Skip to main content

Advertisement

SpringerLink
Log in

Treatment of Acute Radiodermatitis with an Oil-in-Water Emulsion Following Radiation Therapy for Breast Cancer

A Controlled, Randomized Trial

  • Original Article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Background:

A side effect of radiotherapy for breast cancer is acute radiodermatitis. It is a common practice to keep irradiated skin dry on account of data from the 1950s that suggested this regimen limits dermatitis. However, severe dryness of the skin induced by irradiation results in itching and discomfort. Dry skin is characterized by scaliness, epidermal barrier dysfunction, and reduced stratum corneum hydration, and these signs and symptoms are reduced by treatment with an emulsion.

Patients and Methods:

We performed a randomized, controlled, open-label study with 66 patients (ITT population), treating the irradiated skin in one group (n = 34) with an oil-in-water emulsion (WO1932), while leaving the other group untreated (n = 32). Clinical scoring (ONS radiation skin reaction scoring, pruritus) and biophysical measurements (stratum corneum hydration and transepidermal water loss (TEWL), as a marker of skin barrier function) were determined at day 1 (directly after termination of the radiation therapy), day 8, and day 47 (± 7).

Results:

Irradiation increased the ONS score and pruritus, whereas skin hydration and TEWL were reduced. The primary hypothesis that the increase in skin hydration was significantly greater in the emulsion-treated compared to the untreated group as early as after 8 days of treatment could not be confirmed. At the end of the study (day 47 ± 7), however, normalization of stratum corneum hydration was more advanced in the treatment group compared to the untreated group and nearly reached the values of the contralateral healthy breast skin. ONS score and pruritus also revealed an advantage for the emulsion-treated group. TEWL did not show significant changes during emulsion treatment. No adverse events were caused by the treatment regimens

Conclusion:

Treatment of radiodermatitis with an oil-in-water emulsion was well tolerated, enhanced stratum corneum hydration, improved clinical indicators, and provided relief from itching.

Hintergrund:

Eine häufige Nebenwirkung der Strahlentherapie bei Brustkrebs ist die Radiodermatitis. Üblicherweise wird die Haut trocken gehalten, da nach Untersuchungen aus den 50er Jahren so die Haut am wenigsten geschädigt wird. Starke Hauttrockenheit im Rahmen der Bestrahlung führt jedoch zu Missempfindungen und Juckreiz. Trockene Haut weist eine Schuppung, eine Hautbarrierestörung und einen erniedrigten Wassergehalt des Stratum corneum auf.

Patienten und Methoden:

In einer kontrollierten, randomisierten, unverblindeten Studie behandelten wir 34 von 66 Brustkrebspatientinnen (ITT-Population) mit einer Öl-in-Wasser-Emulsion (WO1932), 32 Patienten blieben unbehandelt. Wir untersuchten den klinischen Befund (ONS-Score), fragten nach dem Juckreiz und führten biophysikalische Messungen des Wassergehalts des Stratum corneum und des transepidermalen Wasserverlusts (TEWL) als Marker der Hautbarrierefunktion am 1., 8. und letzten Tag (Tag 47 ± 7) durch.

Ergebnisse:

Die Bestrahlung führte zu erhöhten ONS- und Prurituswerten und erniedrigten Werten des Wassergehalts der Haut und des TEWL. Die primäre Hypothese, dass sich die Hauthydration bereits nach 8 Tagen Behandlung gegenüber der unbehandelten Gruppe signifikant verbesserte, konnte nicht bestätigt werden. Jedoch hatte sich nach 47 ± 7 Tagen in der Behandlungsgruppe der erniedrigte Wassergehalt des Stratum corneum weitgehend normalisiert. Im Gegensatz zur unbehandelten Kontrollgruppe wurden in der Behandlungsgruppe auf der bestrahlten Brust fast die Werte der kontralateralen, gesunden Brust erreicht. Der Juckreiz und die ONS-Punktzahl nahmen stärker in der Behandlungsgruppe ab. Klinisch zeigte sich eine stärker ausgeprägte Besserung der Symptome in der Cremetherapiegruppe. Der TEWL als Marker der Barriere änderte sich nicht signifikant. Die Behandlung führte zu keinen unerwünschten Nebenwirkungen.

Schlussfolgerung:

Die Behandlung mit der Emulsion wurde gut toleriert. Die Ergebnisse zeigen, dass WO1932 das klinische Bild verbesserte, den Wassergehalt des Stratum corneum erhöhte und den Juckreiz reduzierte.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bauer A, Kelterer D, Bartsch R et al. Prevention of hand dermatitis in bakers’ apprentices: different efficacy of skin protection measures and UVB hardening. Int Arch Occup Environ Health 2002;75:491–499.

    Article  PubMed  Google Scholar 

  2. Bauer A, Kelterer D, Bartsch R et al. Skin protection in the food industry. Curr Probl Dermatol 2007;34:138–150.

    Article  PubMed  CAS  Google Scholar 

  3. Benomar S, Boutayeb S, Lalya I et al. Treatment and prevention of acute radiation dermatitis. Cancer Radiother 2010;14:213–216.

    PubMed  CAS  Google Scholar 

  4. Brüning H, Knaußmann HG, Rüther TH et al. Nachtkerzensamenöl-Creme (Linola® Gamma)- ein gutes Basisthera peutikum für Patienten mit atopischem und ande rem Ekzem. Akt Der matol 2004;30:204–209

    Article  Google Scholar 

  5. Engelke M, Jensen JM, Ekanayake-Mudiyanselage S et al. Effects of xerosis and ageing on epidermal proliferation and differentiation. Br J Dermatol 1997;137:219–225.

    Article  PubMed  CAS  Google Scholar 

  6. Hashimoto-Kumasaka K, Takahashi K, Tagami H. Electrical measurement of the water content of the stratum corneum in vivo and in vitro under various conditions: comparison between skin surface hygrometer and corneometer in evaluation of the skin surface hydration state. Acta Derm Venereol 1993;73:335–339.

    PubMed  CAS  Google Scholar 

  7. Hornstein und Nürnberg: Externe Therapie von Hautkrankheiten. Thieme, Stuttgart, 1985, p 466

  8. Hymes SR, Strom EA, Fife C. Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006. J Am Acad Dermatol 2006;54:28–46.

    Article  PubMed  Google Scholar 

  9. Jensen JM, Fölster-Holst R, Baranowsky A et al. Impaired sphingomyelinase activity and epidermal differentiation in atopic dermatitis. J Invest Dermatol 2004;122:1423–1431.

    Article  PubMed  CAS  Google Scholar 

  10. Jensen JM, Pfeiffer S, Witt M et al. Different effects of pimecrolimus and betamethasone on the skin barrier in patients with atopic dermatitis. J Allergy Clin Immunol 2009;123:1124–1133 and J Allergy Clin Immunol 2009;124(Suppl 2):R19–28. Erratum in: J Allergy Clin Immunol 2009;124:1038.

    Article  PubMed  CAS  Google Scholar 

  11. Kärcher KH. Die Wirkung exogener und endogener Faktoren auf die Strahlenreaktion der Haut. 2. Mitteilung: Der Einfluß lokaler Wirkstoffe auf Ablauf des Röntgenerythems im Tierversuch. Strahlentherapie 1961;114:376–385.

    Google Scholar 

  12. Leonardi MC, Gariboldi S, Ivaldi GB et al. A double-blind, randomised, vehicle-controlled clinical study to evaluate the efficacy of MAS065D in limiting the effects of radiation on the skin: interim analysis. Eur J Dermatol 2008;18:317–321.

    PubMed  Google Scholar 

  13. Mai SK, Welzel G, Hermann B et al. Can the radiation dose to CT-enlarged but FDG-PET-negative inguinal lymph nodes in anal cancer be reduced? Strahlenther Onkol 2009;185:254–259.

    Article  PubMed  Google Scholar 

  14. Maisin J, Maisin H, Deckers C. Medical care after irradiation: Skin reactions. Handbuch der Medizinischen Radiologie, Springer, Berlin, 1967, pp 530–532.

    Google Scholar 

  15. McQuestion M. Evidence-based skin care management in radiation therapy. Semin. Oncol Nurs 2006;22:163–173.

    Article  Google Scholar 

  16. McDougall CJ, Franklin LE, Gresle SO. Management of radiation dermatitis in a patient after mastectomy. J Wound Ostomy Continence Nurs 2005;32:337–339.

    Article  PubMed  Google Scholar 

  17. Mizumoto M, Nakayama H, Tokita M et al. Technical considerations for noncoplanar proton-beam therapy of patients with tumors proximal to the optic nerve. Strahlenther Onkol 2010;186:36–39.

    Article  PubMed  Google Scholar 

  18. Morczek A, Neumeister K. Die Nebenreaktionen unter der Bestrahlung und ihre Behandlung. Strahlentherapie 1963;121:349–364

    PubMed  CAS  Google Scholar 

  19. Osako T, Oguchi M, Kumada M et al. Acute radiation dermatitis and pneumonitis in Japanese breast cancer patients with whole breast hypofractionated radiotherapy compared to conventional radiotherapy. Jpn J Clin Oncol 2008;38:334–338.

    Article  PubMed  Google Scholar 

  20. Ott OJ, Lotter M, Sauer R et al. Accelerated partial-breast irradiation with interstitial implants: the clinical relevance of the calculation of skin doses. Strahlenther Onkol 2007;183:426–431.

    Article  PubMed  Google Scholar 

  21. Pardo Masferrer J, Murcia Mejía M, Vidal Fernández M et al. Prophylaxis with a cream containing urea reduces the incidence and severity of radio-induced dermatitis. Clin Transl Oncol 2010;12:43–48.

    Article  PubMed  CAS  Google Scholar 

  22. Patyánik M, Nemeskéri C, Póti Z et al. Concomitant radiochemotherapy of cervical cancer: is it justified to reduce the dosage of cisplatin? Strahlenther Onkol 2009;185:582–587.

    Article  PubMed  Google Scholar 

  23. Pinnagoda J, Tupker RA, Agner T et al. Guidelines for transepidermal water loss (TEWL) measurement. A report from the Standardization Group of the European Society of Contact Dermatitis. Contact Dermatitis 1990;22:164–181.

    Article  PubMed  CAS  Google Scholar 

  24. Porock D, Kristjanson L. Skin reactions during radiotherapy for breast cancer: the use and impact of topical agents and dressings, Eur J Cancer Care 1999;8:143–153.

    Article  CAS  Google Scholar 

  25. Primavera G, Carrera M, Berardesca E et al. A double-blind, vehicle-controlled clinical study to evaluate the efficacy of MAS065D (XClair), a hyaluronic acid-based formulation, in the management of radiation-induced dermatitis. Cutan Ocul Toxicol 2006;25:165–171.

    Article  PubMed  CAS  Google Scholar 

  26. Proksch E. Linolsäure-haltige Externa. Theoretische Grundlagen und praktische Bedeutung. Internistische Praxis 1998;38:877–883.

    Google Scholar 

  27. Proksch E. The role of emollients in the management of diseases with chronic dry skin. Skin Pharmacol Physiol 2008;21:75–80.

    Article  PubMed  CAS  Google Scholar 

  28. Proksch E, Fölster-Holst R, Bräutigam M et al. Role of the epidermal barrier in atopic dermatitis. J Dtsch Dermatol Ges 2009;7:899–910.

    PubMed  Google Scholar 

  29. Röper B, Kaisig D, Auer F et al. Thêta-Cream versus Bepanthol lotion in breast cancer patients under radiotherapy. A new prophylactic agent in skin care? Strahlenther Onkol 2004;180:315–322.

    Article  PubMed  Google Scholar 

  30. Schmuth M, Wimmer MA, Hofer S et al. Topical corticosteroid therapy for acute radiation dermatitis: a prospective, randomized, double-blind study. Br J Dermatol 2002;146:983–991.

    Article  PubMed  CAS  Google Scholar 

  31. Schmuth M, Sztankay A, Weinlich G et al. Permeability barrier function of skin exposed to ionizing radiation. Arch Dermatol 2001;137:1019–1023.

    PubMed  CAS  Google Scholar 

  32. Schreck U, Paulsen F, Bamberg M et al. Intraindividual comparison of two different skin care conceptions in patients undergoing radiotherapy of the head-and-neck region. Creme or powder? Strahlenther Onkol 2002;178:321–329.

    Article  PubMed  Google Scholar 

  33. Simard PF, Bolton RM, Tarbell NJ. Anti-inflammatory cream reduces skin damage induced by ionizing radiation. Oncologist 2009;14:197–198.

    Article  PubMed  Google Scholar 

  34. Tagami H, Kobayashi H, Zhen XS et al. Environmental effects on the functions of the stratum corneum. J Investig Dermatol Symp Proc 2001;6:87–94.

    Article  PubMed  CAS  Google Scholar 

  35. Veronesi U, Zurrida S. Preserving life and conserving the breast. Lancet Oncol 2009;10:736

    Article  PubMed  Google Scholar 

  36. Watkins SA, Maibach HI. The hardening phenomenon in irritant contact dermatitis: an interpretative update. Contact Dermatitis 2009;60:123–130.

    Article  PubMed  Google Scholar 

  37. Yoshida K, Yamazaki H, Takenaka T et al. Objective assessment of dermatitis following post-operative radiotherapy in patients with breast cancer treated with breast-conserving treatment. Strahlenther Onkol 2010;186:621–629.

    Article  PubMed  Google Scholar 

  38. Zimmermann JS, Seegenschmiedt MH, Niehoff P et al. Topographic documentation of acute radiation morbidity. Strahlenther Onkol 1998;174(Suppl. 3):30–36.

    PubMed  Google Scholar 

  39. Zimmermann JS, Wilhelm R, Niehoff P et al. Prevention and therapy of acute radiation injuries of the skin and mucosa. I. Results of a German multicenter questionnaire. Strahlenther Onkol 1998;174:142–148.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, University Hospitals of Schleswig-Holstein, University of Kiel, Kiel, Germany

    Jens-Michael Jensen MD, Tanja Gau, Regina Fölster-Holst & Ehrhardt Proksch

  2. Department of Therapeutic Radiology, University Hospitals of Schleswig-Holstein, University of Kiel, Kiel, Germany

    Jürgen Schultze

  3. Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany

    Gunter Lemmnitz & Christoph Abels

  4. Gesellschaft für Biometrie und Psychometrie GbR, Bielefeld, Germany

    Theodor May

  5. Department of Dermatology, University of Kiel, Schittenhelmstr. 7, 24105, Kiel, Germany

    Jens-Michael Jensen MD

Authors
  1. Jens-Michael Jensen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tanja Gau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jürgen Schultze
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gunter Lemmnitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Regina Fölster-Holst
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Theodor May
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christoph Abels
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ehrhardt Proksch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jens-Michael Jensen MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jensen, JM., Gau, T., Schultze, J. et al. Treatment of Acute Radiodermatitis with an Oil-in-Water Emulsion Following Radiation Therapy for Breast Cancer. Strahlenther Onkol 187, 378–384 (2011). https://doi.org/10.1007/s00066-011-2224-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-011-2224-8

Key Words

Schlüsselwörter

Search

Navigation