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Dermatology Online Journal Feb 2017Radiation recall dermatitis (RRD) canpresent days to years after radiation exposure andis most commonly caused by chemotherapy drugs,with tamoxifen-induced radiation...
BACKGROUND
Radiation recall dermatitis (RRD) canpresent days to years after radiation exposure andis most commonly caused by chemotherapy drugs,with tamoxifen-induced radiation recall dermatitisbeing exceptionally rare.
PURPOSE
To report a newcase of tamoxifen-induced radiation recall dermatitisafter 4.5 years of tamoxifen exposure, making this thelongest time of onset to RRD after tamoxifen initiation.
MATERIALS AND METHODS
The case of a woman withtamoxifen-induced RRD is presented. Using PubMedand Google Scholar, the terms tamoxifen, radiation,recall, dermatitis were searched. Relevant citationswere utilized and discussed.
RESULTS
An adult womanwith history of inflammatory breast carcinomadeveloped an erythematous, scaly, tender plaquelocalized to previously irradiated skin of the left chestafter more than four years of tamoxifen therapy. Thepatient was diagnosed with RRD and was treated withtopical triamcinolone 0.1% cream twice daily to theaffected areas. The patient experienced subsequentrapid improvement despite continuation of tamoxifentreatment. Biopsy revealed changes consistent withradiation dermatitis with no evidence of malignancy.
CONCLUSION
Radiation recall dermatitis can havesignificant impact on affected patients and can posea diagnostic dilemma for clinicians who may mistakeRRD for infection or recurrence of malignancy. It isimportant to be familiar with the presenting signs andsymptoms of this entity so that affected patients canreceive timely and appropriate therapy.
Topics: Administration, Cutaneous; Antineoplastic Agents, Hormonal; Carcinoma; Female; Glucocorticoids; Humans; Inflammatory Breast Neoplasms; Mastectomy; Middle Aged; Radiodermatitis; Radiotherapy; Tamoxifen; Triamcinolone
PubMed: 28329490
DOI: No ID Found -
Oncology Letters May 2016Currently in Japan, breast-conserving therapy, consisting of breast-conserving surgery and post-operative radiation therapy, is performed frequently for the treatment of...
Currently in Japan, breast-conserving therapy, consisting of breast-conserving surgery and post-operative radiation therapy, is performed frequently for the treatment of invasive breast cancer. It has been demonstrated that radiation therapy not only prevents recurrence in the preserved breast, but that it also contributes to improved patient survival. The present study describes the case of a 37-year-old woman with radiation recall dermatitis that occurred 6 years and 4 months after breast-conserving surgery. Erythema with a relatively distinct border was observed at the irradiated site on the left breast; eczema was diagnosed by a dermatologist. Inflammatory breast cancer was ruled out, since chest X-ray, abdominal ultrasound and bone scintigraphy were negative. Following ~1 month of topical corticosteroid application and oral second generation antihistamine treatment, the erythema was alleviated and the subjective symptoms also disappeared. Only a few cases of radiation recall dermatitis have been described in the fields of radiology and dermatology, but not yet in the surgical field. In the future, the incidence of radiation recall dermatitis is predicted to increase due to the increasing number of patients undergoing breast-conserving therapy. Whether in the surgical, radiological or dermatological field, if erythema is detected at the irradiated site during post-operative follow-up, routine care should be provided, keeping in mind the possibility of radiation recall dermatitis and inflammatory breast cancer.
PubMed: 27123065
DOI: 10.3892/ol.2016.4346 -
International Journal of Molecular... Mar 2024An important hallmark of radiation dermatitis is the impairment of the mitotic ability of the stem/progenitor cells in the basal cell layers due to radiation-induced DNA... (Review)
Review
An important hallmark of radiation dermatitis is the impairment of the mitotic ability of the stem/progenitor cells in the basal cell layers due to radiation-induced DNA damage, leading to suppressed cell renewal in the epidermis. However, this mechanism alone does not adequately explain the complex pathogenesis of radiation-induced skin injury. In this review, we summarize the latest findings on the complex pathogenesis of radiation dermatitis and correlate these with the clinical features of radiation-induced skin reactions. The current studies show that skin exposure to ionizing radiation induces cellular senescence in the epidermal keratinocytes. As part of their epithelial stress response, these senescent keratinocytes secrete pro-inflammatory mediators, thereby triggering skin inflammation. Keratinocyte-derived cytokines and chemokines modulate intercellular communication with the immune cells, activating skin-resident and recruiting skin-infiltrating immune cells within the epidermis and dermis, thereby orchestrating the inflammatory response to radiation-induced tissue damage. The increased expression of specific chemoattractant chemokines leads to increased recruitment of neutrophils into the irradiated skin, where they release cytotoxic granules that are responsible for the exacerbation of an inflammatory state. Moreover, the importance of IL-17-expressing γδ-T cells to the radiation-induced hyperproliferation of keratinocytes was demonstrated, leading to reactive hyperplasia of the epidermis. Radiation-induced, reactive hyperproliferation of the keratinocytes disturbs the fine-tuned keratinization and cornification processes, leading to structural dysfunction of the epidermal barrier. In summary, in response to ionizing radiation, epidermal keratinocytes have important structural and immunoregulatory barrier functions in the skin, coordinating interacting immune responses to eliminate radiation-induced damage and to initiate the healing process.
Topics: Humans; Epidermis; Keratinocytes; Skin; Radiodermatitis; Dermatitis; Skin Neoplasms; Chemokines
PubMed: 38542294
DOI: 10.3390/ijms25063320 -
CMAJ : Canadian Medical Association... May 2023
Topics: Humans; Carcinoma; Liver Neoplasms; Radiodermatitis
PubMed: 37156558
DOI: 10.1503/cmaj.221122-f -
Journal of Investigative Medicine High... 2023Radiation recall dermatitis is an inflammatory reaction of the skin that may infrequently occur in areas of the skin that have been previously treated with radiation... (Review)
Review
Radiation recall dermatitis is an inflammatory reaction of the skin that may infrequently occur in areas of the skin that have been previously treated with radiation therapy. This is thought to be due to a triggering agent administered after radiation therapy which leads to an acute inflammatory reaction, manifesting as a skin rash. We present the case of a 58-year-old male with recurrent invasive squamous cell carcinoma of the tongue, previously treated with chemotherapy and radiation therapy, who presented with progression of his disease. He was treated with pembrolizumab and subsequently developed a new-onset facial rash over the previously treated radiation field. The distribution of the rash was suggestive of radiation recall dermatitis. A biopsy showed dermal necrosis without evidence of dermatitis, vasculitis, or infectious process. This case highlights the incidence of a rare complication of immune checkpoint inhibitor therapy and emphasizes the need for careful monitoring for radiation recall dermatitis.
Topics: Male; Humans; Middle Aged; Radiodermatitis; Neoplasm Recurrence, Local; Antibodies, Monoclonal, Humanized; Carcinoma, Squamous Cell; Exanthema
PubMed: 37096743
DOI: 10.1177/23247096231168114 -
Oncology (Williston Park, N.Y.) Dec 2017Radiation therapy (RT) is a frequently used modality for cancer treatment. Acute and/or chronic skin changes may occur and carry risk of influencing quality of life...
Radiation therapy (RT) is a frequently used modality for cancer treatment. Acute and/or chronic skin changes may occur and carry risk of influencing quality of life during and after completion of RT. Radiation reactions may lead to delays in treatment, diminished cosmesis, and functional deficits. Lifestyle factors, treatment modalities, topical agents, and, in some cases, wound dressings may be utilized to help prevent or ameliorate radiation-induced skin reactions. While rigorous evidence supporting specific interventions may be lacking or contradictory, this article summarizes the current knowledge of the etiology, manifestations, and interventions available for prevention and management of radiation dermatitis. Further well-designed studies are needed to confirm the efficacy of current recommendations and facilitate development of novel strategies for optimal care of patients with radiation dermatitis.
Topics: Humans; Radiodermatitis
PubMed: 29297172
DOI: No ID Found -
In Vivo (Athens, Greece) 2023Adjuvant radiotherapy (RT) for breast cancer can be associated with acute dermatitis (ARD) and pneumonitis (RP). Prevalence and risk factors were characterized.
BACKGROUND/AIM
Adjuvant radiotherapy (RT) for breast cancer can be associated with acute dermatitis (ARD) and pneumonitis (RP). Prevalence and risk factors were characterized.
PATIENTS AND METHODS
This study included 489 breast cancer patients receiving adjuvant RT with conventional fractionation (CF) ± sequential or simultaneous integrated boost, or hypo-fractionation ± sequential boost. RT-regimen and 15 characteristics were investigated for grade ≥2 ARD and RP.
RESULTS
Prevalence of grade ≥2 ARD and RP was 25.3% and 2.5%, respectively. On univariate analyses, ARD was significantly associated with CF and radiation boost (p<0.0001), age ≤60 years (p=0.008), Ki-67 ≥15% (p=0.012), and systemic treatment (p=0.002). On multivariate analysis, RT-regimen (p<0.0001) and age (p=0.009) were associated with ARD. Chronic inflammatory disease was significantly associated with RP on univariate (p=0.007) and multivariate (p=0.016) analyses.
CONCLUSION
Risk factors for grade ≥2 ARD and RP were determined that may help identify patients who require closer monitoring during and after RT.
Topics: Humans; Middle Aged; Female; Breast Neoplasms; Radiation Pneumonitis; Radiodermatitis; Pneumonia; Dose Fractionation, Radiation; Lung Neoplasms
PubMed: 37905621
DOI: 10.21873/invivo.13374 -
CMAJ : Canadian Medical Association... Feb 2010
Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Dermatitis; Female; Humans; Radiodermatitis; Radionuclide Imaging
PubMed: 20026631
DOI: 10.1503/cmaj.090320 -
Strahlentherapie Und Onkologie : Organ... May 2016Radiation recall dermatitis (RRD) is an acute inflammatory reaction confined to previously irradiated skin, mainly subsequent to the administration of certain... (Review)
Review
BACKGROUND
Radiation recall dermatitis (RRD) is an acute inflammatory reaction confined to previously irradiated skin, mainly subsequent to the administration of certain chemotherapeutics. Here we present a rare case of RRD induced by the oral multikinase inhibitor sorafenib.
CASE REPORT
A 77-year-old male with hepatocellular carcinoma was irradiated at ten different sites for bone metastases with 20-36 Gray in 5-12 fractions from January to March 2015. Sorafenib 400 mg was administered twice daily from mid-March. One week later the patient presented with fever and erythematous lesions on the right upper arm, mandible, and trunk. All skin symptoms were confined to previously irradiated areas. After RRD was diagnosed by exclusion of other causes and skin biopsy, sorafenib was paused. With the administration of topical corticosteroids and oral antihistamines, the skin reaction subsided within several days. Sorafenib was readministered after 3 weeks, which did not lead to recurrence of RRD but did cause fluctuating fever.
DISCUSSION
Only four other such cases have been reported in the literature and WHO pharmacovigilance database on individual case safety reports. The current report is the first to show a potential relationship between the severity of sorafenib-induced RRD and radiation dose, histopathological features, and simultaneous acute radiation dermatitis and mucositis.
CONCLUSION
RRD induced by sorafenib is a rare phenomenon, but should be considered in patients showing erythematous skin lesions 1-2 weeks after initiation of the drug, predominantly in areas where skin has been irradiated with an equivalent dose ≥ 30 Gy. Discontinuation of sorafenib with possible readministration should be evaluated with respect to the clinical situation and severity of reaction.
Topics: Aged; Antineoplastic Agents; Bone Neoplasms; Humans; Male; Niacinamide; Phenylurea Compounds; Protein Kinase Inhibitors; Radiodermatitis; Radiotherapy, Conformal; Sorafenib; Treatment Outcome
PubMed: 26907093
DOI: 10.1007/s00066-016-0950-7 -
Blood May 2021Plasminogen is an abundant plasma protein that exists in various zymogenic forms. Plasmin, the proteolytically active form of plasminogen, is known for its essential... (Review)
Review
Plasminogen is an abundant plasma protein that exists in various zymogenic forms. Plasmin, the proteolytically active form of plasminogen, is known for its essential role in fibrinolysis. To date, therapeutic targeting of the fibrinolytic system has been for 2 purposes: to promote plasmin generation for thromboembolic conditions or to stop plasmin to reduce bleeding. However, plasmin and plasminogen serve other important functions, some of which are unrelated to fibrin removal. Indeed, for >40 years, the antifibrinolytic agent tranexamic acid has been administered for its serendipitously discovered skin-whitening properties. Plasmin also plays an important role in the removal of misfolded/aggregated proteins and can trigger other enzymatic cascades, including complement. In addition, plasminogen, via binding to one of its dozen cell surface receptors, can modulate cell behavior and further influence immune and inflammatory processes. Plasminogen administration itself has been reported to improve thrombolysis and to accelerate wound repair. Although many of these more recent findings have been derived from in vitro or animal studies, the use of antifibrinolytic agents to reduce bleeding in humans has revealed additional clinically relevant consequences, particularly in relation to reducing infection risk that is independent of its hemostatic effects. The finding that many viruses harness the host plasminogen to aid infectivity has suggested that antifibrinolytic agents may have antiviral benefits. Here, we review the broadening role of the plasminogen-activating system in physiology and pathophysiology and how manipulation of this system may be harnessed for benefits unrelated to its conventional application in thrombosis and hemostasis.
Topics: Animals; Antifibrinolytic Agents; Brain; Conjunctivitis; Enzyme Activation; Fibrin; Fibrinolysin; Fibrinolysis; Fibrinolytic Agents; Humans; Immunity; Infections; Inflammation; Mice; Plasminogen; Radiodermatitis; Receptors, Cell Surface; Skin Diseases, Genetic; Thrombosis; Tranexamic Acid; Wound Healing; Wounds and Injuries
PubMed: 33735914
DOI: 10.1182/blood.2020008951