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Radiodermatitis chronicL58.1

Author:Prof. Dr. med. Peter Altmeyer

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Last updated on: 30.05.2024

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Synonym(s)

chronic x-ray dermatitis; Radiodermia; Radio term; Röntgenoderm; X-ray atrophy; X-ray dermatitis chronic; X-ray skin

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DefinitionThis section has been translated automatically.

Chronic X-ray damage to the skin that occurs after a latency period of months to years following exposure of the skin to ionizing radiation in the irradiation field. Chronic radiodermatitis has long been subsumed under the term: cutaneous radiation syndrome.

EtiopathogenesisThis section has been translated automatically.

Radiation doses 12-15 Gy (1200-1500 Rd), after 2nd and 3rd degree radiodermatitis acuta or with repeated small radiation doses. Ionizing radiation generates reactive free radicals by breaking chemical bonds, which influence and change cellular structures such as lipids, peptides or DNA. The effect on the tissue is controlled by cytokine expression, including TGF-beta, interleukin-6, TNF-alpha, which probably begins immediately after irradiation and lasts for months. Activated fibroblasts play a decisive role in irreversible remodeling in the late phase - several months after irradiation.

Clinical featuresThis section has been translated automatically.

Poikilodermatic, dry, atrophic skin, loss of skin appendages, patchy hyper- and/or depigmentation, telangiectasia. Later, trophic disorders with persistent ulcerations (chronic x-ray ulcer) may develop. In rare cases, morphea-like skin scleroses limited to the radiation field develop (see below Radiation-induced morphea)

Complication(s)This section has been translated automatically.

After years of chronic radiodermatitis, X-ray keratoses are developing with a tendency to carcinoma development.

General therapyThis section has been translated automatically.

Close-meshed control of the skin to exclude epithelial neoplasia. Avoidance of trauma and mechanical stimuli as injuries show poor healing tendency and can lead to x-ray ulcer.

External therapyThis section has been translated automatically.

Blande nourishing and moisturising external products (e.g. ash base ointment, linola grease, excipial fat cream). In case of a strong inflammatory reaction glucocorticoids like 0,25% prednicarbate (e.g. Dermatop cream), 0,1% mometasone (e.g. Ecural fat cream). In case of ulceration, conservative treatment by means of ulcer therapy appropriate to the stage of ulceration with wound cleansing and granulation-promoting external agents or hydrocolloid foil (e.g. Varihesive Extra Thin), see below wound treatment.

Internal therapyThis section has been translated automatically.

Analgesic drugs such as acetylsalicylic acid (e.g. ASS) 3 times/day 500 mg p.o., tramadol (e.g. Tramal Trp.) 20-40 Trp./day or ibuprofen (e.g. Ibuprofen Stada) 200-400 mg/day may be helpful.

Operative therapieThis section has been translated automatically.

Due to poor healing tendency, total excision is often unavoidable (consideration of the anatomical conditions). In case of development of keratoses surgical procedure is obligatory! Further procedure according to the histological result (see also X-ray carcinoma).

Progression/forecastThis section has been translated automatically.

Depending on the complications. Favorable in case of early detection and control of carcinoma.

LiteratureThis section has been translated automatically.

  1. Aerts A et al (2003) Chronic radiodermatitis following percutaneous coronary interventions: a report of two cases. J Eur Acad Dermatol Venereol 17: 340-343
  2. Barnea Y et al (2002) Chronic radiodermatitis injury after cardiac catheterization. Ann Plast Surgery 49: 668-672
  3. Escudero A et al (2002) Chronic X-ray dermatitis treated by topical 5-aminolaevulinic acid-photodynamic therapy. Br J Dermatol 147: 394-396
  4. Gottlober P et al (2000) Cutaneous radiation syndrome: clinical features, diagnosis and therapy. dermatologist 51: 567-574
  5. Panizzion R (1993) Dermato X-ray therapy. Present state. Dermatologist 44: 749-760

Authors

Last updated on: 30.05.2024

Author: Prof. Dr. med. Peter Altmeyer