Edit concept Question Editor Create issue ticket

Radiodermatitis

Radiodermatitides

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.


Presentation

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.

Asymptomatic
  • After an asymptomatic period which can last several months, poikiloderma, sclerosis, necrosis, and ulceration of the skin may be observed as typical clinical features of chronic radiodermatitis.[ncbi.nlm.nih.gov]
Lymphedema
  • View Article PubMed Google Scholar Lau RW, Cheing GL: Managing postmastectomy lymphedema with low-level laser therapy. Photomed Laser Surg. 2009, 27: 763-769.[trialsjournal.biomedcentral.com]
Relapsing Polychondritis
  • Polychondritis 594 Metabolic Panniculitis 599 Diseases of the Fatty Tissue 605 Diseases of the Blood Vessels 607 Emboli to the Skin 616 Postoperative Progressive 624 Diseases of the Veins 631 Diseases of the Blood Vessels 645 Hemorrhagic Disorders 649[books.google.com]
Heart Disease
  • All patients had had chronic ischaemic heart disease (IHD) and had undergone lengthy PTCA on several occasions.[ncbi.nlm.nih.gov]
  • Your recognised location is United States (US) Coronary heart disease This article is freely available only to users in the UK. Your recognised location is United States (US) Melanoma This article is freely available only to users in the UK.[evidence.nhs.uk]
Hypertension
  • Transjugular intrahepatic portosystemic shunt is a nonsurgical procedure used to manage the complications of portal hypertension.[ncbi.nlm.nih.gov]
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]
  • 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]
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]
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]
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]
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]

Workup

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.

Chlamydia
  • Nongonococcal Urethritis NGU Absorption Test FTAABS Test 104 Yaws 113 Diseases Caused by Chlamydiae 120 Granuloma Inguinale 129 Leprosy 146 Rhinoscleroma 154 144 162 Brucellosis 190 Diseases Caused by Protozoa 203 Diseases Caused by Protozoa 204 Zoonoses[books.google.com]

Treatment

  • 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]
  • These tools are based on observations performed before starting treatment and then every week during and after completion of radiation therapy.[symptoma.com]

Prognosis

  • 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]

Etiology

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

Epidemiology

  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006. J Am Acad Dermatol. 2006;54(1):28–46. CrossRef PubMed Google Scholar 5. Feight D, Baney T, Bruce S, McQuestion M.[link.springer.com]
  • The pathophysiology of the skin reactions associated with EGFR inhibitors is still not well understood [ 21 ].[doi.org]

Prevention

  • 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]

References

Article

  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.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 21:49