Spałek M
Clinical, cosmetic and investigational dermatology. Date of publication 2016 Dec 9;volume 9():473-482.
1. Clin Cosmet Investig Dermatol. 2016 Dec 9;9:473-482. doi: 10.2147/CCID.S94320.
eCollection 2016.
Chronic radiation-induced dermatitis: challenges and solutions.
Spałek M(1).
Author information:
(1)Department of Radiotherapy I, The Maria Sklodowska-Curie Memorial Cancer
Center and Institute of Oncology, Warsaw, Poland.
Chronic radiation dermatitis is a late side effect of skin irradiation, which may
deteriorate patients' quality of life. There is a lack of precise data about its
incidence; however, several risk factors may predispose to the development of
this condition. It includes radiotherapy dose, fractionation, technique,
concurrent systemic therapy, comorbidities, and personal and genetic factors.
Chronic radiation dermatitis is mostly caused by the imbalance of proinflammatory
and profibrotic cytokines. Clinical manifestation includes changes in skin
appearance, wounds, ulcerations, necrosis, fibrosis, and secondary cancers. The
most severe complication of irradiation is extensive radiation-induced fibrosis
(RIF). RIF can manifest in many ways, such as skin induration and retraction,
lymphedema or restriction of joint motion. Diagnosis of chronic radiation
dermatitis is usually made by clinical examination. In case of unclear clinical
manifestation, a biopsy and histopathological examination are recommended to
exclude secondary malignancy. The most effective prophylaxis of chronic radiation
dermatitis is the use of proper radiation therapy techniques to avoid unnecessary
irradiation of healthy skin. Treatment of chronic radiation dermatitis is
demanding. The majority of the interventions are based only on clinical practice.
Telangiectasia may be treated with pulse dye laser therapy. Chronic
postirradiation wounds need special dressings. In case of necrosis or severe
ulceration, surgical intervention may be considered. Management of RIF should be
complex. Available methods are rehabilitative care, pharmacotherapy, hyperbaric
oxygen therapy, and laser therapy. Future challenges include the assessment of
late skin toxicity in modern irradiation techniques. Special attention should be
paid on genomics and radiomics that allow scientists and clinicians to select
patients who are at risk of the development of chronic radiation dermatitis.
Novel treatment methods and clinical trials are strongly needed to provide more
efficacious therapies.
DOI: 10.2147/CCID.S94320
PMCID: PMC5161339
PMID: 28003769
Conflict of interest statement: The author reports no conflicts of interest in
this work.
