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radiodermatitis (radiation dermatitis)
Etiology:
- radiation exposure
- radiation therapy
Pathology:
- acute
- cytokine-mediated inflammation & DNA damage
- damage of sebaceous glands & hair follicles in the dermal layer
- destruction of regenerative basal cells
- chronic
- permanent damage to the dermis
- radiation destroys fibroblasts in the dermis, resulting in reabsorption of collagen & tissue atrophy
- radiation also stimulates growth of atypical fibroblasts which produce dense, fibrous tissue
- radiation also damages the vasculature of the dermal layer; blood vessels become prominent, dilated, & thin resulting in telangiectasias
- radiation may destroy the dermal melanocytes, leading to hypopigmentation, or it may trigger increased production of melanin, causing hyperpigmentation
Clinical manifestations:
1) acute skin changes (graded manifestations)
a) occur within 90 days of exposure
b) usually resolves within 3-4 weeks after cessation of radiation exposure
c) erythema & edema may begin within hours or days
d) epilation & dryness may occur within days to weeks
e) desquamation
- dry desquamation
- scaling, & pruritus
- can occur after the 3rd week of radiation therapy or after a cumulative dose of 30 Gy
- typically resolves within 1-2 weeks of therapy
- moist desquamation
- red, exposed dermis & serous oozing
- occurs after 4-5 weeks of therapy or with 45 to 60 Gy
f) ulceration
g) necrosis
2) late effects
- can occur anywhere from 90 days to years after exposure
- atrophy, fibrosis, telangiectasias, & pigmentation changes
- progressive induration, edema, & thickening of the dermis
Differential diagnosis:
- radiation recall dermatitis
- cellulitis
- eczema
- secondary skin malignancy
- angiosarcoma
Management:
- skin hygiene
- bacterial decontamination (esp S aureus) reduces risk of acute radiation dermatitis [3]
- emollients
- hydrocolloid dressing
Specific
radiation recall dermatitis
General
dermatitis
References
- Johns C
OncoLink
http://www.oncolink.org/resources/article.cfm?c=16&s=59&ss=224&id=1050
- Singh M, Alavi A, Wong R, Akita S.
Radiodermatitis: A Review of Our Current Understanding.
Am J Clin Dermatol. 2016 Jun;17(3):277-92.
PMID: 27021652 Review.
- Bassett M
Bacterial Decolonization Reduces Severity of Acute Radiation Dermatitis.
S. aureus plays a role in the development of this common condition.
MedPage Today May 4, 2023
https://www.medpagetoday.com/radiology/therapeuticradiology/104341
- Kost Y, Deutsch A, Mieczkowska K et al
Bacterial Decolonization for Prevention of Radiation Dermatitis.
A Randomized Clinical Trial.
JAMA Oncol. Published online May 4, 2023
PMID: 37140904
https://jamanetwork.com/journals/jamaoncology/article-abstract/2804692
- Kost Y, Rzepecki AK, Deutsch A et al
Association of Staphylococcus aureus Colonization With Severity of Acute Radiation
Dermatitis in Patients With Breast or Head and Neck Cancer.
JAMA Oncol. Published online May 4, 2023
PMID: 37140927
https://jamanetwork.com/journals/jamaoncology/fullarticle/2804696