Moist desquamation
Moist desquamation is a description of the clinical pattern seen as a consequence of
Moist desquamation is a common side effect of radiotherapy treatment, where approximately 36% of radiotherpay patients will present with symptoms of moist desquamation.[3] While modern megavoltage external beam radiotherapy have peak radiation doses below the skin, older orthvoltage systems have peak radiation doses at the skin of a patient. As such, moist desquamtation and other skin related radiotherapy complications were significantly more commonplace before the introduction of higher energy cobalt therapy and linear accelerator systems between the 1950s to 1970s.[4]
Historically, this was a common phenomenon in
Clinical characteristics
Sloughing of the
Treatment
Due to the deterministic nature of moist desquamation, once symptoms occur the condition itself can not be reversed and a patient must wait for the condition to subside. Management of these partial-thickness wounds has been influenced by the Winter principle of moist wound healing, which suggests that wounds heal more rapidly in a moist environment.[7] Hydrocolloid dressings applied directly to these wounds prevent the evaporation of moisture from the exposed dermis and create a moist environment at the wound site that promotes cell migration. As additional radiation exposure may either exacerbate or cause the re-occurrence of moist dequamation, patients are advised to use sunscreen over the irradiated area after completion of treatment.[8]
References
- ^ Fluoroscopically Guided Interventional Procedures: A Review of Radiation Effects on Patients’ Skin and Hair Stephen Balter, John W. Hopewell, Donald L. Miller, Louis K. Wagner, and Michael J. Zelefsky Radiology 2010 254:2, 326-341
- ^ van den Aardweg GJ , Hopewell JW , Simmonds RH . Repair and recovery in the epithelial and vascular connective tissues of pig skin after irradiation . Radiother Oncol 1988 ; 11 : 73 – 82 .
- ^ Suresh R., Yuen F., Murase J.E. Methods for decreasing the incidence of moist desquamation in patients undergoing radiotherapy. J Am Acad Dermatol. 2018 S0190–9622(18)32317
- ^ Mukherji, A. (2018). Management of Skin Reactions. In: Basics of Planning and Management of Patients during Radiation Therapy. Springer, Singapore. https://doi.org/10.1007/978-981-10-6659-7_23
- ^ Huda, W. Review of Radiologic Physics. 3rd edition. Lippincott, Williams & Wilkins, 2009.
- ^ Zenda S, Ota Y, Tachibana H, et al. A prospective picture collection study for a grading atlas of radiation dermatitis for clinical trials in head-and-neck cancer patients. J Radiat Res. 2016;57:301-6.
- ^ Junker JP, Kamel RA, Caterson EJ, Eriksson E. Clinical Impact Upon Wound Healing and Inflammation in Moist, Wet, and Dry Environments. Adv Wound Care (New Rochelle). 2013 Sep;2(7):348-356. doi: 10.1089/wound.2012.0412. PMID 24587972; PMCID: PMC3842869.
- ^ Michael J. Veness, Julie Howle, in Clinical Radiation Oncology (Fourth Edition), 2016