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 ] [msdmanuals.com]

• Inflammation

  If the moist decrustation did not recover during the tcm treatment course, the tcm was stopped and other treatments were adopted to control inflammation. [current-oncology.com]

  Application of a low-power laser has been shown to promote tissue repair by reducing inflammation and inducing collagen synthesis. Moreover, this treatment approach has not been associated with adverse events and is cost-effective. [ncbi.nlm.nih.gov]

  Sometimes inflammation is also called ‘ radio-recall ‘ or radio-toxicity. ‘ Radio-dermatitis ‘ is a name sometimes used to describe the whole range of possible skin reactions including erythema, edema, vesicular eruptions, ulceration, and erosions, but [breast-cancer.ca]

  Takayasu’s arteritis is a collagen vascular disease (CVD) characterized by stenosis of large blood vessels, such as the aorta and its main branches, as a consequence of inflammation of large blood vessels. 3 Corticosteroids and bypass surgery are often [journals.lww.com]

  Effects of ethanol on pulmonary inflammation in postburn intratracheal infection. J Burn Care Res 2008 ; 29 : 323 – 30. 12. [doi.org]

• 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]

• Surgical Procedure

  SURGICAL PROCEDURE We resected the keloid completely, preserving the pocket. The pocket was cut at the left end and hinged to the right, and the lid of the pocket was used as an advancement flap to cover the raw surface. [journals.lww.com]

  Such advanced injuries require surgical excision and skin grafting. When surgical treatment is planned [ 5, 10, 11 ], CT and MRI are helpful in observing possible lesions in the underlying bone and soft tissue. [doi.org]

• 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]

• 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]

• Dermatitis

  It was concluded that where EGFR inhibitor-related acne-like rash and dermatitis coexist within irradiated fields, management should be based on the grade of dermatitis: for grade 1 (or no dermatitis), treatment recommendations for EGFR-related acne-like [ncbi.nlm.nih.gov]

  What is radiation dermatitis ? Radiation dermatitis is a side effect of external beam ionizing radiation. It is also called radiodermatitis, x-ray dermatitis, radiation skin damage or a radiation burn. [dermnetnz.org]

• 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]

• Skin Lesion

  The diagnosis of radiation induced skin injury relies essentially on clinical and histopathological findings, location of skin lesions, and careful medical history. [ncbi.nlm.nih.gov]

• Pruritus

  RESULTS: Irradiation increased the ONS score and pruritus, whereas skin hydration and TEWL were reduced. [ncbi.nlm.nih.gov]

  View all recommendations from this society Released April 23, 2015 Radiodermatitis can cause patient pain and pruritus that affect quality of life, body image and sleep. [choosingwisely.org]

  Don’t use Aloe Vera on skin to prevent or treat radiodermatitis Radiodermatitis can cause patient pain and pruritus that affect quality of life, body image, and sleep (Schnur et al., 2012). [aannet.org]

  At 3 weeks the patient developed pruritus and her skin blistered and necrosed. It subsequently healed slowly over the next 4-5 months. In 1976, Iyer [ 3 ] published a report of two cases of severe radiation injury. [doi.org]

• Irritability

  Allergies, irritants, your genetic makeup, and certain diseases and immune system problems can cause rashes, hives, and other skin conditions. Many skin problems, such as acne, also affect your appearance. [icdlist.com]

  […] cyclohexanes 692.2 dander, animal (cat) (dog) 692.84 deodorant 692.81 detergents 692.0 dichromate 692.4 drugs and medicinals (correct substance properly administered) (internal use) 693.0 dyes 692.89 epidermophytosis - see Dermatophytosis esters 692.2 external irritant [icd9data.com]

  Patients receiving radiation therapy should be advised to avoid: sun exposure by covering the treated area with protective clothing or SPF 50+ broad-spectrum sunscreen topical skin irritants, such as perfumes, deodorants and alcohol-based lotions scratching [dermnetnz.org]

  Aloe has been used for medicinal purposes for centuries as a treatment for cuts, burns, and skin irritations. Aloe has reportedly been used since the 1930s for skin reactions from radiation therapy (American Cancer Society, 2011). [aannet.org]

  Overtreatment, including overuse of antiseptic creams, can irritate the skin. [doi.org]

• Burning Sensation

  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. [symptoma.com]

  Progressive chronic radiodermatitis frequently gives rise to a painful burning sensation. With malignant chronic radiodermatitis, neoplastic transformation develops in the ulcers or the keratoses. [opusdei.or.ke]

  The patient did not complain of burning sensations or skin changes during the weeks following the procedure and was put under regular clinical follow up to detect ulceration and malignant transformation. [heart.bmj.com]

• Asthenia

  The acute side-effects of radiation therapy are well documented and include dermatitis, mucositis, xerostomia, weight loss, dysphagia, taste alteration, nausea and vomiting, pain and asthenia. [doi.org]

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]

1. 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
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.