Radiodermatitis is also known as radiation dermatitis/radiation-induced skin reaction (RISR) or radiation injury. It occurs following exposure to high doses of ionizing radiation. This can occur either when patients are irradiated for malignancies; during diagnostic or therapeutic procedures like coronagraphy or fluoroscopy and following nuclear disasters and occupational radiation exposure [1]. Radiodermatitis is the most common complication of roentgen therapy in cancer patients [1] [2].

It typically develops several years following exposure but acute effects can also be seen subsequent to excessive radiation. The clinical presentation depends on the dose, duration, and extent of the area receiving the X-rays. Within 48 hours to 7 days after exposure, the affected skin becomes severely inflamed and patients present with redness, pain, burning sensation, and itching [3] at the site. These symptoms will usually aggravate, subside and then recur with erythema, swelling, and vesicles lasting for up to 30 days accompanied by pustules, and ulceration which can become infected [4] followed by desquamation and necrotic skin changes. Although healing is slow, the recovery is complete in most cases. In some patients, however, lesions may fail to heal especially, if the radiation dose is large.

Delayed effects of radiation, also known as chronic radiodermatitis, may appear up to several years after the end of treatment or exposure and include hypo or hyperpigmentation of the skin, atrophic changes, photosensitivity, telangiectasia and delay in healing of accidental or surgical wounds.

• Pain

  The mere purpose was to free the patient from the unrelenting pain and discomfort. In this case, the authors achieved complete success in wound healing but only partial success in pain relief. [ncbi.nlm.nih.gov]

  This 0–10 score gradually increases from full analgesia to extreme pain, with scores of 1–3 representing mild pain, 4–6 representing moderate pain, and 7–10 representing severe pain. [current-oncology.com]

  Advanced Search: • Use “ “ for phrases o [ “pediatric abdominal pain” ] • Use – to remove results with certain terms o [ “abdominal pain” –pediatric ] • Use OR to account for alternate terms o [teenager OR adolescent ] [merckmanuals.com]

• Swelling

  These symptoms will usually aggravate, subside and then recur with erythema, swelling, and vesicles lasting for up to 30 days accompanied by pustules, and ulceration which can become infected followed by desquamation and necrotic skin changes. [symptoma.com]

  Moderate swelling. Grade 3 – Confluent, moist desquamation greater than 1.5 cm diameter, which is not confined to the skin folds. Pitting oedema (severe swelling). [dermnetnz.org]

  […] microbes out, preventing infections Helps you feel things like heat, cold, and pain Keeps your body temperature even Makes vitamin D when the sun shines on it Anything that irritates, clogs, or inflames your skin can cause symptoms such as redness, swelling [icdlist.com]

  Early-stage manifestations include local redness, swelling, and congestion. [current-oncology.com]

  Revenue-wise, the radiodermatitis market is estimated to be worth US$421.5 million by the end of 2024, swelling up from its evaluated worth of US$321.9 million as of 2017. [transparencymarketresearch.com]

• Weakness

  Symptoms of radiation sickness include nausea, weakness, hair loss, skin burns and reduced organ function. If the exposure is large enough, it can cause premature aging or even death. [icdlist.com]

• Abdominal Pain

  Advanced Search: • Use “ “ for phrases o [ “pediatric abdominal pain” ] • Use – to remove results with certain terms o [ “abdominal pain” –pediatric ] • Use OR to account for alternate terms o [teenager OR adolescent ] [merckmanuals.com]

• Hypotension

  Acute Radiation Syndrome involves most of the vital system of the body and with increasing exposure can manifest as hematopoietic disorder, gastrointestinal disturbance like diarrhoea, cardiovascular instability leading to hypotension and finally convulsion [ncbi.nlm.nih.gov]

• Ulcer

  We describe two patients in whom chronic radiodermatitis with therapy-resistant ulceration of the right scapular region developed, following percutaneous coronary intervention with fluoroscopic imaging. [ncbi.nlm.nih.gov]

  As the incidence of secondary bacterial infection is high, a swab from the ulcerated skin for microbiological testing is useful for early detection and management of the condition. [symptoma.com]

  Histopathological examination revealed deep epidermal ulceration with important dermal and hypodermal fibrosis. The histopathological findings were consistent with a diagnosis of chronic radiation injury and secondary ulceration. [heart.bmj.com]

• Erythema

  Radiodermatitis is an acute or chronic dermatological condition characterized by erythema, rash, desquamation, necrosis, fibrosis, and depigmentation of the affected skin. [symptoma.com]

  Radiation dermatitis is classified to four grades according to National Cancer Institute – Common Terminology Criteria for Adverse Events v4.0. : Grade 1- faint erythema or dry desquamation; Grade 2- moderate to risk erythema, patchy, moist desquamation [omicsonline.org]

  […] the degree of erythema of the skin Objective measurement of degree of erythema of the skin [ Time Frame: day 33 ] Mexa meter MX18 will be used to objectively measure the degree of erythema of the skin Objective measurement of degree of erythema of the [clinicaltrials.gov]

  Primary lesions include lichen planus, necrolytic acral erythema, sialadenitis, and Mooren's corneal ulceration. Secondary disorders result from perturbations of the immune system. Lichen planus and necrolytic acral erythema can cause skin erythema. [doi.org]

• Dry Skin

  It is a common practice to keep irradiated skin dry on account of data from the 1950s that suggested this regimen limits dermatitis. However, severe dryness of the skin induced by irradiation results in itching and discomfort. [ncbi.nlm.nih.gov]

  NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases Acrodermatitis (Medical Encyclopedia) Cryotherapy (Medical Encyclopedia) Cutaneous skin tags (Medical Encyclopedia) Dry skin -- self-care (Medical Encyclopedia) Erythema multiforme [icdlist.com]

  Everyday care Skin care basics Skin care secrets Injured skin Itchy skin Sun protection Hair & scalp care Nail care secrets Basic skin care Dry, oily skin Hair removal Tattoos and piercings Anti-aging skin care For your face For your skin routine Preventing [aad.org]

  It is important to instruct patients to gently clean and dry the skin in the radiation field before each irradiation session. [doi.org]

• Withdrawn

  The drug was withdrawn, supportive care was instituted, and the patient subsequently improved. RRD should be suspected in patients who develop an erythematous rash in a previously irradiated region. [ncbi.nlm.nih.gov]

  If any of the evaluators perceive any adverse event that could be attributed to the intervention, or if the patient withdraws consent at any time, this patient will be immediately withdrawn from the study. [trialsjournal.biomedcentral.com]

• Confusion

  Usually, a clearly demarcated border is a characteristic finding of radiation-induced injury; however, such injuries should not be confused with monitoring or defibrillator electrode pad placement, adhesive tape burns, or an allergy to the disinfectant [doi.org]

• Dizziness

  […] various research programs to investigate whether there is any risk to users of these devices There is no scientific evidence to date that proves that wireless phone usage can lead to cancer or a variety of other health effects, including headaches, dizziness [fcc.gov]

The diagnosis of radiodermatitis depends on the history, and physical examination. The affected individual will usually be able to provide detailed information about acute or long-term radiation exposure at work or for the treatment of a malignancy. A dermatological examination may reveal skin erythema, blisters, ulceration with sloughing in acute cases while hypo or hyperpigmentation with skin atrophy, patchy alopecia, telangiectasia, and fibrosis may be noticed in chronic radiodermatitis.

Biopsy of the affected skin for histopathological examination can help confirm the diagnosis but is rarely performed. As the incidence of secondary bacterial infection is high, a swab from the ulcerated skin for microbiological testing is useful for early detection and management [5] of the condition.

Several subjective grading tools are used to document radiodermatitis [6] [7] [8] [9] [10] [11]. These tools are based on observations performed before starting treatment and then every week during and after completion of radiation therapy.

Sensory alterations (hypo- and hyperthesias) were found in four cases (66%) 1 month after treatment, although this complication was not observed 6 months after treatment. [ncbi.nlm.nih.gov]

Several authors have reported that MCPyV-negative cases have a worse prognosis than MCPyV-positive ones. Furthermore, in cases of MCC associated with SCC, most tumors have been reported to be MCPyV-negative. [ncbi.nlm.nih.gov]

[…] system manifestations due to the underlying etiology. [icd10data.com]

Leeper, "Electrical Wiring Configurations and Childhood Cancer," American J Epidemiology, 1979; 109:273-284. N. Wertheimer and E. Leeper, "Adult Cancer Related to Electrical Wires Near the Home," Internat'l J Epidemiology, 1982; 11:345-355. [arrl.org]

New type of agents should be developed to improve the efficiency based on the pathophysiology of RD. [ncbi.nlm.nih.gov]

Skin toxicity during breast irradiation: Pathophysiology and management. South Med J 2004;97:989-93. 4. Simard PF, Bolton RM, Tarbell NJ. Anti-Inflamatory cream reduces skin damage Induced by ionizing radiation. [indianjcancer.com]

Future research should examine therapies that incorporate the current understanding of the pathophysiology of radiodermatitis while measuring effectiveness using objective and universal outcome measures. [pubmed.ncbi.nlm.nih.gov]

Radiation dermatitis: Clinical presentation, pathophysiology and treatment 2006. J Am Acad Dermatol 2006; 54:28-46.. Richardson J, Smith JE, McIntyre M, Thomas R, Pilkington K. [dermnetnz.org]

Acute skin reactions are one of the most common side effects of radiation therapy, and prevention of this adverse event has been investigated in several studies. However, a clinically applicable, preventative treatment remains unavailable. [ncbi.nlm.nih.gov]

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2. Trotti A, Byhardt R, Stetz J, et al. Common toxicity criteria: version 2.0. an improved reference for grading the acute effects of cancer treatment: impact on radiotherapy. Int J Radiat Oncol Biol Phys. 2000;47:13–47.
3. Noble-Adams R. Radiation-induced reactions 1: an examination of the phenomenon. Br J Nurs. 1999;8(17):1134–1140.
4. Hill A, Hanson M, Bogle MA, Duvic M. Severe radiation dermatitis is related to Staphylococcus aureus. Am J Clin Oncol. 2004;27:361–3.
5. Altoparlak U, Koca O, Koca T. Incidence and Risk Factors of the Secondary Skin Infections in Patients with Radiodermatitis. Eurasian J Med. 2011 Dec;43(3):177–181.
6. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341–1346.
7. National Cancer Institute Cancer Therapy Evaluation Program. Common terminology criteria for adverse events [v.4.03]. Bethesda, MD: National Cancer Institute. 2010. Available: https://evs.nci.nih.gov/ftp1/CTCAE
8. Berthelet E, Truong PT, Musso K, et al. Preliminary reliability and validity testing of a new Skin Toxicity Assessment Tool (STAT) in breast cancer patients undergoing radiotherapy. Am J Clin Oncol. 2004;27:626–631.
9. Catlin-Huth C, Haas ML, Pollock V (Eds). Radiation therapy patient care record: A tool for documenting nursing care. Pittsburgh, PA: Oncology Nursing Society. 2002
10. Noble-Adams R. Radiation-induced skin reactions 2: Development of a measurement tool. Br J Nurs. 1999a;8:1208–1211.
11. Noble-Adams R. Radiation-induced skin reactions 3: Evaluating the RISRAS. Br J Nurs. 1999b;8:1305–1312.