New hope for painful skin problems caused by cancer radiation therapy

By Denise Mann Health Day Reporter

MONDAY, May 8, 2023 (HealthDay News) — When Ann Alexander underwent chemotherapy to treat breast cancer a decade ago, she was warned of potential hair loss, nausea and vomiting.

The 73-year-old man, however, was not informed of the potential side effects of radiotherapy, namely acute radiodermatitis. Symptoms can range from mild to severe and include itchy skin, swelling, blisters, and open sores.

“It was painful and scary,” the Bronx, NY resident said. “I did everything I was supposed to do and ended up with really bad burns on my skin. I wish I knew if that could happen.”

Now 10 years cancer-free, Alexander regularly counsels other women on what to expect and how to manage this side effect as a friend of the Bronx Oncology Living Daily (BOLD).

Each year, 95% of people who undergo radiation therapy to treat cancer will develop acute radiation dermatitis. Until recently, this condition was poorly understood and there was little that could be done to prevent it.

All of that could change due to the results of two new studies that implicate a common bacteria as the culprit and suggest that a simple antibacterial treatment could be the answer.

“I absolutely believe these results should change practice,” said the study’s author. Dr. Beth McLellandirector of supportive oncodermatology at Montefiore Einstein Cancer Center and chief of the division of dermatology at Montefiore Health System and 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 therapy from 76 people being treated for cancer, they began to see the things differently.

Investigators took samples from the inside of the nose, skin from the irradiated area, and skin from the side of the body not treated with radiation. Prior to treatment, approximately 20% of people tested positive for Staphylococcus aureus bacteria (staphylococcus) 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 disease, according to the study.

Staph usually lives on the skin and does not cause any problems. But radiation can weaken the structure of the skin and allow bacteria to pass through the skin, the study authors explained.

Many people have tested positive for nasal staph, suggesting that nasal bacteria could infect the skin.

The second study included 77 patients undergoing radiation therapy. They were told to follow standard care (normal hygiene and moisturizing treatment like Aquaphor) or an experimental antibacterial diet.

This treatment consisted of using chlorhexidine and mupirocin, an antibacterial body wash, an antibiotic nasal ointment, daily for five days, every two weeks, throughout their radiation therapy.

More than half of people treated with the new antibacterial regimen developed mild to moderate symptoms, but no one developed severe symptoms. In contrast, 23% of people who followed the current standard of care developed severe symptoms, according to the results.

“People should know that there are options to prevent radiation dermatitis, including our antibacterial regimen, and they should ask their radiation oncologist if this is an option for them before starting treatment,” McLellan said. .

“Radiodermatitis is an expected side effect for many people undergoing radiation therapy for various cancers, an effect that can be extremely distressing, disabling, potentially interferes with treatment, and for which we have no standard of care for prevention or treatment,” said Dr. Adam Friedman. He holds the chair of dermatology at the George Washington University School of Medicine and Health Sciences, in Washington, D.C.

People who develop more severe radiation dermatitis tend to have staph in their nasal passages, said Friedman, who is unrelated to the new study.

“The use of a relatively simple decolonization regimen significantly limited the severity of radiation dermatitis in cancer patients, compared to those receiving standard care for prevention/management,” he said.

“More work is needed; however, given the simplicity of this preventative strategy, I will definitely consider it in my supportive oncodermatology clinic at George Washington University,” Friedman added.

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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