Radiation dermatitis

Radiation induced skin reactions or radiation dermatitis occurs in 95% of cancer patients undergoing radiation therapy.

Skin changes range from mild redness to dry or moist desquamation.

Can manifest as acute erythema is exclamation, or as chronic effects including skin atrophy, telangiectasia and fibrosis.

May be associated with pain that may cause premature discontinuation of radiation therapy.

Skin changes result from the combination of radiation therapy features and patients intrinsic risk factors.

The acute phase of radiation dermatitis is often defined as changes seen within 90 days following RT.

Transient mild erythema can occur within hours of RT and is probably due to dilatation of capillaries shortly after the exposure to radiation.

Dry desquamation which manifests pruritus and flaking of the skin, may occur 3-6 weeks into the radiation regimen, at cumulative dose above 20 Gy.

With increasing radiation doses above 30 to 40 Gy patients may develop moist desquamation characterized by tender, red skin associated with serious exudate, hemorrhagic crusting, and the potential for the development of bullae.

When the skin barrier breakdown occurs, this stage is generally painful.

Sustained hyperpigmentation or erythema associated with radiation therapy typically does not occur until 2-4 weeks into treatment.

Hair follicles and sebaceous glands can be affected early in a course of treatment, leading to dry skin and hair loss.

When erythema develops, a sunburn like reaction can occur with associated edema pruritus tenderness and burning sensation

Radiation causes a small fraction of rapidly proliferating basal layer cells of the skin to be injured or destroyed, and precipitates a decrease in the population of differentiated epidermal keratinocytes and can result in desquamation.

The amount of exclamation-peeling and shedding of the epidermis depends in the total dose of radiation delivered.

Approximately 10% of patients treated with radiation therapy experience moist desquamation and ulceration.

Radiation dermatitis may lead to treatment delays, decreased quality-of-life and painful sensations.

Patients may experience tightness, skin splitting and tenderness.

Radiation may impair his skin barrier function and increased the risks of wound formation, loss of immune function, and infection.

Radiation can damage the micro vascular system, and increase the risk of tissue hypoxia and fibrosis, and activate an inflammatory cascade that leads to acute and chronic skin changes.

There is no gold standard in the management.

The most effective treatment is washing with mild soap.

Treatment to decrease moist desquamation is helpful.

Leave a Reply

Your email address will not be published. Required fields are marked *