Radiodermatitis - review of treatment options

Abstract

Radiation dermatitis is one of the commonest side effects of ionizing radiation which is applied in radiotherapy of carcinoma of all localizations, most frequently of tumors of breast, head and neck region, lungs and soft tissue sarcomas. It usually occurs as a complication of breast radiotherapy and thus it is more often recorded in female patients on the skin in the region of breast subjected to radiation. Clinical manifestations of radiation dermatitis can be divided into four phases: acute phase (erythema, dry desquamation, moist desquamation, ulceration and necrosis with resulting re-epithelialization, residual post-inflammatory hyperpigmentation, reduction and suppression of sebaceous and sweat glands and epilation); subacute phase (hyperpigmentation and hypopigmentation, telangiectasia, skin atrophy, even ulceration); chronic phase (skin atrophy, dermal fibrosis and permanent skin epilation) and late phase (increased risk of skin cancer). In order to prevent radiation dermatitis, skin care products should be applied throughout radiotherapy that will decrease the frequency of skin reactions or block them and thus improve life quality. Although the therapy includes not only topical corticosteroids but numerous other products with active ingredients such as aloe vera, calendula, hyaluronic acid, sucralfat, sorbolene, mineral and olive oil, honey, vitamin C, zinc, antimicrobials and silver, common therapeutic consensus has not been reached on their application in radiation dermatitis. Therefore, the treatment should be conducted according to the basic guidelines but tailor-made for each individual patient.

Radiodermatitis Treatment: Traditional Review

“…Günümüzde rutin bir deri bakımı prosedürü olarak radyasyondan etkilenen derinin ılık su ve pH'si nötr pH'ye ayarlanmış sabunla yıkanması tavsiye edilir. 26 Sabun kullanımı, geçmişte bir tartışma konusu olmasına rağmen artık standart klinik uygulama olarak kabul edilmektedir. 2 İki büyük randomize kontrollü çalışma, sabun ve su ile yıkamanın, yıkama yapılmamasına kıyasla, önemli ölçüde kaşıntıyı azalttığı ve RTOG dermatit skorlarını da azalttığını göstermiştir.…”

Mexican radiation dermatitis management consensus

“…Additionally, patients required fewer interruptions of RT and reported less stinging, burning, pain [5]; • aloe vera: recommended to relieve erythema but there is no consensus regarding its application. However, when cumulative doses of RT are higher than 27 Gy, the application of aloe vera gel has provided protective effects from unwanted reactions due to its anti-inflammatory and antibacterial effects [21]. A multinational study [22] was carried out on women who began RT for breast cancer to evaluate the combination of hygiene products.…”

“…Characteristics of the bandages [4,27]: • non traumatic: they do not adhere to the damaged skin in order to decrease pain upon changing of the bandages; • non-adhesive base or only with silicone: to avoid damaging delicate or damaged skin; • absorbent: capable of containing the exudate; • adaptable: for areas with limitations in their application, such as the neck or the pelvic area; • comfortable: to improve tolerance on the part of the patient and to reduce pain while the bandage is on the skin; • ease in applying and removing: so that patients can do this themselves at home. Examples of bandages used in RD treatment: • hydrogel bandages: do not adhere to the wounds and allow for easy cleansing and application [18]; • hydrocoloid bandages: absorbent, self-adhering, can be left in place for several days to simplify the care [18]; • silver bandages: antibacterial properties, prevent progression of the lesions [21,26]. Kedge [27] in a systematic review, included an analysis of 10 studies, analyzed the effectiveness and acceptability of the interventions on moist desquamation on patients treated with RT.…”

“…aloe vera: recommended to relieve erythema but there is no consensus regarding its application. However, when cumulative doses of RT are higher than 27 Gy, the application of aloe vera gel has provided protective effects from unwanted reactions due to its anti-inflammatory and antibacterial effects [ 21 ].…”

“…If the affected skin becomes infected, it should be treated with topical or systemic antibiotics, according to the severity of the infection [ 26 , 28 ]. Topical antibiotics should be avoided unless a swab of the wound has been made and the bacterial infection is confirmed [ 15 , 21 ].…”