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.


OBJECTIVE
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.
Schmuth
M
M
Department of Dermatology, University of Innsbruck, Austria. matthias.schmuth@uibk.ac.at
Wimmer
M A
MA
Hofer
S
S
Sztankay
A
A
Weinlich
G
G
Linder
D M
DM
Elias
P M
PM
Fritsch
P O
PO
Fritsch
E
E
D000208:Acute Disease; D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000532:radiotherapy; D015331:Cohort Studies; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D008875:Middle Aged; D009824:Ointments; D010205:Pantothenic Acid / Q000008:administration & dosage* / Q000031:analogs & derivatives; D011446:Prospective Studies; D011855:Radiodermatitis / Q000188:drug therapy* / Q000209:etiology
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D009824:Ointments; D010205:Pantothenic Acid; C007288:dexpanthenol; C078007:methylprednisolone aceponate; D008775:Methylprednisolone