CUTANEOUS EFFECTS OF RADIOTHERAPY- A REVIEW ARTICLE

  • Dr Syed Yousuf Ali
  • Dr. Harin Reddy
  • Dr. Syed Fiaz Hussain
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D. S. Y. Ali, D. H. Reddy, and D. S. F. Hussain, “CUTANEOUS EFFECTS OF RADIOTHERAPY- A REVIEW ARTICLE”, ijmhs, vol. 4, no. 1, Feb. 2014.
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Abstract

Radiotherapy is a common modality in cancer treatment and more than 50 % of affected patients will eventually receive some form of radiotherapy as definite, preoperative, postoperative or palliative treatment.

Radiation induced skin changes were recognized soon after the discovery of x-rays and were scientifically reported as early as 1902. Even when the skin is not the primary target, it may be injured as an innocent bystander and develop profound alteration on functional, gross and molecular levels.

Radiotherapy can result in common, inevitable cutaneous side effects such as acute radiodermatitis, chronic radiodermatitis and skin cancers.

Acute radiation dermatitis manifests as erythema, edema, burning or tingling, pruritus, pigmentation, desquamation, epilation, shedding of nails, vesiculation or bulla formation, erosion or ulceration. Chronic radiation changes include excessive wrinkling or atrophy of the skin, hyperpigmentation, permanent loss of hair, excessive dryness of skin, excessive longitudinal ridging of nails, keratosis and skin carcinomas.

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References

1. Omidvari S, Saboori H, Mohammadianpanah M, Mosalaei A, Ahmadloo N, Mosleh – Shirazi MA, et al. Topical betamethasone for prevention of radiation dermatitis. Indian J Dermatol Venereol Leprol 2007;73:209–15. 2. Venkatesan S, Thappa DM, D’Souza M, Ratnakar C. Radiation induced localized bullous pemphigoid. Ind J Dermatol 1998;43:182-84. 3. Lichter SA. Radiation therapy. In: Abeloff MD, Armtage JO, Lichter AS, Niederherber JE, eds. Clinical oncology,2nd ed. New York: Churchill livingstone publisher; 2000. pp423-70. 4. Hymes SD, Strom EA, Fife C. Radiation dermatitis: clinical presentation, path physiology and treatment 2006. J Am Acad Dermatol 2006;54:28-46. 5. Carper E, Mc Guire M, Boland N. Head and neck cancer nursing. In: Harrison LB, Sessions RB, Hong WK, eds. Head and Neck A Multidisciplinary Approach, 1st ed. New York: Lippincott Raven publishers; 1999. pp179-95. 6. Price NM. Radiation dermatitis following electron beam therapy. Arch Dermatol 1978;114:63-6. 7. Cipollero AC, Crossland PM. X rays and radium in the treatment of diseases of the skin, 5thed. Lea and Febiger publishers;1967. 8. Crowther JA. Biological action of radiation. Br J Radiol 1938;11:132. 9. Dessauer F. The question of fundamental biological reaction of radiation. Radiol 1930;14:1. 10. Malkinson FD, Panizzon RG. Radiobiology and radiotherapy of skin diseases. In:Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, eds. Fitzpatricks Dermatology In General Medicine, 6th ed. New York: McGraw Hill Medical Publishing division; 2003.pp 1229-38. 11. Schmuth M, Sztankay A, Weinlich G, Linder DM, Wimmer MA, Fritsch PO, et al. Permeability barrier function of skin exposed to ionizing radiation. Arch Dermatol 2001;137:1019-23. 12. Jolles B, Harrison RG. Enzymatic processes and vascular changes in the skin radiation. Br J Radiol 1966;39:12. 13. Goldschmidt H, Sherwin WK. Reaction to ionizing radiation Am Acad Dermatol 1980;3:551-79. 14. Rueda RA, Valencia IC, Covelli C, Escobar C, Alzate A, Saldarriage, et al.Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy.Arch Dermatol 1999;135:804 15. Kim JH, Krivda SJ. Lichen Planus confined to a radiation therapy site. J Am Acad dermatol 2002;46:604-5. 16. Nawalkha PL, Mathur NK, Malhotra YK, Saksena HC, Severe erythema multiforme (Stevens-Johnson syndrome) following telecobalt therapy. Br J Radiol 1972;45:768-69. 17. Arnold H. Erythema multiforme following high voltage roentgen therapy. Arch Dermatol Syphilol 1949;60:143. 18. Kaya TI, Kokturk A, Polat A, Tursen U, Ikizoglu G. A case of lymphangiectasis secondary to breast cancer treatment. Int J Dermatol 2001;40:760-61. 19. Chopra S, Sharma V, Nischal KC, Khopkar U, Baisane C, Amare (Kadam) P. Darier's disease following radiotherapy for carcinoma of cervix. Indian J Dermatol Venereol Leprol 2004;70:300-303. 20. Pavithran k. Discoid Lupus Erythematosus on a Pre-exi Patch of Chronic Radiodermatitis. Indian J Dermatol Venereol Leprol 1998;54:266-67. 21. Stein KM, Leyden JJ, Goldschmidt H. Localized acneiform eruption following cobalt irradiation.Br J Dermatol 1972;87:274-9. 22. Vergara G, Vargas-Machuca I, Pastor MA, Farina MC, Martin L, Requena L. Localization of Sweet's syndrome in radiation-induced locus minoris resistentae.J Am Acad Dermatol 2003;49:907-9. 23. Ristic B. Radiation recall dermatitis. Int J Dermatol 2004;43:627-31. 24. Yeo W, Johnson PJ. Radiation-recall skin disorders associated with the use of antineoplastic drugs. pathogenesis, prevalence and management. Am J Clin Dematol 2000;1:113-16. 25. Bostrom A, Sjolin- Forsberg G, Wilking N. Radiation recall-another call with tamoxifen. Acta Oncol 1999;38:955-59. 26. Thomas R, Stea B. Radiation recall dermatitis from high dose interferon alfa- 2b. J Clin Oncol 2002;20:355-57. 27. Abadir R, Liebmann J. Radiation reaction recall following simvastatin therapy: a new observation. Clin Oncol (R Coll Radiol) 1995;7:325-26. 28. Extermann M, Vogt N, Forni M, et al. Radiation recall in a patient with breast cancer treated for tuberculosis. Eur J Clin Pharmacol 1994;48:77-8. 29. Camidge R, Price A. Characterizing the phenomenon of radiation recall dermatitis. Radiother Oncol 2001;59:237-45. 30. Smith KJ, Germain M, Skelton H. Histopathologic features seen with radiation recall or enhancement eruptions. J Cutan Med Surg 2002;6:535-40. 31. Hom DB, Adams G, Kories M, Maisel R. Choosing the optimal wound dressing for irradiated soft tissue wounds. Otolaryngol Head Neck Surg 1999;121:591-8. 32. Heggie S, Bryant GP, Tripcony L, Keller J, Rose P, Glendenning M, et al. A phase III study on the efficacy of tropical aloe vera gel on irradiated breast tissue. Cancer Nurs 2002;25:442-51. 33. Wickline MM. Continuing education: prevention and treatment of acute radiation dermatitis: a literature review. Oncol Nurs Forum 2004;31:237-47. 34. Schmuth M, Wimmer MA, Hofer S, Sztankay A, Weinlich G, Linder DM et al. Tropical corticosteroid for acute radiation dermatitis: a prospective, randomized, double-blind study. Br J Dermatol 2002;146:983-91. 35. Margolin SG, Breneman JC, Denman DL, LaChapelle P, Wecckbach L, Aron BS. Management of radiation-induced moist skin desquamation using hydrocolloid dressing. Cancer Nurs 1990;13:71-80.

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References

1. Omidvari S, Saboori H, Mohammadianpanah M, Mosalaei A, Ahmadloo N, Mosleh – Shirazi MA, et al. Topical betamethasone for prevention of radiation dermatitis. Indian J Dermatol Venereol Leprol 2007;73:209–15.
2. Venkatesan S, Thappa DM, D’Souza M, Ratnakar C. Radiation induced localized bullous pemphigoid. Ind J Dermatol 1998;43:182-84.
3. Lichter SA. Radiation therapy. In: Abeloff MD, Armtage JO, Lichter AS, Niederherber JE, eds. Clinical oncology,2nd ed. New York: Churchill livingstone publisher; 2000. pp423-70.
4. Hymes SD, Strom EA, Fife C. Radiation dermatitis: clinical presentation, path physiology and treatment 2006. J Am Acad Dermatol 2006;54:28-46.
5. Carper E, Mc Guire M, Boland N. Head and neck cancer nursing. In: Harrison LB, Sessions RB, Hong WK, eds. Head and Neck A Multidisciplinary Approach, 1st ed. New York: Lippincott Raven publishers; 1999. pp179-95.
6. Price NM. Radiation dermatitis following electron beam therapy. Arch Dermatol 1978;114:63-6.
7. Cipollero AC, Crossland PM. X rays and radium in the treatment of
diseases of the skin, 5thed. Lea and Febiger publishers;1967.
8. Crowther JA. Biological action of radiation. Br J Radiol 1938;11:132.
9. Dessauer F. The question of fundamental biological reaction of radiation. Radiol 1930;14:1.
10. Malkinson FD, Panizzon RG. Radiobiology and radiotherapy of skin diseases.
In:Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, eds.
Fitzpatricks Dermatology In General Medicine, 6th ed. New York: McGraw Hill Medical Publishing division; 2003.pp 1229-38.
11. Schmuth M, Sztankay A, Weinlich G, Linder DM, Wimmer MA, Fritsch PO, et al. Permeability barrier function of skin exposed to ionizing radiation. Arch Dermatol 2001;137:1019-23.
12. Jolles B, Harrison RG. Enzymatic processes and vascular changes in the skin radiation. Br J Radiol 1966;39:12.
13. Goldschmidt H, Sherwin WK. Reaction to ionizing radiation Am Acad Dermatol 1980;3:551-79.
14. Rueda RA, Valencia IC, Covelli C, Escobar C, Alzate A, Saldarriage, et al.Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy.Arch Dermatol 1999;135:804
15. Kim JH, Krivda SJ. Lichen Planus confined to a radiation therapy site. J Am Acad dermatol 2002;46:604-5.
16. Nawalkha PL, Mathur NK, Malhotra YK, Saksena HC, Severe erythema multiforme (Stevens-Johnson syndrome) following telecobalt therapy. Br J Radiol 1972;45:768-69.
17. Arnold H. Erythema multiforme following high voltage roentgen therapy.
Arch Dermatol Syphilol 1949;60:143.
18. Kaya TI, Kokturk A, Polat A, Tursen U, Ikizoglu G. A case of lymphangiectasis secondary to breast cancer treatment. Int J Dermatol 2001;40:760-61.
19. Chopra S, Sharma V, Nischal KC, Khopkar U, Baisane C, Amare (Kadam) P. Darier's disease following radiotherapy for carcinoma of cervix. Indian J Dermatol Venereol Leprol 2004;70:300-303.
20. Pavithran k. Discoid Lupus Erythematosus on a Pre-exi Patch of Chronic Radiodermatitis. Indian J Dermatol Venereol Leprol 1998;54:266-67.
21. Stein KM, Leyden JJ, Goldschmidt H. Localized acneiform eruption following cobalt irradiation.Br J Dermatol 1972;87:274-9.
22. Vergara G, Vargas-Machuca I, Pastor MA, Farina MC, Martin L, Requena L. Localization of Sweet's syndrome in radiation-induced locus minoris resistentae.J Am Acad Dermatol 2003;49:907-9.
23. Ristic B. Radiation recall dermatitis. Int J Dermatol 2004;43:627-31.
24. Yeo W, Johnson PJ. Radiation-recall skin disorders associated with the use of antineoplastic drugs. pathogenesis, prevalence and management. Am J Clin Dematol 2000;1:113-16.
25. Bostrom A, Sjolin- Forsberg G, Wilking N. Radiation recall-another call with tamoxifen. Acta Oncol 1999;38:955-59.
26. Thomas R, Stea B. Radiation recall dermatitis from high dose interferon alfa- 2b. J Clin Oncol 2002;20:355-57.
27. Abadir R, Liebmann J. Radiation reaction recall following simvastatin therapy: a new observation. Clin Oncol (R Coll Radiol) 1995;7:325-26.
28. Extermann M, Vogt N, Forni M, et al. Radiation recall in a patient with breast cancer treated for tuberculosis. Eur J Clin Pharmacol 1994;48:77-8.
29. Camidge R, Price A. Characterizing the phenomenon of radiation recall dermatitis. Radiother Oncol 2001;59:237-45.
30. Smith KJ, Germain M, Skelton H. Histopathologic features seen with radiation recall or enhancement eruptions. J Cutan Med Surg 2002;6:535-40.
31. Hom DB, Adams G, Kories M, Maisel R. Choosing the optimal wound dressing for irradiated soft tissue wounds. Otolaryngol Head Neck Surg 1999;121:591-8.
32. Heggie S, Bryant GP, Tripcony L, Keller J, Rose P, Glendenning M, et al. A phase III study on the efficacy of tropical aloe vera gel on irradiated breast tissue. Cancer Nurs 2002;25:442-51.
33. Wickline MM. Continuing education: prevention and treatment of acute radiation dermatitis: a literature review. Oncol Nurs Forum 2004;31:237-47.
34. Schmuth M, Wimmer MA, Hofer S, Sztankay A, Weinlich G, Linder DM et al. Tropical corticosteroid for acute radiation dermatitis: a prospective, randomized, double-blind study. Br J Dermatol 2002;146:983-91.
35. Margolin SG, Breneman JC, Denman DL, LaChapelle P, Wecckbach L, Aron BS. Management of radiation-induced moist skin desquamation using hydrocolloid dressing. Cancer Nurs 1990;13:71-80.

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