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      Topical treatment of radiation-induced dermatitis: current issues and potential solutions

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          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.

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          Most cited references81

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          Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006.

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            Ionizing radiation: the good, the bad, and the ugly.

            Julie Ryan (2012)
            Skin changes caused by ionizing radiation have been scientifically documented since 1902. Ionizing radiation is a widely accepted form of treatment for various types of cancer. Despite the technological advances, radiation skin injury remains a significant problem. This injury, often referred to as radiation dermatitis, occurs in about 95% of patients receiving radiation therapy for cancer, and ranges in severity from mild erythema to moist desquamation and ulceration. Ionizing radiation is not only a concern for cancer patients, but also a public health concern because of the potential for and reality of a nuclear and/or radiological event. Recently, the United States has increased efforts to develop medical countermeasures to protect against radiation toxicities from acts of bioterrorism, as well as cancer treatment. Management of radiation dermatitis would improve the therapeutic benefit of radiation therapy for cancer and potentially the mortality expected in any "dirty bomb" attack. Currently, there is no effective treatment to prevent or mitigate radiation skin injury. This review summarizes "the good, the bad, and the ugly" of current and evolving knowledge regarding mechanisms of and treatments for radiation skin injury.
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              Is Open Access

              Wound healing after radiation therapy: Review of the literature

              Radiation therapy is an established modality in the treatment of head and neck cancer patients. Compromised wound healing in irradiated tissues is a common and challenging clinical problem. The pathophysiology and underlying cellular mechanisms including the complex interaction of cytokines and growth factors are still not understood completely. In this review, the current state of research regarding the pathomechanisms of compromised wound healing in irradiated tissues is presented. Current and possible future treatment strategies are critically reviewed.
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                Author and article information

                Journal
                Drugs Context
                Drugs Context
                DIC
                Drugs in Context
                BioExcel Publishing Ltd
                1745-1981
                1740-4398
                2020
                12 June 2020
                : 9
                : 2020-4-7
                Affiliations
                [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
                Author notes
                Correspondence: Luca Giacomelli, Polistudium SRL, Milan, Italy. luca.giacomelli@ 123456polistudium.it
                Article
                dic-2020-4-7
                10.7573/dic.2020-4-7
                7295106
                32587626
                9f0de780-1294-48a3-8a70-55a0c16440b7
                Copyright © 2020 Iacovelli NA, Torrente Y, Ciuffreda A, Guardamagna AV, Gentili M, Giacomelli L, Sacerdote P.

                Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

                History
                : 14 April 2020
                : 15 May 2020
                : 18 May 2020
                Categories
                Review

                pain,quality of life,radiation-induced dermatitis,radiotherapy,skin toxicity,topical treatment

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