Topical treatment of radiation-induced dermatitis
DRUGS IN CONTEXT
RIGOROUS – RAPID – RESPONSIVE
A continuous publication, open access, peer-reviewed journal
Topical treatment of radiation-induced dermatitis: current issues and potential solutions
Nicola Alessandro Iacovelli MD(1), Yvan Torrente MD, PhD(2,3), Adriana Ciuffreda MD(4), Vittorio A Guardamagna MD, PhD(5,6),Marta Gentili MS(7), Luca Giacomelli PhD(8,9), Paola Sacerdote PhD(10)
(1)Radiation Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; (2)Stem Cell Laboratory, Department of Pathophysiology and Transplantation, Universitá degli Studi di Milano, Milan, Italy; (3)Unit of Neurology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Centro Dino Ferrari, Milan, Italy; (4)Medico Chirurgo, Specialista in Dermatologia e Venereologia, Dermatologia Pediatrica, Milan, Italy; (5)Division of Palliative Care and Pain Therapy, IRCCS Istituto Europeo di Oncologia IEO, Milan, Italy; (6)Director of ESMO, Designated Center of Integrated Oncology and Palliative Care, Milan, Italy; (7)Research Biologist, Private Practice, Milan, Italy; (8)Polistudium SRL, Milan, Italy; (9)Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; (10)Department of Pharmacological and Biomolecular Science, University of Milano, Milan, Italy
ABSTRACT
Approximately 95% of patients receiving radiotherapy (RT) will ultimately develop radiation-induced dermatitis (RID) during or after the course of treatment, with major consequences on quality of life and treatment outcomes. This paper reviews the pathophysiology of RID and currently used topical products for the prevention and treatment of RID. Although there is no consensus on the appropriate management, recent evidence suggests that the use of topical products supports to protect and promote tissue repair in patients with RID. Basic recommendations include advice to wear loose clothing, using electric razors if necessary, and avoiding cosmetic products, sun exposure or extreme temperatures. Based on mechanisms involved and on the clinical characteristics of oncological patients, the profile of the ideal topical product for addressing RID can be designed; it should have limited risk of adverse events, systemic adsorption and drug–drug interactions, should be characterized by multiple clinical activities, with a special focus on localized pain, and should have a careful formulation as some vehicles can block the RT beam.
Keywords: pain, quality of life, radiation-induced dermatitis, radiotherapy, skin toxicity, topical treatment.
CITATION
Iacovelli NA, Torrente Y, Ciuffreda A, Guardamagna AV, Gentili M, Giacomelli L, Sacerdote P. Topical treatment of radiation induced dermatitis: current issues and potential solutions. Drugs in Context 2020; 9: 2020-4-7. DOI: 10.7573/dic.2020-4-7
INTRODUCTION
Radiation-induced dermatitis (RID) is a very common side effect that is almost universally experienced by patients undergoing radiotherapy (RT) for cancer treatment. RID results from cutaneous or subcutaneous lesions due to external beam radiation. Indeed, it has been estimated that approximately 95% of patients receiving RT will ultimately develop RID during or after the course of treatment, with major consequences on quality of life and adherence to RT treatments, thereby affecting clinical outcomes.(1–3) However, at present, there is no consensus on the appropriate management of this condition. Therefore, there is urgent need for increased knowledge to guarantee a range of therapeutic options available for the treatment of RID.(1)
Recent evidence suggests that topical products may be used to protect and promote tissue repair in patients with RID, including within the prophylactic setting.(4,5)
The aim of this paper is to discuss current knowledge on RID and propose targets for the prevention/treatment of this condition. On these bases, the characteristics of the ‘ideal’ compound to address this side effect will be described.
Manuscripts for consideration in the present paper were retrieved via a PubMed search, using pertinent keywords (e.g. radiation-induced dermatitis). Papers were then selected for inclusion according to their relevance to the topic, as judged by the authors. The reference lists of the papers were also browsed to identify other suitable publications. Papers from personal collections of literature of the authors were also considered.