Radiodermatitis is an acute or chronic dermatological condition characterized by erythema, rash, desquamation, necrosis, fibrosis, and depigmentation of the affected skin. It develops as a consequence of exposure to radiation either during diagnostic radiological procedures, cancer treatment or environmental or occupational exposure.
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 . Radiodermatitis is the most common complication of roentgen therapy in cancer patients  .
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  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  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.
Entire Body System
Jaw & Teeth
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]
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]
Abstract The medical and nursing literature suggests a wide variety of pharmacological and nonpharmacological approaches to treatment of acute radiation skin damages (erythema, dry and moist desquamation, ulceration), but no specific and standardized [ncbi.nlm.nih.gov]
[…] 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]
Delayed Wound Healing
Inflammatory skin exudation in the irradiation field, delayed wound healing, and pain during radiotherapy can affect treatment tolerance, resulting in interruption of radiotherapy, a prolonged treatment course, and insufficient dose, which directly affects [current-oncology.com]
Clinical, photographic and ultrasound examination revealed clear and lasting thickening of the superficial tissues, increased coverage of the implant, and reduced skin discoloration and tension. [ncbi.nlm.nih.gov]
This criterion identifies grades 0 (no change over baseline), 1 (follicular faint or dull erythema, epilation, dry desquamation, decreased sweating), 2 (tender or bright erythema, patchy moist desquamations, moderate edema), 3 (confluent, moist desquamation [trialsjournal.biomedcentral.com]
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  of the condition.
Several subjective grading tools are used to document radiodermatitis      . These tools are based on observations performed before starting treatment and then every week during and after completion of radiation therapy.
- Singh M, Alavi A, Wong R, Sadanori A. Radiodermatitis: A Review of Our Current Understanding. Am J Clini Dermatol. 2016 Jun;17:3:277-292
- 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.
- Noble-Adams R. Radiation-induced reactions 1: an examination of the phenomenon. Br J Nurs. 1999;8(17):1134–1140.
- Hill A, Hanson M, Bogle MA, Duvic M. Severe radiation dermatitis is related to Staphylococcus aureus. Am J Clin Oncol. 2004;27:361–3.
- 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.
- 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.
- 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
- 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.
- 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
- Noble-Adams R. Radiation-induced skin reactions 2: Development of a measurement tool. Br J Nurs. 1999a;8:1208–1211.
- Noble-Adams R. Radiation-induced skin reactions 3: Evaluating the RISRAS. Br J Nurs. 1999b;8:1305–1312.