Radiation‐induced morphea – a literature review

Spałek, Mateusz; Jońska-Gmyrek, Joanna; Gałecki, J.

doi:10.1111/jdv.12704

Cited by 60 publications

(98 citation statements)

References 51 publications

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“…In some cases, especially when the clinical presentation is unclear or suspicious, a biopsy and histopathological examination are obligatory. It includes conditions that may mimic chronic radiation dermatitis, such as secondary cancers, angiosarcoma, or radiation-induced morphea 44. However, the biopsy or any other surgical intervention may deteriorate the course of RIF and cause prolonged wound healing 31…”

Section: Diagnosis and Assessmentmentioning

confidence: 99%

Chronic radiation-induced dermatitis: challenges and solutions

Spałek

2016

CCID

117

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Chronic radiation dermatitis is a late side effect of skin irradiation, which may deteriorate patients’ quality of life. There is a lack of precise data about its incidence; however, several risk factors may predispose to the development of this condition. It includes radiotherapy dose, fractionation, technique, concurrent systemic therapy, comorbidities, and personal and genetic factors. Chronic radiation dermatitis is mostly caused by the imbalance of proinflammatory and profibrotic cytokines. Clinical manifestation includes changes in skin appearance, wounds, ulcerations, necrosis, fibrosis, and secondary cancers. The most severe complication of irradiation is extensive radiation-induced fibrosis (RIF). RIF can manifest in many ways, such as skin induration and retraction, lymphedema or restriction of joint motion. Diagnosis of chronic radiation dermatitis is usually made by clinical examination. In case of unclear clinical manifestation, a biopsy and histopathological examination are recommended to exclude secondary malignancy. The most effective prophylaxis of chronic radiation dermatitis is the use of proper radiation therapy techniques to avoid unnecessary irradiation of healthy skin. Treatment of chronic radiation dermatitis is demanding. The majority of the interventions are based only on clinical practice. Telangiectasia may be treated with pulse dye laser therapy. Chronic postirradiation wounds need special dressings. In case of necrosis or severe ulceration, surgical intervention may be considered. Management of RIF should be complex. Available methods are rehabilitative care, pharmacotherapy, hyperbaric oxygen therapy, and laser therapy. Future challenges include the assessment of late skin toxicity in modern irradiation techniques. Special attention should be paid on genomics and radiomics that allow scientists and clinicians to select patients who are at risk of the development of chronic radiation dermatitis. Novel treatment methods and clinical trials are strongly needed to provide more efficacious therapies.

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Section: Diagnosis and Assessmentmentioning

confidence: 99%

Chronic radiation-induced dermatitis: challenges and solutions

Spałek

2016

CCID

117

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“…Secondly, morphea is an uncommon complication after radiation therapy. A recent literature review summarized 66 cases with radiation-induced morphea (RIM) [83]. Radiation may lead to secretion of T h 2 cytokines (Il-4 and -5), which leads to TGF-β-mediated fibrogenesis.…”

Section: Pathogenesismentioning

confidence: 99%

Morphea and Eosinophilic Fasciitis: An Update

et al. 2017

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Morphea, also known as localized scleroderma, encompasses a group of idiopathic sclerotic skin diseases. The spectrum ranges from relatively mild phenotypes, which generally cause few problems besides local discomfort and visible disfigurement, to subtypes with severe complications such as joint contractures and limb length discrepancies. Eosinophilic fasciitis (EF, Shulman syndrome) is often regarded as belonging to the severe end of the morphea spectrum. The exact driving mechanisms behind morphea and EF pathogenesis remain to be elucidated. However, extensive extracellular matrix formation and autoimmune dysfunction are thought to be key pathogenic processes. Likewise, these processes are considered essential in systemic sclerosis (SSc) pathogenesis. In addition, similarities in clinical presentation between morphea and SSc have led to many theories about their relatedness. Importantly, morphea may be differentiated from SSc based on absence of sclerodactyly, Raynaud’s phenomenon, and nailfold capillary changes. The diagnosis of morphea is often based on characteristic clinical findings. Histopathological evaluation of skin biopsies and laboratory tests are not necessary in the majority of morphea cases. However, full-thickness skin biopsies, containing fascia and muscle tissue, are required for the diagnosis of EF. Monitoring of disease activity and damage, especially of subcutaneous involvement, is one of the most challenging aspects of morphea care. Therefore, data harmonization is crucial for optimizing standard care and for comparability of study results. Recently, the localized scleroderma cutaneous assessment tool (LoSCAT) has been developed and validated for morphea. The LoSCAT is currently the most widely reported outcome measure for morphea. Care providers should take disease subtype, degree of activity, depth of involvement, and quality-of-life impairments into account when initiating treatment. In most patients with circumscribed superficial subtypes, treatment with topical therapies suffices. In more widespread disease, UVA1 phototherapy or systemic treatment with methotrexate (MTX), with or without a systemic corticosteroid combination, should be initiated. Disappointingly, few alternatives for MTX have been described and additional research is still needed to optimize treatment for these debilitating conditions. In this review, we present a state-of-the-art flow chart that guides care providers in the treatment of morphea and EF.

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“…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 radiation-induced localized scleroderma [92]. Vigneron C and colleagues, (2014) believes that radiation-induced localized scleroderma is unrecognized and under-diagnosed [93].…”

Section: Scleroderma and Oncologic Diseasesmentioning

confidence: 99%

Localized Scleroderma: Predisposing and Triggering Factors

Хамаганова¹

2017

TODJ

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Abstract:The etiology of localized scleroderma remains unclear. The objective of this article is to review different theories of etiology, specifically provocative and predisposing factors for the development of localized scleroderma. The mini-review presents the factors, which may influence the occurrence of localized scleroderma. The genetic predisposition for the development of scleroderma is a relevant characteristic of the disease. Different traumatic factors, viral & bacterial infections, chemical substances, pharmaceutical agents may trigger localized scleroderma. Neoplasia is regarded as a distinct triggering impulse for scleroderma.

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Radiation‐induced morphea – a literature review

Cited by 60 publications

References 51 publications

Chronic radiation-induced dermatitis: challenges and solutions

Chronic radiation-induced dermatitis: challenges and solutions

Morphea and Eosinophilic Fasciitis: An Update

Localized Scleroderma: Predisposing and Triggering Factors

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