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PubMed2002

[Radiation recall dermatitis after docetaxel and external beam radiotherapy. Report of two cases and review of the literature].

Radiation recall refers to a tissue reaction produced by a chemotherapeutic agent in a previously irradiated field that would not occur in a nonirradiated field. Docetaxel is a member of the taxane group of antineoplastic agents that cause disruption of cell division by enhancing microtubule assembly and inhibiting tubulin depolymerisation. As well as in breast cancer and lung cancer treatment, its association in a chemoradiation planned treatment becomes frequent and effective. Most of radiation recall dermatitis (RDD) reported in literature concerned paclitaxel or other drugs. We report two particularly striking cases of RDD with docetaxel and radiotherapy. Even if etiology remains undetermined, a number of hypotheses can be formulated. Familiarity with this phenomenon and potential complications of chemotherapy following tumor irradiation may expedite early diagnosis and appropriate lifesaving treatment.

Antineoplastic Agents, Phytogenic↗
PubMed2002

Breast cancer acute radiotherapy morbidity evaluated by different scoring systems.

Reporting of the outcome of radiotherapy is not satisfactory without a description of the treatment-related side effects. The purposes of this paper were: (1) to evaluate the frequency and the severity of collateral skin reactions in a group of breast cancer patients; (2) to report the acute reactions using some current scoring systems and to compare the application of them, and (3) to investigate the variation between intra- and interobservers using these different scales. We studied 108 breast cancer patients who, after surgical treatment, received adjuvant radiotherapy. Clinical skin evaluation was always performed by the same radiotherapist the last day of treatment, and the collateral radiation effects were photographed at that moment to facilitate later evaluations by another two expert doctors. Normal tissue damage was scored according to the Radiation Therapy Oncology Group/The European Organisation for Research, and Treatment of Cancer/ (RTOG/EORTC), the Danish, the European, and the Biomed2 side-effect scales. The most frequent acute complications found were erythema (91.7%), dry desquamation (29.6%) and moist desquamation (35.2%). The reactions were classified as severe in 13.9, 23, 18.5 and 13% of the patients with each of the different systems used, respectively. The concordance between the scoring of radiation-induced side effects on the skin assessed by direct observation of the patients or by examination of the photographic document was sufficient. This is a warrant of accuracy in the evaluation of acute normal tissue lesions. Our results allow us to state the advantage of the RTOG system over the others in terms of evaluating the acute effects produced by radiotherapy of women with breast cancer.

Breast Neoplasms↗
PubMed1999

[Chemical peel--current possibilities and limits].

The increased exposure to UV-radiation as well as the longer life expectation are the main reasons for photo-aging of the skin, which becomes more and more important in dermatology. Chemical peels represent potent agents, which meets not only the aesthetic aspect of skin rejuvenation, but also the medical aspects of skin aging. It allows to remove skin pigmentations, to smooth fine wrinkles and to improve the skin texture, and it can successfully be used in the therapy of actinic keratosis as well. The selection of the most suitable peeling-procedure is crucial for a successful treatment. It must always be guided by the given indication, and the results strongly depend on the experience and the skills of the treating physician.

Chemexfoliation↗
PubMed1999

[Photo-aging].

Photodamage starts early in childhood due to repeated and unprotected sun exposure. It is observed almost exclusively in individuals with white skin, especially skin phototypes I and II. Clinical studies show that 50 to 80% of an individual's life time ultraviolet (uv) radiation occurs before the age of 18 years. Photodamage, also known as dermatoheliosis, represents a polymorphic alteration of several structures of the skin, especially keratinocytes and melanocytes in the epidermis, the vascular system, and the dermal connective tissue. This damages caused by acute and chronic uv-exposure result in a substantially increased incidence of skin cancers. The severity of photodamages depends on constitual factors, e.g. skin phototype (skin color, capacity to tan), and on duration as well as intensity of sun exposure. Tanning for cosmetic purposes by sunbathing or by using artificial tanning devices is still widespread. Thus, it is important that clinicians are familiar with the clinical manifestations of photodamages and skin cancer. Further efforts to educate both public and medical professions are essential to direct more patients earlier to treatment. Furthermore new strategies need to be developed to influence behaviour as well as to increase awareness.

Adolescent↗
PubMed1999

[Prevention of ultraviolet ray damage: external and internal sunscreens].

Acute and chronic exposures to non-physiological doses of UV-light lead to a variety of changes of the skin. The most significant of these changes are a premature aging of the skin, UV-induced hyperkeratosis or atrophy, provocation of skin diseases and neoplasms of the skin. Furthermore, the local and systemic immune response can be negatively modulated. As long as society views tanned skin as a sign of beauty and success, and provided no behavioral changes occur, it will be required to emphasize prevention through education and the use of external and internal sun protection products. It is presently customary to use only sunscreens which can block UVB and UVA light to varying degrees. It could also be shown that presupplementation with beta carotene combined with topical sunscreens are more effective than sunscreen cream alone. Therefore the use of such a combination for the general health of population at risk e.g. before UV-exposure would seem advisable. There are no acceptable alternatives of protection against UV-radiation except suitable clothing and avoiding skin exposure to direct sun light.

Administration, Oral↗
PubMed1994

Blue light curing units--a dermatological hazard?

The setting reactions of a large number of dental materials are activated upon exposure to visible blue light emitted from a curing unit. Although the wavelength (lambda) from such devices is principally in the visible spectrum (lambda > 400 nm) a small amount of ultraviolet radiation (UV) is also present. Little attention has been paid to the consequences of such exposure upon the skin of dental surgeons' fingers. This investigation studied the level of UVA I (lambda = 340-400 nm) emitted by three commonly used polymerisation sources and assessed the level of protection afforded by six brands of surgical glove. The integrated irradiances of the Translux, Topaz T100 and Heliomat units in the UVA I range were 15861, 3611 and 305 mW/m2 respectively. For all gloves the mean % transmission, at lambda = 400 nm, was less than 4% with the exception of one brand where, in the stretched state, the level of transmission was 7%. It is concluded that the risk of initiating adverse dermatological consequences as a result of exposure to UVA I, emitted by light polymerisation units, is minimal in normal usage. The combined effects of exposure to radiation of this type and contamination of the fingers with quantities of irritant chemicals, such as found in many dental materials, are unknown. Due to the ability of the gloves to shield the skin from both chemicals and UVA I it is recommended that gloves are routinely worn for all light curing procedures.

Dental Equipment↗
PubMed2001

Photobiologic and photoimmunologic characteristics of XPA gene-deficient mice.

Xeroderma pigmentosum group A (XPA) gene-deficient mice cannot repair UV-induced DNA damage and easily develop skin cancers by UV irradiation. Just like human XP patients, homozygous (-/-) mice developed stronger longer-lasting acute inflammation than did wild-type mice after a single irradiation with UVB. Moreover, the model mice showed more severe UV-induced damage of keratinocytes and Langerhans cells than did the control mice. UVB-induced local and systemic immunosuppression was greatly enhanced in the (-/-) mice. Treatment with indomethacin, an inhibitor of prostaglandin (PG) synthesis, inhibited UV-induced inflammation and abrogated immunosuppression. In XPA-deficient mice, the amount of PGE2 and the expression level of COX-2 mRNA greatly increased after UVB irradiation compared with wild-type mice. These results suggest that the excess DNA photoproducts remaining in XPA-deficient cells after UV radiation induce COX-2 expression and subsequently produce a high amount of PGE2, which causes the enhancement of inflammation and immunosuppression. In XPA-deficient mice, the natural killer cell activity significantly decreased after repeated exposures to UVB. Our experimental data indicate that cancer development in XP patients involves not only mutagenesis due to the defect in DNA repair, but also the enhanced UV-immunosuppression and intensified impairment of natural killer function.

Animals↗
PubMed2002

Topical corticosteroid therapy for acute radiation dermatitis: a prospective, randomized, double-blind study.

BACKGROUND: Radiation dermatitis is a common side-effect of radiation therapy, but there is no current consensus about its appropriate therapy. OBJECTIVES: To compare treatment with topical 0.1% methylprednisolone vs. 0.5% dexpanthenol in a cohort of patients undergoing fractionated radiation therapy for breast cancer. METHODS: In a randomized, double-blind design, treatment was initiated at the beginning of radiation therapy and continued for 2 weeks after termination of radiation. Outcomes were compared by three different measures: clinical (symptom score), functional (transepidermal water loss, TEWL) and subjective (quality of life, QOL). RESULTS: In a preliminary cohort of untreated patients undergoing radiation therapy, clinical signs and TEWL levels increased progressively during radiation therapy, reaching highest values at 5 and 4 weeks, respectively. Although neither topical treatment reduced the incidence of radiation dermatitis, both delayed the emergence of greatest clinical and TEWL scores until approximately 6 and 5 weeks, respectively. With topical corticosteroids, clinical symptoms and TEWL were less pronounced than with dexpanthenol. Whereas general QOL improved after completion of radiation therapy, skin-related QOL declined. However, the skin-related QOL decline could be at least in part reversed by use of topical corticosteroid vs. dexpanthenol-containing emollient. CONCLUSIONS: We provide evidence that prophylactic and ongoing use of topical therapy with either topical corticosteroid or a dexpanthenol-containing emollient ameliorates, but does not prevent radiation dermatitis. Our data suggest, but do not prove, a benefit of a topical corticosteroid vs. a dexpanthenol-containing emollient. Further controlled studies with larger cohorts will be needed to determine optimal forms of topical therapy for radiation dermatitis.

Acute Disease↗
PubMed2003

Photoageing shows histological features of chronic skin inflammation without clinical and molecular abnormalities.

BACKGROUND: Photodamage is characterized by degradation of collagen and accumulation of abnormal elastin in the superficial dermis. Mast cells and macrophages, which are found in higher numbers in photoaged skin, have been implicated in this process. OBJECTIVES: To analyse the phenotype of haematopoietic-derived infiltrating cells in photodamaged skin. METHODS: Chronically sun-exposed (preauricular) and control sun-protected (postauricular) skin was recovered from eight healthy subjects undergoing cosmetic surgery (facial lifting). RESULTS: Histological analysis showed that sun-exposed skin harboured more infiltrating mononuclear cells than sun-protected skin. Cellular infiltrates were found at the periphery of areas of elastolysis around hair follicles in sun-exposed sites, whereas they were found in the interfollicular dermis around blood vessels and around hair follicles in sun-protected samples. Immunohistochemical analysis revealed an increased number of mast cells, macrophages and CD4+ CD45RO+ T cells in sun-exposed dermis as well as a higher number of CD1a+ dendritic cells in sun-exposed epidermis, compared with the sun-protected samples. Thus photoageing displays histological features of chronic skin inflammation. However, no molecular sign of inflammation was observed and we even found a decreased expression of interleukin-1beta mRNA in sun-exposed compared with sun-protected sites. Furthermore, the patients' skin looked normal and did not display any clinical inflammation. CONCLUSIONS: Collectively, these data show that chronic ultraviolet irradiation induces alterations of innate immune cells which are recruited in sun-exposed skin without being activated.

Aged↗
PubMed2003

Prolonged recovery of ultraviolet B-irradiated skin in neuropsin (KLK8)-deficient mice.

BACKGROUND: Neuropsin (KLK8), a serine protease of the kallikrein family, is thought to be involved in the function of keratinocytes, i.e. migration, differentiation and desquamation. However, how neuropsin participates is still unknown. OBJECTIVE: To observe the epidermal function of serine protease in neuropsin-deficient mice. METHODS: We irradiated the skin of neuropsin-deficient mice with ultraviolet light to induce acute inflammation and compared the morphology with that of wild-type mice. RESULTS: We observed a phenotypic change in the epidermis. An acute inflammatory dose of ultraviolet light induced a marked increase in neuropsin mRNA expression in the skin. The signal intensity of the mRNA expression was highest on day 2-3 after irradiation, when keratinocytes were aligned irregularly in the recovery period. Morphological comparison between neuropsin -/- and +/+ mice revealed that an irregular alignment of cells in the thickened epidermis was obvious on day 2 after irradiation in the wild-type mice, whereas it was prolonged for at least 2 days in the neuropsin-deficient mice. The stratum corneum of neuropsin-deficient mice was remarkably thicker than that of the wild-type mice at 5, 14 and 21 days after irradiation. The increase, as a response to this stimulus, in involucrin immunoreactivity, a marker for cell envelope assembly, was delayed in the mutant mice. CONCLUSIONS: Thus, neuropsin might be involved early in the process of differentiation, such as in the assembly of the cell envelope, but not in migration and desquamation.

Acute Disease↗
PubMed1999

Skin reactions during radiotherapy for breast cancer: the use and impact of topical agents and dressings.

Radiation skin reactions occur in the majority of cases of patients undergoing radiotherapy for breast cancer with varying degrees of severity. Guidelines for skin care and for the use of topical agents and dressings have developed over the years of practice but there is little empirical evidence on which to base a decision for best practice. This paper describes the incidence of radiation skin reactions in a sample of 126 women treated for breast cancer post-lumpectomy. The results show that by the end of whole breast irradiation between 4-8% of patients will have no reaction and less than 10% will have moist desquamation as measured by the RTOG acute scoring system. The majority of patients did not require application of a topical agent during the treatment period. Statistical analysis of relationships between the severity of radiation skin reaction and the use of topical agents found no support for additional healing or preventative benefit. However, these topical agents were found to promote comfort. The use of Fixomull as a protector and potential preventive measure for moist desquamation is described.

Administration, Topical↗