Physical forces agents may induce distinctive skin changes. Pressure and friction induce callus and corn. Callus and corn arise at sites of friction or pressure, particularly palms and soles, and especially the bony prominences of the joints. Pressure, shearing forces, friction, and moisture are main etiologic factors of pressure ulcer. The pressure ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles. Skin has long been known to be a very radiosensitive organ. Skin changes after radiation exposure follow a predictable course dictated by radiation dose, timing, and the biology of the human inflammatory reaction. When the skin is exposed to radiation, acute radiation dermatitis, chronic radiation dermatitis, skin cancer, and radiation recall dermatitis may be developed.
Biology ; Bony Callus ; Dermatitis ; Friction ; Humans ; Ischemia ; Joints ; Muscles ; Pressure Ulcer ; Radiation Exposure ; Radiodermatitis ; Skin ; Skin Diseases ; Skin Neoplasms ; Zea mays

Sorafenib is widely used for unresectable and metastatic hepatocellular carcinomas. Radiation recall dermatitis (RRD) is an acute inflammatory reaction confined to previously irradiated skin that occurs after the administration of certain drugs. RRD after sorafenib treatment is rare; five cases have been reported thus far. We describe a 44-year-old man irradiated for chest wall bone metastasis from hepatocellular carcinoma. Eight days after radiotherapy completion, systemic therapy for metastatic hepatocellular carcinoma was initiated with sorafenib treatment. Eleven days after starting sorafenib, the patient complained of erythematous rash with pruritus in the chest wall, in a location consistent with the previous radiation field. Sorafenib was continued at the same dose, despite the RRD. The skin reaction subsided over the next 2 weeks without any medical intervention.
Adult ; Carcinoma, Hepatocellular* ; Exanthema ; Humans ; Neoplasm Metastasis ; Pruritus ; Radiodermatitis* ; Radiotherapy ; Skin ; Thoracic Wall

Sorafenib is widely used for unresectable and metastatic hepatocellular carcinomas. Radiation recall dermatitis (RRD) is an acute inflammatory reaction confined to previously irradiated skin that occurs after the administration of certain drugs. RRD after sorafenib treatment is rare; five cases have been reported thus far. We describe a 44-year-old man irradiated for chest wall bone metastasis from hepatocellular carcinoma. Eight days after radiotherapy completion, systemic therapy for metastatic hepatocellular carcinoma was initiated with sorafenib treatment. Eleven days after starting sorafenib, the patient complained of erythematous rash with pruritus in the chest wall, in a location consistent with the previous radiation field. Sorafenib was continued at the same dose, despite the RRD. The skin reaction subsided over the next 2 weeks without any medical intervention.
Adult ; Carcinoma, Hepatocellular* ; Exanthema ; Humans ; Neoplasm Metastasis ; Pruritus ; Radiodermatitis* ; Radiotherapy ; Skin ; Thoracic Wall

PURPOSE: The number of coronary interventions is increasing in Korea. Medical team tend to underestimate the radiation that is used during coronary interventions. For this reason if a person who underwent coronary intervention are less likely to be diagnosed with chronic radiodermatitis. METHODS: From March 1, 2012 to February 28, 2017, patients who had a history of coronary intervention visited our plastic surgery clinic with chronic ulceration on the back, shoulders, and scapula. Subjects were classified by age, sex, lesion location, size, medication, time of exposure, onset after last exposure, treatment method, complication, and recurrence. RESULTS: 5 cases were reported, two in the left scapula, one in the right scapular, one in the mid back, and one in the below right axilla. Coronary interventions were performed twice in two patients and three times in a patient. The average exposure time was 84 minutes. The average elapsed time after for last exposure was three years and 3 months ago and ranged from 1 year to 10 years. The size of ulcer lesions was 11.1 cm² on average. All patients underwent debridement of the dead tissue and flap surgery. CONCLUSION: Patients with a history of coronary intervention should be aware of the possibility of chronic radiation dermatitis if they come with chronic scarring or ulcerative chronic wounds with a clear border at the back, shoulders and scapula. So accurate diagnosis based on the patient's medical history is important and awareness of medical team who perform coronary interventions is also necessary.
Axilla ; Cicatrix ; Debridement ; Dermatitis ; Diagnosis ; Fluoroscopy ; Humans ; Korea ; Methods ; Radiodermatitis* ; Recurrence ; Scapula ; Shoulder ; Surgery, Plastic ; Ulcer ; Wounds and Injuries

Although carbohydrate antigen (CA) 19-9 is a useful tumor marker for pancreatic cancer, it can also become elevated from a variety of benign and malignant conditions. Herein we describe an unusual presentation of elevated CA 19-9 in an asymptomatic patient who had previously undergone adjuvant chemotherapy and radiation therapy for resected early stage pancreatic cancer. The rise in CA 19-9 might be due to delayed radiation-induced inflammation related to previous intra-abdominal radiation therapy with or without radiation recall induced by gemcitabine. After treatment with corticosteroids the CA 19-9 level decreased to normal, and the patient has not developed any evidence of recurrent cancer to date.
Adrenal Cortex Hormones ; Biomarkers, Tumor ; CA-19-9 Antigen ; Chemotherapy, Adjuvant ; Humans ; Inflammation* ; Pancreatic Neoplasms* ; Radiodermatitis

BACKGROUND AND OBJECTIVES: Radiofrequency catheter ablation (RFCA) exposes patients to fixed angle radiation for extended periods of time. We investigated the incidence and characteristics of radiation-induced dermatitis (RID) associated with RFCA. SUBJECTS AND METHODS: We screened 1347 consecutive patients from 2000 to 2011 who underwent RFCA for any indication and reviewed patients with dermatologic issues at the 1-month follow-up. Skin lesions were classified into three groups: most likely RID, probable RID, and possible RID. RESULTS: Of the 1347 enrolled patients, 12 (0.89%) experienced dermatologic issues within 1 month after RFCA, including six patients (0.45%) clinically classified as 'most likely RID' and four patients (0.30%) with 'probable RID'. Ten patients, including most likely RID or probable RID patients, developed skin lesions on the right back and upper arm. Skin lesions did not improve without meticulous treatment, and three cases required surgical intervention. We compared the RID group to the remaining 1335 patients (normal group). The mean body mass indices (BMIs) of the RID and normal groups were 29.3 and 23.9 kg/m², respectively (p<0.001). Radiation exposure times were longer in the RID group (180±31.0 vs. 47±49.9 minutes, p<0.001). We further analyzed 44 patients (6 RID cases and 38 normal patients) that had BMIs >26 kg/m2 and exposure times >115 minutes based on receiver operator characteristic curve analyses. Among the 35 patients without RID, 29 patients (82.9%) did not use biplane fluoroscopy. CONCLUSIONS: Patients with high BMIs have a higher risk of developing severe RID with increasing fluoroscopy times using biplane fluoroscopy.
Arm ; Body Mass Index ; Catheter Ablation* ; Dermatitis ; Fluoroscopy ; Follow-Up Studies ; Humans ; Incidence* ; Radiation Exposure ; Radiodermatitis* ; Skin

Radiation dermatitis can develop after fluoroscopy-guided interventional procedures. Cases of fluoroscopy-induced radiation dermatitis have been reported since 1996, mostly documented in the fields of radiology, cardiology and dermatology. Since diagnosis and treatment of fluoroscopy-induced radiation dermatitis can be difficult, high grade of suspicion is required. The extent of this reaction is determined by radiation dose, duration of exposure, type of procedure, and host factors and can be aggravated by concomitant use of photosensitizers. Follow-up is important after long and complicated procedures and efforts to minimize radiation exposure time will be necessary to prevent radiation dermatitis. Herein, we report a case of a 58-year-old man with hepatocellular carcinoma presenting with subacute radiation dermatitis after prolonged fluoroscopic exposure during transarterial chemoembolization and chemoport insertion. Physicians should be aware that fluoroscopy is a potential cause of radiation dermatitis.
Carcinoma, Hepatocellular/*radiotherapy ; Embolization, Therapeutic ; Fluoroscopy ; Fluorouracil/therapeutic use ; Gamma Rays ; Humans ; Liver Neoplasms/*radiotherapy ; Male ; Middle Aged ; Radiodermatitis/*diagnosis/pathology

OBJECTIVETo introduce the application of "tennis racket" flap with fascial pedicle on the healthy chest for radiation ulcer after surgical treatment of breast cancer.

METHODSThe " tennis racket" flap was designed on the healthy chest along the cartilage with fascia pedicle near the sternum. 9 cases were treated. The flaps size ranged from 5.0 cm x 3.5 cm to 13 cm x 11 cm with pedicle size of 2-8 cm in length and 2.0-3.0 cm in width.

RESULTSAll the 9 flaps survived completely with satisfactory appearance. The patients were followed up for 2 months to 3 years without ulcer reoccurrence.

CONCLUSIONSThe "tennis racket" flap has a slender fascial pedicle without major blood vessel. It has the advantages of good flexibility for rotation and large flap size for the reconstruction of the radiation ulcer after surgical treatment of breast cancer.

Breast Neoplasms ; radiotherapy ; Fascia ; Female ; Humans ; Radiodermatitis ; surgery ; Skin Ulcer ; etiology ; surgery ; Sternum ; Surgical Flaps ; Tennis

Tamoxifen and radiotherapy are used in breast cancer treatment worldwide. Radiation recall dermatitis (RRD), induced by tamoxifen, has been rarely reported. Herein, we report a RRD case induced by tamoxifen. A 47-year-old woman had a right quadrantectomy and an axillary lymph node dissection due to breast cancer. The tumor was staged pT2N0; it was hormone receptor positive, and human epidermal growth factor receptor 2 negative. The patient received adjuvant chemotherapy followed by tamoxifen and radiotherapy. After 22 months of tamoxifen, the patient developed a localized heating sensation, tenderness, edema, and redness at the irradiated area of the right breast. The symptoms improved within 1 week without treatment. Three weeks later, however, the patient developed similar symptoms in the same area of the breast. She continued tamoxifen before and during dermatitis, and symptoms resolved within 1 week.
Breast ; Breast Neoplasms* ; Chemotherapy, Adjuvant ; Dermatitis ; Edema ; Female ; Heating ; Hot Temperature ; Humans ; Lymph Node Excision ; Middle Aged ; Radiodermatitis* ; Radiotherapy ; Receptor, Epidermal Growth Factor ; Sensation ; Tamoxifen*

PURPOSE: This study was designed to evaluate the efficacy and safety of topically applied recombinant human epidermal growth factor (rhEGF) for the prevention of radiation-induced dermatitis in cancer patients. MATERIALS AND METHODS: From December 2010 to April 2012, a total of 1,172 cancer patients who received radiotherapy (RT) of more than 50 Gy were prospectively enrolled and treated with EGF-based cream. An acute skin reaction classified according to the Radiation Therapy Oncology Group 6-point rating scale was the primary end point and we also assessed the occurrence of edema, dry skin, or pruritus. RESULTS: The percentage of radiation dermatitis with maximum grade 0 and grade 1 was 19% and 58% at the time of 50 Gy, and it became 29% and 47% after completion of planned RT. This increment was observed only in breast cancer patients (from 18%/62% to 32%/49%). Adverse events related to the EGF-based cream developed in 49 patients (4%) with mild erythema the most common. Skin toxicity grade >2 was observed in 5% of the patients. Edema, dry skin, and pruritus grade > or =3 developed in 9%, 9%, and 1% of the patients, respectively. CONCLUSION: Prophylactic use of an EGF-based cream is effective in preventing radiation dermatitis with tolerable toxicity. Further studies comparing EGF cream with other topical agents may be necessary.
Breast Neoplasms ; Dermatitis ; Edema ; Epidermal Growth Factor ; Erythema ; Humans ; Observational Study* ; Prospective Studies ; Pruritus ; Radiodermatitis ; Radiotherapy ; Skin*