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Radiation dermatitis

Julie L Ryan Wolf, PhD, MPH
Marilyn Ling, MD
Section Editor
Joseph Fowler, MD
Deputy Editor
Rosamaria Corona, MD, DSc


Radiation dermatitis is one of the most common side effects of radiotherapy for cancer, affecting approximately 95 percent of patients receiving radiotherapy [1-5]. Cutaneous adverse effects of radiation therapy can be divided into early/acute reactions, occurring within 90 days of initiating treatment, and late effects, which often become apparent months to years after radiation treatment has been completed (table 1).

Acute injury, which occurs within hours to weeks after radiation exposure, results from immediate structural tissue damage, generation of short-lived free radicals, irreversible double-stranded breaks in nuclear and mitochondrial DNA, and initiation of an inflammatory response in the epidermis and dermis [6-8]. Repeated exposure to low-dose ionizing radiation does not allow time for cells to repair DNA or tissue damage. The accumulation of radiation-induced changes to dermal vasculature, appendageal structures, and epidermal stem cells results in the progression of radiation dermatitis through characteristic stages of severity (picture 1).

Radiation dermatitis has a profound impact on the quality of a patient's life, due to pain and discomfort. In addition, it may be the cause of premature interruption of radiation therapy, resulting in inadequate disease treatment [9-11].

This topic will discuss the pathogenesis, clinical manifestations, and treatment of radiation dermatitis. The complications of breast and chest wall irradiation and radiation-induced fibrosis are discussed separately. (See "Clinical manifestations, prevention, and treatment of radiation-induced fibrosis" and "Patterns of relapse and long-term complications of therapy in breast cancer survivors", section on 'Chest wall and breast complications'.)


Incidence — Radiation dermatitis occurs in approximately 95 percent of patients receiving radiotherapy, especially patients with breast cancer, head and neck cancer, lung cancer, or sarcoma [1,6,7,12]. The reason for the higher incidence in these cancer patient populations is due to a higher radiation dose to the skin. In most cases, the skin reaction is mild or moderate (table 2). Approximately 20 to 25 percent of patients experience moist desquamation and ulceration [13].


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Literature review current through: Apr 2017. | This topic last updated: May 09, 2017.
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