Radiation Dermatitis: A Comparative Review of Prevention and Management

Abstract

ABSTRACT Background Radiation dermatitis (RD) is a universal side effect of radiation therapy (RT), with management strategies differing depending on the type of cancer being treated. This review highlights the pathogenesis and management of RD following treatment of internal malignancies versus non‐melanoma skin cancers (NMSC) treated with superficial RT (SRT). Methods A literature search was conducted using PubMed, in addition to the authors' clinical experience with RD. Results In patients receiving RT, RD is a concerning side effect during and following treatment of internal malignancies, yet a necessary factor in the treatment of NMSC. RD is characterized by barrier dysfunction, cellular necrosis, and inflammation. In RT for internal malignancies, many strategies may be employed to preserve skin barrier integrity. In contrast, for NMSC, the occurrence of RD is integral to the therapeutic outcome of SRT, thus interventions must be used selectively or postponed. In this setting, low‐grade RD is expected and even needed; the goal should be to prevent the progression to more severe RD optimizing the therapeutic index. A ceramide‐dominant triple‐lipid barrier formulation (EC) has shown promise in both contexts in the management of RD through the restoration of the epidermal barrier. Conclusions In internal malignancies, maintaining skin integrity is critical to decrease morbidity and prevent RT interruption. When treating NMSC, a more cautious approach is favored, with RD management using breaks in RT and ultimately topical therapy deferred until after RT. Nonetheless, EC may offer a safe and effective strategy in restoring the epidermal barrier in both contexts.

Topics & Concepts