[Radiodermatitis and cancer; study of 52 cases of radiodermatitis, of which 12 were cancerous].
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Humans↗
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Altered immune cell proportions in the radiodermatitis induced hairless mice-1 (HR-1).
Accidental radiation exposures or radiation therapy can cause internal and external damage including radiodermatitis. Even though radiodermatitis is one of the dose limiting factors in radiotherapy, the immunological nature of it is not yet been clearly understood. In this study, we have examined the alteration in immune cell population during the radiodermatitis process. A radiodermatitis model was established in HR-1 mice by locally exposing a posterior dorsal region to 10 Gy X-ray/day for 4 consecutive days. Collagen accumulation, redness, erythema, and dry desquamation of the skin were detected after X-irradiation. The size and total cell number of the spleen decreased immediately after X-irradiation, compared to those of the sham-irradiated mice, and recovered to the normal levels two weeks later. Reduction and recovery of the bone marrow cell population preceded a similar change of the spleen cell population. The proportion of CD4+ T cell increased, while the proportion of CD8+ T cell decreased ahead of the obvious skin damage, in both lymph node and spleen of the irradiated mice. Interestingly, the proportion of splenic monocytes/macrophages was expanded gradually at a similar kinetics with the aggravation of the radiodermatitis. The infiltration of the CD11b+ monocyte/macrophage to the X-irradiated skin also coincided with the development of radiodermatitis. These altered proportions of immune cells may play important roles in radiodermatitis.
Adaptation, Physiological↗
[Secondary radiodermatitis caused by endovascular explorations: 5 cases].
BACKGROUND: Fluoroscopically guided interventional procedures expose patients to high doses of ionizing radiation. OBSERVATIONS: We describe 5 patients in whom radiodermatitis developed following vascular catheterization: cardiac catheterization and coronary angioplasty in 4 cases and renal artery catheterization and angioplasty in 1 case. All patients were men. The endovascular procedures have been repeated or prolonged in all cases excepted one. The clinical aspects were those of a chronic radiodermatitis (4 cases) and acute radiodermatitis (1 case). An extensive and painful ulceration was observed in 3 patients for which surgical excision was proposed. In one case lesions were bilateral. Delay of onset after the last exploration varied from a few weeks to 3 years. Biopsy specimen was suggestive of chronic radiodermatitis but, in 2 cases, was not contributive in the absence of clinical proposal. DISCUSSION: About 20 cases of radiodermatitis following coronary angioplasty have been reported in the literature since 1996. The cumulative radiation doses to which the patients were exposed are compatible with the occurrence of radiodermatitis. Coronary angiography using fluoroscopy and cineradiography delivers notably higher radiation doses than any other routine procedure. Even higher levels of radiation may result from percutaneous transluminal angioplasty, which is a more complicated and lengthier procedure frequently repeated. Radiodermatitis have been described during many other vascular procedures like radiofrequency catheter ablation, renal angioplasty, interventional neuroradiologic and hepato-biliary procedures. Medical facilities and physicians performing interventional procedures should be aware of these sides effects and implement measures to reduce the potential for radiation skin injuries.
Aged↗
[Radiodermatitis after transjugular intrahepatic portosystemic shunt: 4 cases].
BACKGROUND: Radiodermatitis following invasive radiographic procedures has been reported recently in the literature, mainly after cardiac catheterization. Only two publications are related to transjugular intrahepatic portosystemic shunt (TIPS), a recently introduced angiographic technique for achieving portal decompression. CASE REPORTS: We report four cases of radiodermatitis following a transjugular intrahepatic portosystemic shunt. A 63-year-old woman developed in 1997 a chronic radiodermatitis under the right scapula; a shunt was placed in 1992; from 1992 to 1997, she had a second transjugular intrahepatic portosystemic shunt and thereafter four dilatations. A 50-year-old man developed in 1994 a radio-induced ulceration in the same area, one week after a transjugular intrahepatic portosystemic shunt; the same year the shunt was expanded. The patient had a second transjugular intrahepatic portosystemic shunt in 1995; at that time, the cutaneous lesions evolved into chronic radiodermatitis. In 1995 a 67-year-old man developed chronic radiodermatitis under the right scapula; a transjugular intrahepatic portosystemic shunt was placed in 1992; endoprosthesis was dilated four times from 1992 to 1995. A 82-year-old women developed in 1993 an ulcerated radiodermatitis, five days after a transjugular intrahepatic portosystemic shunt. DISCUSSION: The major advantage of the transjugular intrahepatic portosystemic shunt is the ability to provide portosystemic decompression without major surgery. However, radiation exposure during the procedure is sometimes very high. Otherwise the prosthesis is readily blocked up; this side-effect requires repeated angiographic dilatations. The procedures were very long by all our patients. This explains the high absorbed radiation doses. Transjugular intrahepatic portosystemic shunt and cardiac catheterization are not the only procedures at risk. A lot of invasive radiographic techniques can result in high radiation exposure and hence radiodermatitis.
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[Incidence of radiodermatitis following interventional radiology. Results of a feasibility study among members of the French Dermatology Society].
INTRODUCTION: Radiodermatitis due to fluoroscopically guided interventional radiology procedures was reported, mostly by dermatologists, several times between 1992 and 2000, but less frequently since 2000. TYPE OF STUDY AND OBJECTIVE: This feasibility study sought to determine whether radiodermatitis secondary to interventional radiology was still occurring recently (2003-2004). METHODS: During summer 2004, we sent a questionnaire to the 1450 dermatologists belonging to the French Dermatology Society (société française de dermatologie), asking them to report any cases of radiodermatitis related to fluoroscopically guided interventional radiology between 1 September 2003 and 31 August 2004. RESULTS: Responses from 218 dermatologists reported ten cases of radiodermatitis. Median age at diagnosis was 56 years. The procedures involved interventional neuroradiology (n=1), interventional cholangiography (n=1), pacemaker insertion (n=1), and interventional cardiology (n=7). Median time from the fluoroscopic procedure to first symptoms was 2 months and from procedure to radiodermatitis diagnosis 7.5 months. Plastic surgery was necessary for two patients. CONCLUSION: Radiodermatitis related to interventional radiology still occurs. We recommend the development of a reporting system for this adverse effect as part of the optimization of interventional radiology practices, including dose reduction.
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Expression profiling of radiation-induced genes in radiodermatitis of hairless mice.
BACKGROUND: Radiation induces many cellular events leading to radiodermatitis. OBJECTIVES: The aim of this study was to establish a radiodermatitis model using experimental animals, and to examine the expression profile of radiation-induced genes. METHODS: Hairless mice were irradiated on the dorsal skin; then total RNAs were isolated and microarray hybridizations were performed. RESULTS: Irradiation with a total of 40 Gy (10 Gy day-1 for four consecutive days) provokes radiodermatitis in the hairless mouse. After microarray analysis, 130 genes that showed upregulation by radiation were selected and organized into four different clusters, depending on the time-kinetic pattern. Classification of these genes into several functional categories revealed that various biological processes were globally affected by radiation. These include transcription regulation, signal transduction, cell communication, cell death regulation and metabolism. CONCLUSIONS: These results demonstrate the complexity of the transcriptional profile of the radiation response, providing important clues on which to base further investigations of the molecular events underlying radiodermatitis.
Animals↗
[Radiodermatitis].
All radiations that cross the skin to reach the target organ may produce dermatitis. The skin reaction essentially depends on the total dose delivered, but the fractioning of that dose and its distribution over time are important factors. As benign lesions are no longer irradiated and as accidental or occupational exposure to radiations has become exceptional, the main cause of these lesions is irradiation of malignant tumours, increasingly combined with supportive treatments. Owing to technical improvements radiodermatitis is now less frequent than formerly. Acute radiodermatitis clinically resembles burns. Chronic radiodermatitis may follow the acute phase or occur suddenly after a latent period, sometimes very long. An untractable ulceration developed on an area previously irradiated should suggest malignant degeneration which is by no means infrequent. The best treatment of radiodermatitis is prevention, but plastic surgery has progressed, and patent lesions can now be removed in one stage (skin and muscle), thus transforming the patients' life, previously made very uncomfortable by invalidating lesions.
Humans↗
[Chronic radiodermatitis--a historical and current diagnosis].
Chronic radiodermatitis was already diagnosed a few years after the discovery of X-rays. Despite the fact that protection should be known to be necessary to avoid radiodermatitis, cases of chronic radiodermatitis still occur. The present case report describes a nurse who endured years of direct hand exposure, leading to chronic radiodermatitis ten years after cessation of exposure.
Chronic Disease↗
Chronic radiodermatitis following percutaneous coronary interventions: a report of two cases.
We describe two patients in whom chronic radiodermatitis with therapy-resistant ulceration of the right scapular region developed, following percutaneous coronary intervention with fluoroscopic imaging. Contrary to most reported cases in the literature, which involve numerous cardiac catheterization procedures, in both patients described here the total radiation dose was given during two successive procedures, involving difficult and prolonged coronary intervention with stent implantation. In both cases, local treatment of the ulcerative lesions was insufficient, necessitating excision of the radiodermatitis area and replacement with a skin graft, with good therapeutic result. The incidence of radiodermatitis after percutaneous coronary interventions is rising with the increasing number and complexity of these procedures. The main risk factor is a long duration of fluoroscopy using the same incidence. The skin lesions encompass a wide spectrum, ranging from erythema, telangiectasia, atrophy, hyperpigmentation and hypopigmentation to necrosis, chronic ulceration and squamous cell carcinoma. The lesions can appear from 15 days to 10 years after the procedure. To prevent radiation-induced injury, the radiation dose has to be limited and monitored. Also, careful inspection of the skin at the site of exposure is necessary and the radiographic beam has to be restricted to the smallest field size. A good clinical follow-up at regular intervals is important after long and complicated procedures.
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[Linear radiodermatitis following total body electron beam therapy].
BACKGROUND: We describe herein a peculiar clinical presentation of a linear overlapping radiodermatitis, localized on the internal side of the limbs, following a total body electron beam therapy. CASE REPORT: A 68-year-old-man was treated in April 1998 by a total body electron beam therapy, for a stage I mycosis fungoides. Few days after the last irradiation, the patient suffered from a linear eruption localized on the internal side of the limbs and the external side of the abdominal wall. DISCUSSION: Total body electron beam therapy can be proposed in early stage mycosis fungoides with localized or generalized cutaneous lesions. Because penetration depth of electron is well controlled and is limited to the skin, usual side effects of total body electron beam therapy do not concern internal organs (bone marrow,.). We report here a peculiar clinical presentation of a linear radiodermatitis in frontal plane which has not been reported to date, to our knowledge. This radiodermatitis corresponds to overlapping of posterior and anterior fields of irradiation.
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Cryosurgical treatment of professional chronic radiodermatitis.
BACKGROUND: Chronic x-ray dermatitis in professionals is a frequent problem for doctors in our country due to the fact that many of them widely used radiotherapy without any protection 15-20 years ago. Surgery has been the most accepted treatment, though it generally decreases hand function. OBJECTIVE: Up to now, cryosurgery was not usually considered as a possible treatment if the lesions were located on fingers. In this study, the advantages of cryosurgery for the treatment of professional chronic radiodermatitis with incipient pretumoral lesions are emphasized. METHODS: Cryosurgery was performed on six patients affected with chronic professional radiodermatitis that showed keratomas and ulcerations, using both spray (keratomas) and a probe 0.5 cm in diameter (ulcerations, in situ squamous cell carcinoma). Nerve block anesthesia with mepivacaine 1% was used in all cases. Before the treatment, all suspected lesions were biopsied; if invasive squamous cell carcinoma was revealed in the dermatopathological study, the patient was rejected. Variables such as blister and necrosis formation, pain, and achromatic, sensibility, and mobility disorders were studied. The follow-up period was 2 years. RESULTS: Immediate postoperative results showed great pain and blistering in all cases. Residual achromias were observed early postoperatively in all cases, but were repigmented 1 year after therapy in four cases (66%). Sensory alterations (hypo- and hyperthesias) were found in four cases (66%) 1 month after treatment, although this complication was not observed 6 months after treatment. Finger mobility was perfect in all cases 2 months after treatment, and there was no recurrence in any case after 2 years of follow-up. CONCLUSIONS: We believe cryosurgery must be considered as an excellent treatment for professional chronic radiodermatitis with keratomas, ulcerations, and incipient squamous cell carcinomas. Its use may prevent further dramatic surgical treatment, like amputations, allowing the preservation of finger function.
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[Chronic radiodermatitis after heart catheterization: the contributing role of ciprofibrate (Lipanor)?].
BACKGROUND: Radiodermatitis after cardiac catheterization procedures has been reported in only a few cases in the literature. This side effect may not however be uncommon after long or repeated endocavitary explorations. CASE REPORT: We observed a case of chronic radiodermatitis which developed after cardiac catheterization, in a patient treated with corticosteroids and ciprofibrate for lupus. The patient had undergone only one heart catheterization. A second catheterization performed when the patient had stopped ciprofibrate did not provoke new lesions. DISCUSSION: This observations would suggest that ciprofibrate could participate as a radiosensitizing factor in the development of radiodermatitis.
Cardiac Catheterization↗
Acute radiodermatitis from accidental overexposure to X-rays.
Approximately 2 weeks after accidental overexposure to X-ray radiation, a worker developed acute radiodermatitis on fingers of both hands. Exposure simulation indicated that total ionizing radiation absorbed by his fingers amounted to about 20 Gy. After 2 years, acute radiodermatitis evolved to chronicity of lesions with presence of atrophic skin, teleangiectasia, alopecia, and dyskeratosis on three right-hand fingers. Cytogenetic dosimetry of peripheral blood lymphocytes, performed 2 months after acute radiation, showed an increase of micronuclei (7% vs. 1 +/- 0.4% according to laboratory reference data). The increase was ascribed to the high dose of ionizing radiation absorbed by circulating lymphocytes in the vessels of overexposed tissues. The cytogenetic examination was repeated 27 months after acute irradiation; it was found that the percentage of micronuclei had been restored to within reference levels. The possibility of using cytogenetic dosimetry, following acute partial exposure to X-rays, not just as an indicator of previous exposure, but also as an indicator of the absorbed radiation dose is examined. Lastly, the possible stochastic effects that may set in on the skin of the affected fingers and the need for periodically monitoring the evolution of chronic skin lesions, are discussed.
Absorption↗
Radiation-induced skin cancer and radiodermatitis of the head and neck.
From a cohort of 2400 patients who had been irradiated 19 to 48 years previously for benign diseases in the head and neck region a randomly selected group of 605 patients was selected and traced back. From the 360 patients alive, 257 were examined clinically and 49 were examined by questionnaire for radiation-induced skin tumors and radiodermatitis. In 21 patients, a total of 30 skin tumors were diagnosed. In 8 of 21 patients, 10 skin carcinomas were detected at recall. A dose-effect relationship of 40 carcinomas/10(4) persons/Gy for a median follow-up period of 41 years for the area exposed was calculated. The severity of radiodermatitis is associated with a higher prevalence of skin cancer. The number of radiation-induced skin cancers rises with the post-treatment time. Because of these late radiation effects, radiotherapy of benign skin lesions is contraindicated, especially now that other therapy modalities are available.
Age Factors↗
Chronic radiodermatitis after cardiac catheterization.
A woman presented with a chronic radiodermatitis after a percutaneous transluminal coronary angioplasty (PTCA) for unstable angina. Two PTCAs had already been performed previously. Although rare, these chronic radiodermatitis have been described after multiple cardiac catheterization procedures as a result of cumulative X-ray exposure. Prevention must therefore be implemented.
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Radiodermatitis after transjugular intrahepatic portosystemic shunt.
Transjugular intrahepatic portosystemic shunt (TIPS) is a recently introduced angiographic technique for achieving portal decompression. New invasive radiographic procedures such as TIPS can result in radiation exposure equal to that received by patients during radiation therapy. With these high doses of radiation, patients are at increased risk for radiodermatitis and long-term sequelae, such as scarring and carcinoma. Ours is the first reported case of radiodermatitis after TIPS.
Angiography↗
Chronic radiodermatitis following cardiac catheterisation: a report of two cases and a brief review of the literature.
Cardiac angiography produces one of the highest radiation exposures of any commonly used diagnostic x ray procedure. Recently, serious radiation induced skin injuries have been reported after repeated therapeutic interventional procedures using prolonged fluoroscopic imaging. Two male patients, aged 62 and 71 years, in whom chronic radiodermatitis developed one to two years after two consecutive cardiac catheterisation procedures are reported. Both patients had undergone lengthy procedures using prolonged fluoroscopic guidance in a limited number of projections. The resulting skin lesions were preceded, in one case, by an acute erythema and took the form of a delayed pigmented telangiectatic, indurated, or ulcerated plaque in the upper back or below the axilla whose site corresponded to the location of the x ray tube during cardiac catheterisation. Cutaneous side effects of radiation exposure result from direct damage to the irradiated tissue and have known thresholds. The diagnosis of radiation induced skin injury relies essentially on clinical and histopathological findings, location of skin lesions, and careful medical history. Interventional cardiologists should be aware of this complication, because chronic radiodermatitis may result in painful and resistant ulceration and eventually in squamous cell carcinoma.
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Subungual chronic radiodermatitis.
We report a patient who developed a subungual radiodermatitis 25 years following radiotherapy for a verruca of the lateral nail fold. The different stages and the treatment of chronic radiodermatitis of the nail apparatus are described. We want to emphasize the late onset of such lesions and the prime importance of the anamnesis.
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