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Letters to the Editor

Anti-Inflammatory Cream Reduces Skin Damage Induced by Ionizing Radiation

Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA

Correspondence: Philippe F. Simard, 5223 Springlake Way, Baltimore, Maryland 21212, USA. Telephone: 410-706-1769; Fax: 410-706-0333; e-mail: Phil_simard123{at}yahoo.com

Received November 19, 2008; accepted for publication January 12, 2009.

Disclosure: Philippe F. Simard: None; Rachel M. Bolton: None; Nancy J. Tarbell: None

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers.

The use of ionizing radiation to treat cancer often results in damage at the skin entry site, especially if the dose exceeds 30–40 Gy fractionated [1]. Ionizing radiation can cause erythema, skin discoloration, muscle soreness, death of hair follicles, tissue swelling, and skin breakdown [2]. Damage may be significant enough to interrupt treatment. Methods currently used to reduce radiation-induced entry site damage include the use of multiple entry sites, free radical scavengers, and creams containing metal oxides to block radiation.

Radiation-induced skin damage can be attributed to either a direct effect of ionizing radiation causing DNA damage or an indirect effect resulting from inflammation-induced secondary injury [3]. Inflammation can be prevented using anti-inflammatory agents [4], but systemic anti-inflammatory agents are generally contraindicated when receiving chemotherapy.

We assessed the hypothesis that the use of a topical anti-inflammatory agent at the radiation entry site would prevent skin damage. A patient undergoing fractionated proton therapy (54 Gy total) plus concurrent chemotherapy (vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide) for mesenchymal chondrosarcoma of the temporal bone received twice-daily application of an anti-inflammatory cream containing 10% trolamine salicylate (Aspercreme®; Chattem, Inc., Chattanooga, Tennessee; over-the-counter; off-label use). Aspercreme® treatment was started 1 week after beginning radiation, and initially involved treating only a limited area with erythema and discomfort. Three weeks after beginning radiation, when a new area of erythema and discomfort emerged, Aspercreme® was applied to the entire radiation entry site. Shortly after initiating treatment in any particular area, erythema and discomfort in the corresponding area were markedly reduced. At its worst, the skin reaction induced by radiation was limited to a region of mild-to-moderate erythema and swelling, and an 4 mm fissure at the ear–scalp junction (grade 3–4, see Liang et al. [4]) (Fig.). Overall, the skin damage was noticeably less than expected, radiation treatment never had to be interrupted, and the scalp healed fully (Fig.).

View larger version (115K): [in this window] [in a new window]   Figure 1. Radiation-induced skin changes. Images of nonirradiated side of head (A) and irradiated side of head (B–D). (B) and (C) were taken 31 and 40 days, respectively, after the start of radiation. (D) was taken 1 month after the end of radiation. (B) represents the worst of the radiation-induced skin changes.

In summary, we suggest that the use of a topical anti-inflammatory agent, such as Aspercreme®, may reduce skin damage at the radiation entry site if used prophylactically.

	REFERENCES

Top References

 

1. Blanco AI, Chao C. Management of radiation-induced head and neck injury. Cancer Treat Res 2006;128:23–41.[CrossRef][Medline]
2. Sitton E. Early and late radiation-induced skin alterations. Part I: Mechanisms of skin changes. Oncol Nurs Forum 1992;19:801–807.[Medline]
3. Hei TK. Cyclooxygenase-2 as a signaling molecule in radiation-induced bystander effect. Mol Carcinog 2006;45:455–460.[CrossRef][Medline]
4. Liang L, Hu D, Liu W et al. Celecoxib reduces skin damage after radiation: Selective reduction of chemokine and receptor mRNA expression in irradiated skin but not in irradiated mammary tumor. Am J Clin Oncol 2003;26:S114–S121.[Medline]

This Article Full Text (PDF) eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Simard, P. F. Articles by Tarbell, N. J. Search for Related Content PubMed PubMed Citation Articles by Simard, P. F. Articles by Tarbell, N. J.