Since last few decades the role of radiation therapy has become well recognized as a treatment for many types of cancers. Its application can be curative or palliative. In this therapy, the patient is subjected to precise dose of radiation over the cancerous growth. The aim is to destroy the DNA of cancer cells and prevent its further multiplication.
However, together with the diseased cells, the normal cells are also damaged by radiation exposure. The best example is a skin change which in medical terms is known as radiation dermatitis. At least 90 percent of cancer patients taking radiotherapy may sometime or the other experience moderate to severe damage to the skin.It can be acute or chronic dermatitis.
Chronic radiation dermatitis may develop 15 days to 10 years after the first dose of radiation exposure. It is generally an extension of acute radiation dermatitis. In chronic radiation dermatitis there is irreparable damage to the skin. Loss of sensation and thickened skin with ulceration are important clinical features. Skin grafting may be needed as the damage to skin cells is irreversible.
Cause And Risk Factors For Radiation Dermatitis
Chronic radiation dermatitis of skin is caused due to exposure to ionizing radiation. Patients suffering from certain type of cancers may need radiation therapy as a curative or palliative measure.These patients are administered certain amount of radiation dose. It can be frequent high or low level dose.
This intentional exposure to radiation besides having beneficial effects may also have some side effects in the form of radiation dermatitis also called as radiation burns on the skin. As the name suggests chronic radiation dermatitis occurs over a period of time. Many patients who are administered radiation may suffer from some damage to skin.
The risk increases in following conditions:
- Patient having poor nutrition.
- If patient is suffering from some form of preexisting skin condition such as psoriasis or fungus infection.
- Exposure of radiation during angioplasty, angiography etc.
- Occupational exposure
- Diabetes mellitus
- Certain diseases such as HIV, systemic lupus, etc.
- Overlapping of skin folds.
- Use of radiation more than 60 Gyfor.
- Large and frequent dose of radiation.
- Patients taking simultaneous chemotherapy for head and neck cancers.
Signs And Symptoms Of Chronic Radiation Dermatitis
The symptoms of chronic dermatitis due to radiation therapy may develop over a period of time. It may take months and years for the symptoms to develop after the initial dose of radiation. Usually chronic phase is an extension of the acute phase.
Following are the symptoms of chronic dermatitis associated with radiation:
- Thick skin
- Loss of sensation
- Necrosis and ulceration
- Disappearance of skin pores.
- Skin becomes fragile.
- Thin and brittle nails.
- Tiny hemorrhages under the skin due to damage to the capillaries.
- Red and inflamed skin over the exposed area.
Treatment Guidelines For Chronic Radiodermatitis
Chronic radiation dermatitis is often a long standing problem. This form of dermatitis is very difficult to treat and in majority of cases there is irreversible damage to the skin. In many cases the therapy schedule may need to be interrupted or delayed in order for the patient to recover from severe symptoms.
In case if there is mild redness, washing the area with soap solution will reduce the irritation and pain. It also reduces the risk of bacterial infection. If the skin has become dry then moisturizer is valuable for decreasing the discomfort. The radiation dose may be reduced in follow during the follow up therapy.
Patient is also advised to wear loose fitting clothes and avoid certain fabrics that may cause irritation at the affected site. Applying calendula cream is beneficial to alleviate the burning and pain that is common in chronic radiation dermatitis. Some doctors also prescribe corticosteroid ointments.
Lastly if all the measures of healing fail, some patients may need skin grafting especially if patient has cosmetic concern.