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Chronic Radiation Dermatitis

Last updated Aug. 13, 2018

Approved by: Maulik P. Purohit MD, MPH

Radiation dermatitis is skin condition that occurs due to exposure to ionizing radiation, commonly from radiation therapy.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Chronic Radiation Burns
  • Chronic Radiodermatitis

What is Chronic Radiation Dermatitis? (Definition/Background Information)

  • Radiation dermatitis is skin condition that occurs due to exposure to ionizing radiation, commonly from radiation therapy. It may be classified as acute and chronic
  • Chronic Radiation Dermatitis takes place following long-term radiation exposure. The signs and symptoms develop over a period of time, due to multiple high-level dose or frequent low-level radiation exposure, which is usually provided for therapeutic purposes
  • There is a chronic reaction of the skin to radiation exposure, resulting in irreparable skin damage. The condition manifests as thick/thin skin with loss of sensation
  • Chronic Radiation Dermatitis can occur due to many factors, such as radiation treatment for cancer, or due to accidental occupational exposure. Also, the presence of disorders or diseases, such as HIV infection, connective tissue disorders, and diabetes, may contribute towards the development or worsening of the condition
  • Chronic Radiation Dermatitis is often an irreversible condition. Symptomatic treatment may be undertaken, and if necessary, a skin grafting may be performed to restore damaged skin
  • The prognosis of Chronic Radiation Dermatitis may depend upon the duration of radiation exposure, the severity of the condition, and the presence of any other associated disorder

Who gets Chronic Radiation Dermatitis? (Age and Sex Distribution)

  • Any individual who is exposed to ionizing radiation for a sufficiently long period of time may be affected by Chronic Radiation Dermatitis
  • There is no age, gender, race, or ethnicity preference for the condition

What are the Risk Factors for Chronic Radiation Dermatitis? (Predisposing Factors)

The risk factors for Chronic Radiation Dermatitis may include:

  • Radiation therapy for acne
  • Psoriasis treatment
  • Fungal infection of scalp in children
  • Accidental occupational exposure
  • Radiation therapy for underlying malignancy
  • Radiation exposure during angiography or angioplasty procedure

Individuals with the following health conditions are also at risk:

  • Poorly-controlled diabetes
  • Obesity
  • Connective tissue disorders
  • Systemic lupus erythematosus (SLE)
  • HIV infection
  • Genetic disorder such as xeroderma pigmentosa
  • Basal cell nevus syndrome

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chronic Radiation Dermatitis? (Etiology)

  • Chronic Radiation Dermatitis is caused by exposure of the skin to ionizing radiation, which could have been either administered as multiple high-level dose radiation or frequent low-level dose radiation. The condition may be described as a radiation burn
  • The exposure may be intentional, such as due to medical treatment (for cancer), or accidental, such as by nature of one’s occupation
  • The radiation causes progressive and often irreversible damage to the skin cells resulting in the characteristic signs and symptoms. Also, some individuals have more sensitive skin and may react sooner to radiation exposure than others

What are the Signs and Symptoms of Chronic Radiation Dermatitis?

The signs and symptoms observed with Chronic Radiation Dermatitis may develop over a period of time and may include:

  • Thickened skin or thinned out skin
  • Skin ulceration
  • Loss of sensation in the affected area
  • Thinning of nails, brittle nails
  • Telangiectasia - the skin can bleed due to dilatation of the tiny blood vessels
  • The skin rashes are confined to a particular area, usually the area of exposure
  • Any part of the body that is exposed to the radiation may be affected
  • Signs and symptoms of any underlying conditions or disorders

Usually the acute phase of radiation dermatitis precedes the chronic phase.

How is Chronic Radiation Dermatitis Diagnosed?

A diagnosis of Chronic Radiation Dermatitis may involve:

  • A thorough physical examination of the patient to check for signs and symptoms with respect to the condition
  • A complete evaluation of one’s medical history (including occupational history) to learn about the source of the condition
  • A physical exam and medical/occupational history correlated with the signs and symptoms is usually sufficient to diagnose the condition
  • Diagnostic tests depending upon the associated disorder/condition (such as lupus, HIV infection, diabetes, etc.), if any required

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chronic Radiation Dermatitis?

Chronic Radiation Dermatitis could lead to the following complications namely:

  • Any trauma to the blisters (such as picking or scratching) can result in bleeding, ulceration, resulting in secondary infections due to bacteria or fungus
  • The skin condition may give rise to cosmetic concerns in some individuals
  • Long-term exposure to ionizing radiation can result in the development of radiation-induced skin cancer, such as squamous cell carcinoma and basal cell carcinoma
  • Complications of any underlying condition or disorder

How is Chronic Radiation Dermatitis Treated?

  • Chronic Radiation Dermatitis is usually a longstanding and irreversible condition
  • In case radiation therapy is provided, the healthcare provider must consider stopping or discontinuing the treatment, or even holding-off treatment for a certain duration of time, in order for the individual to recover
  • Symptomatic treatment and treatment of the complications, if any, may be undertaken
  • Skin grafting may be necessary in some cases, if there are any cosmetic concerns

Additionally, treatment may have to be taken for any underlying condition.

How can Chronic Radiation Dermatitis be Prevented?

The following measures may be adopted to prevent or reduce the risk of Chronic Radiation Dermatitis:

  • In case of a therapeutic exposure, decreasing the intensity of radiation provided
  • Getting away from chronic exposure to ionizing radiation
  • In case the skin is very sensitive to radiation therapy provided for treatment purposes, other alternative treatment measures may be explored
  • In case of an occupational exposure, identification of the source of the ionizing radiation is very important, following which appropriate safety clothing or protective gear may be used
  • Otherwise, the occupation or job-related tasks or habits may have to be suitably changed/modified
  • Individuals who have received radiation therapy should decrease sun exposure; the use sun protection creams is recommended to protect the skin

What is the Prognosis of Chronic Radiation Dermatitis? (Outcomes/Resolutions)

  • Chronic Radiation Dermatitis is typically an irreversible and chronic condition. It can be managed through adequate treatment
  • The prognosis depends upon the duration of radiation exposure, the intensity of radiation provided, and the severity of the signs and symptoms
  • If there is the presence of any genetic or autoimmune condition, then the prognosis may depend upon its severity

Additional and Relevant Useful Information for Chronic Radiation Dermatitis:

Acute radiation dermatitis is usually a self-resolving issue and no treatment may be generally required.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Jan. 31, 2016
Last updated: Aug. 13, 2018