Radiation dermatitis

Pleural effusions or ascites In patients with significant third space accumulations, evacuate the fluid before treatment and monitor plasma methotrexate levels. Psoriasis lesions Lesions of psoriasis may be aggravated by concomitant exposure to ultraviolet radiation. Radiation dermatitis and sunburn may be recalled by the use of methotrexate. 

As a single agent in the setting of locoregional, recurrent, and metastatic disease, docetaxel is also tolerated fairly well with leukopenia as the primary dose-limiting toxicity (39). Response rates have been favorable at approx 42% when administered docetaxel (100 mg/m2) every 21 d. Hesse et al. reported on significant toxicides encountered in a phase I study of concomitant taxotere (initial dose = 15 mg/m2)/conventional radiation therapy (70 Gy) grade 3/4 radiation dermatitis, neuropathy, and thrombocytopenia at dose level 1 (40). Of five evaluable patients three patients achieved a CR and one patient achieved a PR. Based on the severity of these toxicities, this treatment schedule was not pursued further. 

Radiation dermatitis has been reported in a patient who received a single infusion of paclitaxel (43). This was attributed to the potentiation of radiation effects by paclitaxel because of the close time relation between the radiotherapy and paclitaxel therapy. 

NCT01238198 Oral curcumin for radiation dermatitis in breast cancer patients... 

Sambuco (1985) has described the sunburn response of the Yucatan minipig to ultraviolet (UV) light, suggesting that this species would also make a good model in phototoxicity as well as photocontact dermatitis studies. Thirty 12-cm sites were demarcated, permitting the study of 15 different dermal dosages of UV radiation. 

Burstein HJ. Side effects of chemotherapy. Case 1. Radiation recall dermatitis from gemcitabine. J Clin Oncol 2000 18(3) 693-694. 

The most common adverse effects of topical retinoic acid are erythema and dryness that occur in the first few weeks of use, but these can be expected to resolve with continued therapy. Animal studies suggest that this drug may increase the tumorigenic potential of ultraviolet radiation. In light of this, patients using retinoic acid should be advised to avoid or minimize sun exposure and use a protective sunscreen. Allergic contact dermatitis to topical retinoic acid is rare. 

Tamoxifen has several adverse effects on the skin, including edema, flushing, rashes, hyperhidrosis, urticaria, alopecia, and hypertrichosis. Radiation recall dermatitis, a severe painful inflammatory skin reaction in sites that have previously been exposed to ionized radiation, can occur in patients taking tamoxifen (59). In one case the tamoxifen was withdrawn and the skin healed spontaneously in 7 weeks (60). Toremifene, a tamoxifen analogue, was well tolerated during 18 months of continuous treatment no signs of radiation recall developed. 

Dry, scaly skin is characterized by a decrease in the water retention capacity of the stratum corneum (SC),1 with water content diminished to less than 10%. Barrier function of the SC is usually declined, and transepidermal water loss (TEWL) is increased because of an abnormality on barrier homeostasis.2 People feel tightness of their skin, and the skin surface becomes rough, scaly, and sensitive. Hyperkeratosis, abnormal scaling, and epidermal hyperplasia are usually observed in the dry skin.2 Keratinization also shows abnormal features.2 These phenomena are commonly observed in atopic dermatitis and psoriasis.3 Dermatitis induced by environmental factors such as exposure to chemicals, low humidity, and UV radiation also shows these features. Thus, many researchers have been investigating the cause and treatment of dry skin, and there is currently great interest in adequate model systems for dry skin studies. In this chapter, I will describe several model systems of dry skin for clinical research of dermatitis associated with skin surface dryness and also mention recent studies to improve the dry skin. 

Miyachi, Y., Imamura, S., and Niwas, Y. (1987), Decreased skin superoxide dismutase activity by a single exposure of ultraviolet radiation is reduced by liposomal superoxide dismutase pretreatment,/. Invest. Dermatal., 89,111-112. 

Radiation recall consists of inflammatory reactions triggered by cytotoxic drugs in previously irradiated areas most are skin reactions. Gemcitabine has been implicated in several cases. The authors of a literature review discovered 12 cases of radiation recall caused by gemcitabine and reported a case of myositis in the rectus abdominis muscle of a patient with pancreatic adenocarcinoma as an effect of radiation recall (23). Most of the cases had inflammation of internal organs or tissues and 30% had dermatitis or mucositis. This is different from the effect of other agents that commonly cause radiation recall (anthracyclines and taxanes), with which 63% are skin reactions. Compared with anthracyclines and taxanes, the interval from the completion of radiation therapy to the start of chemotherapy is less with gemcitabine (median time 56 days, compared with 218 days for the taxanes and 646 days for doxorubicin). 

Radiation recall dermatitis developed in a 29-year-old woman after high-dose intravenous interferon alfa-2b was given 5 days after the completion of radiotherapy for malignant melanoma (300). 

Thomas R, Stea B. Radiation recall dermatitis from high-dose interferon alfa-2b. J Clin Oncol 2002 20(l) 355-7. 

Raghavan VT, Bloomer WD, Merkel DE. Taxol and radiation recall dermatitis. Lancet 1993 341(8856) 1354. 

Photochemotherapy, which consists of oral (and sometimes topical) administration of psoralens (the furo-coumarins 5-methoxypsoralen, 8-methoxypsoralen, and trioxysalen) plus long-wave ultraviolet radiation, known as PUVA, is a well-established effective treatment for psoriasis, which has also been used for vitiligo (1), mycosis fungoides, alopecia areata, dyshidrotic eczema, atopic dermatitis, and certain other skin diseases. Guidelines for treatment have been recommended (2,3). 

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