Radiation dermatitis: An overview

Radiation dermatitis is the commonest side effect encountered during definitive radiotherapy. Radiation depletes the basal cell layer of skin and initiates a complex sequence of events leading to dose-dependent acute or late sequelae. The incidence and severity of radiation dermatitis depends upon multiple patient and treatment related factors. With the use of megavoltage radiation and implementation of conformal radiotherapy, the incidence of severe radiation dermatitis has reduced significantly. Treatment interruptions due to severe reactions may affect outcome. Prevention and management of radiation dermatitis requires a multidisciplinary approach. For acute radiation dermatitis, maintaining hydration which will eventually promote epithelialization is the key; while for moist desquamation, prevention of infection and facilitation of epithelialization are important. Barrier dressings like human amniotic membrane and hydrocolloid dressing are useful as they prevent trauma and infection, trap moisture, and thus facilitate healing. Late radiation dermatitis presenting as a difficult to treat long standing chronic radionecrotic ulcer is seen rarely in the current practice. Radionecrosis refractory to hyperbaric oxygen therapy (HBOT) may require surgical intervention to restore function and alleviate pain. Although there is lack of robust data to define strict policies for management of radiation dermatitis, the current practices are based on institutional protocols and personal experiences.