Radiation Induced skin Injuries.pptx

Radiation Induced skin Injuries By R.Hopwood What are radiation induced skin injuries Radiation induced skin injuries occur when the tissue is exposed to high doses of radiation, irreversibly damaging the small blood vessels in the skin tissue. Acute injuries can develop within the first few days t...

Radiation Induced skin Injuries By R.Hopwood What are radiation induced skin injuries Radiation induced skin injuries occur when the tissue is exposed to high doses of radiation, irreversibly damaging the small blood vessels in the skin tissue. Acute injuries can develop within the first few days to a week of radiation treatment, whereas chronic injures can develop anywhere from 90 days to years post radiation treatment. (Simman et al., 2023).  Risk Factors Pathophysiology Poor Nutrition Pre-existing skin conditions High BMI Large Breast Cup Size Excessive Skin folds Smoking Radiation-induced skin injuries occur due to the direct damage caused by Age/Sex (higher risk in women) ionizing radiation to the skin and underlying tissues. The pathophysiology Ethnic Origins and genetic factors Hormonal status involves the immediate structural damage to basal keratinocytes, hair follicle High Sun exposure stem cells, and melanocytes, leading to inflammation and disruption of the Treatment Related Factors epidermis’ self-renewing properties1. Ionizing radiation generates free radicals Proximity of the radiation target and causes DNA double-strand breaks, triggering a cascade of inflammatory to the skin responses. This includes the release of cytokines and chemokines, which Type of Radiation Radiation dose and frequency attract immune cells to the affected area, resulting in erythema, edema, and, Size of exposure to radiation in severe cases, ulceration and fibrosis. The severity of the injury depends on Other Factors the radiation dose and the depth of penetration, with higher doses causing Application of skin creams to more significant damage. exposed area prior treatment Prolonged or multiple treatments  Acute Radiation Injuries  Acute radiation dermatitis occurs within 90 days of exposure to ionising radiation, with the time of onset varying from days to weeks after the initial exposure  Its severity can vary from mild erythema to moist desquamation. (Goel et al., 2022) Grade 0 1 2 3 4 5 Parched Patchy moist Moisture Full-thickness desquamation and desquamation desquamation in dermal ulceration faint erythema limited to skin folds places other than or necrosis, as well Nil symptoms NCI CTCAE and creases, the creases and as spontaneous moderate to brisk wrinkles of the haemorrhaging at Death erythema, and mild skin, bleeding the affected area oedema brought on by a small cut or trauma (National Cancer Institute, 2017)  Injury Level Gra Description de 1 Faint erythema or dry desquamation The degree and depth of tissue damage triggered by radiation-induced skin injuries can be used to 2 Moderate to brisk erythema, patchy moist categorize them into multiple stages. desquamation; mostly confined to skin folds  Grade One: Erythema, which is characterized by and creases: moderate oedema inflammation at the site of injury due to capillary dilatation, is a common presentation for mild injuries. 3 Moist desquamation in areas other than skin  Grade Two: Dry desquamation, a condition in folds and creases, bleeding induced by minor which the skin becomes flaky, dry, and may peel trauma or abrasion off, can occur with moderate injuries.  Grade Three: wet desquamation occurs, which 4 Life-threatening consequences; skin necrosis can cause blisters and open lesions to form when or ulceration of full thickness dermis the skin becomes damaged and starts to peel off. ulceration; spontaneous bleeding from  Grade Four: Serious wounds such as ulceration involved site; skin graft indicated and necrosis, which cause damage to the skin's deeper layers and underlying tissues, leaving open wounds that are vulnerable to infection and 5 Death may need significant medical care. CTCAE Grading for Radiation Dermatitis – Used by NSW Health and Cancer Institute NSW to grade level of injury - (National Cancer Institute, 2017)  Grade One is characterized by: Faint Erythema (redness) or dy desquamation (skin peeling) The mildest form of radiation dermatitis, minimal discomfort Treated with: Skin moisterizer Topical steroids Hydrogel dressings Silver based dressings Gentle skin care Grade Two characterized by: Moderate to brisk erythema Patchy, moist desquamation, mostly in skin folds Increased discomfort and has more visible skin changes Treated with Topical steroid creams: 1% hydrocortisone cream Regular moisturizers Hydrogel dressings Silver based dressings Gentle skin care  Grade Three is characterised by: Confluent, moist desquamations over an area greater than 1.5cms in diameter, not confined to skin folds may include pitting oedema Treated with Strong topical steroids Moisturizers Hydogel dressing Silver based dressings Xerofaom dressings Saline soaks. Grade Four is characterized by: Ulceration: deep ulcers that penetrate into the dermis Spontaneous bleeding Skin necrosis. Treated with: Debridement of necrotic tissue Hydrogel dressings Hydrocolloid dressings Silver dressings Strong corticosteroid creams Skin grafting  Clinical Manifestations of Chronic Radiation induced Skin injuries Skin Atrophy Wrinkly skin is the most prevalent sign of skin atrophy. Chronic Stronger reactions could be accompanied by scaling, shine, or thinning of the skin. Commonly presents at grade II or III lesions. Radiation Telangiectasia occurs when tiny capillaries enlarge, resulting in the formation of Injuries. spider veins and red lines or patterns on the skin. Typical sign in lesions of grade II or III. may endure or vanish at some point. Radiation induced a syndrome where subcutaneous tissue loses its ability to Fibrosis stabilize connective tissue after radiation therapy, resulting in a  Chronic RSI (cRSI, or delayed onset stiffer and more sclerosis in the exposed area radiation ulcers, can present months to years after the initial exposure to radiation therapy Dyspigmentation Could emerge soon after radiation and then diminish, or it could last for months, years, or even longer. Following radiation  It can manifest itself in a variety of ways therapy, there are two conditions: hyperpigmentation and including changes in skin appearcance, the hypopigmentation. This might be irreversible. development of wounds, ulcerations, necrosis, fibrosis and secondary cancers.  Patient may describe subjective symptoms Reduction of Loss of Radiation can induce hair loss, decrease sweat secretions, harm such as tingling or numbness. Other Skin Appendages the skin, and reduce or destroy all hair follicles, sebaceous symptoms include vascular changes, glands, and sweat glands. dermis atrophy and fragility, pigmentation changes and cicatrical alopecia Radiation induced Ulcers are a late lesion that can appear anywhere on the body, Ulcers. but they usually do so in the radiation-exposed areas. If left untreated, they can enlarge and spread. Atrophy Telangiectasia Fibrosis Dyspigmentation - Dyspigmentation – hypopigmentation hyperpigmentation Radiation Ulcer Treatment Measures Acute Injuries Chronic Radiation Injuries  Non-Surgical Management  Growth Factors  Topical Corticosteroids  Topical Anti-Septics  Epidermal Growth Factor  Barrier Protection  Silver Sulfadiazine  Granulocyte Macrophage-Colony  Povidone Stimulating Factor  Silicon Atrumen  Pentoxifylline  Silicon Mepitel  Non-Adhesive Dressings  Plasma  Mepilex Lite  Silver Derivative Dressings  Interleukins  Hydrosor  Mepilex Ag  Superoxide Dismutase  Aquacell Ag  Silver Based Dressings:  Acticoat 3/7  Silver Sulfadizine  Surgical Interventions  Hydrocolloid Dressings  Skin grafting  Silver Nylon Dressing  Duoderm  Plasty flap procedures  Acticoate 3/7  Comfeel  Skin flap  Allevyn Ag  Silicon based dressings  Mepilex Ag  Silicon atrumen/mepitel  Advanced Radiation Techniques  Intensity-modulated radiation therapy  Physical Therapy  Proton therapy  Hyperbaric Oxygen Therapy  Laser Therapy What to do: basically.  Inflammation/Errythmia with or without skin loss: Acticoat  Small area of mid dermal skin loss: comfeel  Bepanthen PRN for areas such as genitals/areas with minimal conformability  Desquamation: mepilex Ag + no tape on injured skin (secure with tubifast/grip or crepe)  Moist desquamation: Mepilex Ag or Acticoat.  Don’t be backwards at seeking surgical intervention.