Topical corticosteroid therapy for acute radiation dermatitis: a prospective, randomized, double-blind study

Abstract

Summary Background Radiation dermatitis is a common side‐effect of radiation therapy, but there is no current consensus about its appropriate therapy. Objectives 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.