatory Dermatoses

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