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.
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]
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]
Radiodermatitis is an acute or chronic dermatological condition characterized by erythema, rash, desquamation, necrosis, fibrosis, and depigmentation of the affected skin. [symptoma.com]
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]
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]
- Skin Discoloration
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]
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.
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]
Future research should examine therapies that incorporate the current understanding of the pathophysiology of radiodermatitis while measuring effectiveness using objective and universal outcome measures. [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]
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]
The pathophysiology of the skin reactions associated with EGFR inhibitors is still not well understood [ 21 ]. [doi.org]
Wound healing in radiated skin: pathophysiology and treatment options. Int Wound J 2008;5:246–57. 6. Koukourakis GV, Kelekis N, Kouvaris J, Beli IK, Kouloulias VE. [current-oncology.com]
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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