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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 [1-3]. 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 [4-6]. 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 [7-9].

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 [1,4,5,10]. 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 1). Approximately 20 to 25 percent of patients experience moist desquamation and ulceration [11].

Risk factors — The risk factors for radiation dermatitis, including radiation recall, are summarized in the table (table 2). Different areas of the body have different sensitivities to radiation. The most sensitive regions of the body are the anterior of the neck, extremities, chest, abdomen, and face [3]. Hair follicles on the scalp and breast tissue also are radiosensitive. In addition, breast reconstructions and implants are associated with increased risk of severe radiation dermatitis due to the skin's inability to dissipate heat after reconstruction. These burns are usually confined to surfaces of transposed flaps or to mastectomy flaps [12,13].


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Literature review current through: Mar 2017. | This topic last updated: May 27, 2016.
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