White : Diseases of the Skin - Vascular Disorders

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Gary M. White & Neil H. Cox

Diseases of the Skin

15	Vascular Disorders

RADIATION THERAPY

Radiation dermatitis

Etiology and pathogenesis

Radiation therapy, if given in sufficient quantity, causes irreversible damage to the skin. The acute phase of radiation dermatitis may be likened to a sunburn. Chronic radiation dermatitis, which develops years to decades after the exposure, leads to fibrosis and, potentially, the development of malignant skin tumors. Typical sources of radiation damage are treatment for breast cancer (mastectomy site), cardiac catheterization (axilla), or X-ray epilation (scalp).

Clinical

In acute radiation dermatitis, the skin is bright red in the areas exposed to X-rays (Fig.15.63). Months to years after radiation therapy, patients may develop atrophy, induration, fibrosis, prominent telangiectases, and hypo- or hyperpigmentation (Fig.15.64). Rarely, comedones may develop. The affected skin is more likely than normal skin to develop basal or squamous cell carcinomas.

Differential diagnosis

The main issue is in those whose radiotherapy was for a skin neoplasm, as distinguishing recurrent tumor from ulcerated radionecrosis may be clinically difficult. Significant pain favors radionecrosis.

Figure 15.64 Radiation damage. (a) Multiple telangiectases years after mastectomy and radiation therapy for breast cancer. (b) Atrophy, scarring, and telangiectases years after X-ray treatment for a childhood hemangioma. (c) Multiple comedones developing in a radiation port. The development of comedones after UV damage is analogous to that seen in Favre–Racouchot syndrome.

Treatment

Acute radiation dermatitis may be treated with topical steroids. There is no good treatment for chronic radiation dermatitis other than monitoring
for malignancy, but if ulceration occurs it is worth considering the role of secondary infection by obtaining bacteriology swab results before embarking on a biopsy.