Randomized, prospective assessment of moisturizer efficacy for the treatment of radiation dermatitis following radiotherapy after breast-conserving surgery

Sekiguchi, Kenji; Ogita, Mami; Akahane, Koshi; Haga, C.; Ito, Ryoko; Arai, Satoru; Ishida, Yasushi; Tsukada, Yoichiro; Kawamori, Jiro

doi:10.1093/jjco/hyv155

Cited by 20 publications

(26 citation statements)

References 26 publications

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“…Because clinical studies showed that topical heparinoid improved stratum corneum hydration in humans, we first assessed whether topical heparinoid‐containing product, Hirudoid ® cream, produces comparable benefits in mice. Indeed, twice‐daily applications of Hirudoid ® cream significantly elevated the levels of stratum corneum hydration, while neither baseline transepidermal water loss rates (TEWL) nor skin surface pH differed in Hirudoid ® cream‐treated versus Hirudoid ® cream‐untreated controls (Figure A).…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, topical heparinoid‐containing cream not only reduces postoperative ecchymosis and oedema, but also prevents the development of pressure ulcers . Furthermore, topical applications of a heparinoid‐containing product significantly increased stratum corneum hydration in both young and aged humans, as well as both epidermal growth factor receptor inhibitor‐ and radiotherapy‐induced skin dryness . Additionally, a questionnaire survey found that twice‐daily applications of a heparinoid cream or lotion for 1 month markedly improved skin dryness, pruritus and inflammation in subjects with atopic dermatitis, particularly in older patients .…”

Section: Introductionmentioning

confidence: 99%

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A topical heparinoid‐containing product improves epidermal permeability barrier homeostasis in mice

Yao

Guo

Feng

et al. 2019

Experimental Dermatology

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Because of the importance of epidermal functions, including stratum corneum hydration and maintenance of permeability barrier homeostasis, in the pathogenesis of a variety of cutaneous and systemic disorders, a wide range of products has been developed to improve epidermal functions. However, the underlying mechanisms whereby certain products, including heparinoid‐containing product, are far little understood. In the present study, we assessed the impact of a heparinoid‐containing product, Hirudoid® cream, on epidermal permeability barrier function and expression levels of a panel of epidermal mRNA related to the formation/maintenance of the permeability barrier in mouse skin. Our results showed that while the baseline levels of transepidermal water rates remained unchanged, treatment with Hirudoid® cream twice daily for 7 days significantly accelerated permeability barrier recovery and increased stratum corneum hydration. In parallel, expression levels of epidermal mRNA for certain differentiation marker‐related proteins, lipid synthetic enzymes, keratinocyte proliferation and antimicrobial peptides also increased significantly. Together, these results provide the underlying mechanisms by which topical Hirudoid® cream improves epidermal permeability barrier and antimicrobial function. Because of its benefits for epidermal functions, heparinoid‐containing product could be more useful in the management of skin conditions, characterized by abnormal permeability barrier and antimicrobial function.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A topical heparinoid‐containing product improves epidermal permeability barrier homeostasis in mice

Yao

Guo

Feng

et al. 2019

Experimental Dermatology

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“…Radiation dermatitis is a common acute side-effect that occurs within hours to weeks after the start of radiotherapy (3,4) and affects more than 87% of patients (2,5). Radiation dermatitis can limit the therapeutic dose delivered to patients and can, sometimes, lead to a break in treatment, thus potentially compromising local control and survival outcome (1,6).…”

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confidence: 99%

Topical Management of Acute Radiation Dermatitis in Breast Cancer Patients: A Systematic Review and Meta-Analysis

Haruna

Lipsett

Marignol

2017

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(OR: 0.29; p<0.0001) and reducing the mean RD score p<0.00001 Radiation induces damage to the skin, activating inflammatory pathways and causing cytokines overproduction (1, 2). Radiation dermatitis is a common acute side-effect that occurs within hours to weeks after the start of radiotherapy (3, 4) and affects more than 87% of patients (2, 5). Radiation dermatitis can limit the therapeutic dose delivered to patients and can, sometimes, lead to a break in treatment, thus potentially compromising local control and survival outcome (1, 6). It can also have a considerable impact on patients' quality of life (7,8). Despite significant development in radiotherapy techniques, efficacious interventions in the prevention of acute skin reactions is still lacking and current evidence is unable to provide adequate guidelines for the management of this sideeffect (9, 10). Studies have examined numerous topical agents such as Aloe Vera, aqueous cream, Calendula, petrolatum and sulcrafate cream as a means to reducing the dehydrating effects of radiation dermatitis (6,11,12). However, the results in terms of managing radiation dermatitis and treatment related pain have not been clinically significant (13,14). Corticosteroids have anti-inflammatory properties and are known to down-regulate cytokine gene expression, making them ideal for managing radiation dermatitis (15-17). A systematic review by Bolderston et al. concluded that there is limited evidence to support or oppose the use of topical agents for the management of acute radiation dermatitis (18).Skin care advice given to breast cancer patients varies among institutions (19). No gold-standard for the appropriate management of this side-effect exists and in most cases the decision of care is left at the discretion of the health care professional rather than clinical evidence (20,21). Clinical advice is often given based on anecdotal evidence (22).The present systematic review and meta-analysis was conducted to assess the potential efficacy of corticosteroids in the management of RD and its impact on pain and quality of life in female breast cancer patients. However, the anticipated adverse effect associated with steroids is not evaluated and is beyond the scope of this review. We restricted our review to one site only due to radiotherapy dose variations used in different sites. Materials and MethodsSearch strategy for identification of studies. The electronic literature search was conducted up to and including March 2017. The search terms used were corticosteroid, radiation dermatitis, breast cancer, management, and prevention. The reference lists of potentially eligible studies were subsequently hand searched to identify 5343

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“…In this study, the subjects did not use moisturizer until after radiodermatitis occurred. Sekiguchi et al reported that the application of a heparinoid moisturizer for 2 weeks resulted in lower skin dryness and desquamation compared to the non-application thereof (17). Therefore, medical staff should advice their patients regarding the appropriate timing of moisturizer usage.…”

Section: Duration Of Skin Observation and Self-carementioning

confidence: 99%

Quantitative assessment of radiodermatitis through a non‑invasive objective procedure in patients with breast cancer

et al. 2019

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Assessment of skin condition is necessary for providing advice regarding skin self-care to patients with breast cancer who have undergone radiation therapy. Acute and chronic phases of radiodermatitis were analyzed in patients using objective assessment tools in the present study. A total of 18 women who received radiation therapy for breast cancer were enrolled in the present study and their skin surface temperature (SST), hydration level of the skin surface (HL), melanin intensity (MI) and erythema intensity (EI) were measured prior to radiation therapy and six months thereafter. Furthermore, skin condition was assessed using the Common Terminology Criteria for Adverse Events (CTCAE). EI and MI levels at the irradiated site peaked upon the completion of radiation therapy and declined to baseline at 6 months. In contrast, SST levels were elevated at the irradiated site during radiation therapy (P<0.05) and plateaued after its completion. The same parameters in non-irradiated control sites remained unchanged during the study period. HL reached the minimum in irradiated and non-irradiated sites upon completion of radiation therapy. Although HL returned to baseline in the non-irradiated site 6 months after radiation therapy, it remained low in the irradiated site. No relationship between the CTCAE and EI level was observed. In conclusion, the present study demonstrated that objective assessment tools, including SST and EI levels, were useful for assessing skin condition during radiodermatitis. The combination of the CTCAE and objective assessment tools will enable a more accurate assessment of radiodermatitis.

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Randomized, prospective assessment of moisturizer efficacy for the treatment of radiation dermatitis following radiotherapy after breast-conserving surgery

Cited by 20 publications

References 26 publications

A topical heparinoid‐containing product improves epidermal permeability barrier homeostasis in mice

A topical heparinoid‐containing product improves epidermal permeability barrier homeostasis in mice

Topical Management of Acute Radiation Dermatitis in Breast Cancer Patients: A Systematic Review and Meta-Analysis

Quantitative assessment of radiodermatitis through a non‑invasive objective procedure in patients with breast cancer

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