by Denise Mann
HealthDay Reporter
MONDAY, May 8, 2023 (HealthDay News) — When Ann Alexander underwent chemotherapy for breast cancer a decade ago, she was warned about possible hair loss, nausea and vomiting.
However, the 73-year-old man was not told about the possible side effects of radiation therapy, namely acute radiation dermatitis. Symptoms can range from mild to severe and include itchy skin, swelling, blisters, and open sores.
“It was painful and scary,” said the Bronx, New York, resident. “I did everything I was supposed to do and ended up with very bad skin burns. I would have liked to know that this could happen.”
Now 10 years cancer-free, Alexander routinely counsels other women on what to expect and how to deal with this side effect as a fellow Bronx Oncology Living Daily (BOLD).
Each year, 95% of people who have radiation to treat cancer will develop acute radiation dermatitis. Until recently, this condition was not well understood and there was not much that could be done to prevent it.
This may all change with the results of two new studies implicating a common bacterium as the culprit and suggesting that a simple antibacterial treatment may do the trick.
“I absolutely believe that these findings should change practice,” said the study author. Dr. Beth McLellandirector of supportive oncodermatology at the Montefiore Einstein Cancer Center and chief of the division of dermatology at Montefiore Health System and the Albert Einstein College of Medicine in the Bronx.
Until now, acute radiation dermatitis was thought to be the result of a radiation burn, but when researchers took cultures of bacteria before and after radiation from 76 people being treated for cancer, they began to see things differently.
The researchers took samples from the inside of the nose, skin from the irradiated area, and skin from the non-radiation treated side of the body. Before treatment, about 20% of people tested positive for staphylococcus aureus bacteria (staph) but did not have an active infection.
After treatment, 48% of people who developed severe radiation dermatitis tested positive for staph., compared to just 17% of those who developed the milder form of the condition, the study found.
Staph usually lives on the skin and does not cause any problems. But radiation could weaken the skin’s structure and allow bacteria to break through the skin, the study authors explained.
Many people have tested positive for nasal staph, suggesting that bacteria from the nose could infect the skin.
The second study included 77 patients undergoing radiation. They were told to follow standard care (normal hygiene and moisturizing treatment such as Aquaphor) or an experimental antibacterial regimen.
This treatment involved the use of the antibacterial body cleanser chlorhexidine and mupirocin, an antibiotic nasal ointment, every day for five days, every two weeks, throughout his radiation treatment.
More than half of the people treated with the new antibacterial regimen developed mild to moderate symptoms, but no one developed severe symptoms. Instead, 23 percent of people who followed the current standard of care developed severe symptoms, the findings showed.
“People should be aware that there are options to prevent radiation dermatitis, including our antibacterial regimen, and should ask their radiation oncologist if it is an option for them before starting treatment,” McLellan said.
Both studies were published online May 4 in JAMA Oncology.
“Radiation dermatitis is an expected bystander effect for many undergoing radiation therapy for various types of cancer, which can be extremely burdensome, disabling, possibly interfere with treatment, and for which we do not have a standard of care for prevention or treatment,” said Dr. Adam Friedman. . He is a professor of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, DC.
People who develop more severe radiation dermatitis tend to have staph in their nasal passages, said Friedman, who was not associated with the new study.
“Using a relatively simple decolonization regimen significantly limited the severity of radiation dermatitis in cancer patients, compared with those receiving standard of care for prevention/management,” he said.
“More work is needed; however, given the simplicity of this preventative strategy, I will certainly consider it in my supportive oncodermatology clinic at George Washington University,” added Friedman.
More information
The American Cancer Society has more about the side effects of radiation therapy.
SOURCES: Ann Alexander, patient advocate, Bronx, NY; Beth McLellan, MD, director, supportive oncodermatology, Montefiore Einstein Cancer Center, chief, division of dermatology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, NY; Adam Friedman, MD, chair, dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC; jama Oncology, May 4, 2023, online
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