1
|
Pazdrowski J, Gornowicz-Porowska J, Kaźmierska J, Krajka-Kuźniak V, Polanska A, Masternak M, Szewczyk M, Golusiński W, Danczak-Pazdrowska A. Radiation-induced skin injury in the head and neck region: pathogenesis, clinics, prevention, treatment considerations and proposal for management algorithm. Rep Pract Oncol Radiother 2024; 29:373-390. [PMID: 39144266 PMCID: PMC11321788 DOI: 10.5603/rpor.100775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 05/16/2024] [Indexed: 08/16/2024] Open
Abstract
Worldwide increase of head and neck cancers ranks these malignancies among top causes of cancer in human population. Radiation induced skin injury (RISI) is one of the major side effects of radiotherapy (RT). Skin of the neck is exposed to radiation due to necessity of therapeutic or prophylactic (elective) irradiation of neck lymph nodes and target organs, including the larynx and hypopharynx. The location of the neck exposes these regions of the skin to various additional exposomes such as ultraviolet radiation (UVR), pollution and cigarette smoke. There are many controversies or inconsistencies regarding RISI, from molecular aspects and therapy to terminology. There is lack of high-quality and large-sample studies in both forms of RISI: acute (aRISI) and chronic (cRISI). Finally, no gold standards in the management of aRISI and cRISI have been established yet. In this article, the authors discuss the pathogenesis, clinical picture, prevention and clinical interventions and present a proposed treatment algorithm.
Collapse
Affiliation(s)
- Jakub Pazdrowski
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
- Department of Head and Neck Surgery, Greater Poland Cancer Centre, Poznan, Poland
| | - Justyna Gornowicz-Porowska
- Department and Division of Practical Cosmetology and Skin Diseases Prophylaxis, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Kaźmierska
- Department of Radiotherapy, Poznan University of Medical Sciences, Poznan, Poland
- Radiotherapy and Oncology, Greater Poland Cancer Centre, Poznan, Poland
| | - Violetta Krajka-Kuźniak
- Department of Pharmaceutical Biochemistry, Poznan University of Medical Sciences, Poznan, Poland
| | - Adriana Polanska
- Department of Dermatology and Venereology Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Masternak
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States
| | - Mateusz Szewczyk
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
- Department of Head and Neck Surgery, Greater Poland Cancer Centre, Poznan, Poland
| | - Wojciech Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
- Department of Head and Neck Surgery, Greater Poland Cancer Centre, Poznan, Poland
| | | |
Collapse
|
2
|
Rakita U, Kaundinya T, Silverberg JI. Associations Between Shower and Moisturizing Practices with Atopic Dermatitis Severity: A Prospective Longitudinal Cohort Study. Dermatitis 2023; 34:425-431. [PMID: 36917546 DOI: 10.1089/derm.2022.29020.jis] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Evidence-based recommendations for optimal showering/bathing practices are lacking for atopic dermatitis (AD) patients. Objective: To determine longitudinal associations between showering/bathing practices and AD severity in AD patients. Methods: A prospective single-center dermatology practice-based study was performed. Shower/bath frequency and duration, and frequency of applying moisturizers after showering/bathing were evaluated. AD severity was assessed using objective component of Scoring Atopic Dermatitis (o-SCORAD), SCORAD-itch, Eczema Area and Severity Index (EASI), Patient-Oriented Eczema Measure (POEM), and Dermatology Life Quality Index (DLQI). Repeated-measures regression models examined associations of showering/bathing and moisturizing practices with change in AD severity measures over time. Results: Showering/bathing more than daily versus once daily was associated with higher SCORAD-itch, o-SCORAD, EASI, POEM, and DLQI scores; less than daily versus once daily showering/bathing was not associated with any outcomes. Consistent and even inconsistent application of moisturizer after showering/bathing was associated with lower o-SCORAD, EASI, and POEM scores. Showering/bathing duration was not associated with AD outcomes. Severe SCORAD-sleep, o-SCORAD, EASI, and POEM were associated with less adherence to all showering/bathing recommendations. Conclusion: Showering/bathing daily or less frequently and applying moisturizer postshower/bath were associated with lower AD severity; showering/bathing duration was not. Recommendations concerning shower durations may not be necessary when counseling AD patients.
Collapse
Affiliation(s)
- Uros Rakita
- From the *Department of Internal Medicine, Montgomery Campus of the University of Alabama Heersink School of Medicine, Montgomery, Alabama, USA
| | - Trisha Kaundinya
- Department of Dermatology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| |
Collapse
|
3
|
Cardona ID, Kempe EE, Lary C, Ginder JH, Jain N. Frequent Versus Infrequent Bathing in Pediatric Atopic Dermatitis: A Randomized Clinical Trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:1014-1021. [PMID: 31733336 DOI: 10.1016/j.jaip.2019.10.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 10/27/2019] [Accepted: 10/30/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Studies evaluating bathing frequency in pediatric atopic dermatitis (AD) are limited. Parents of children with AD often receive conflicting information, leading to frustration and confusion. OBJECTIVE To evaluate efficacy of twice-daily soaking baths, followed by immediate application of an occlusive moisturizer (ie, soak-and-seal [SS]), versus twice-weekly SS baths, in the acute management of pediatric AD. METHODS We conducted a randomized, single-blind, crossover-controlled trial comparing frequent versus infrequent SS baths, in children 6 months to 11 years of age with moderate-to-severe AD. Children were randomized 1:1 into 2 groups: group 1 underwent twice-weekly SS baths, for 10 minutes or less, over 2 weeks ("dry method" [DM]) followed by twice-daily SS baths, for 15 to 20 minutes, over 2 weeks ("wet method" [WM]). Group 2 did the inverse. Patients received the same moisturizer, cleanser, and low-potency topical corticosteroid (TCS). Primary outcome was AD severity evaluated using the SCORing Atopic Dermatitis (SCORAD) index. Caregiver assessment of AD severity (Atopic Dermatitis Quickscore [ADQ]), quality of life, Staphylococcal aureus colonization, skin hydration, moisturizer, and TCS usage were assessed. RESULTS Of the 63 children screened, 42 fulfilled inclusion criteria and were randomized. Forty (95%) completed the study. WM decreased SCORAD by 21.2 compared with DM (95% confidence interval [CI], 14.9-27.6; P < .0001). Secondary analysis showed a greater than 30% SCORAD improvement for WM versus DM (McNemar's χ2 = 8.83, df = 1, P = .0030). SCORAD correlated with ADQ (r = 0.66), and ADQ also showed significant improvement with WM decreasing ADQ by 5.8 (95% CI, 1.8-9.7). No other secondary endpoints showed significance. CONCLUSIONS As an acute treatment intervention, WM is superior to DM at improving disease severity in moderate-to-severe pediatric AD.
Collapse
Affiliation(s)
- Ivan D Cardona
- Department of Pediatrics, Maine Medical Center Research Institute, Portland, Maine.
| | - Erin E Kempe
- Colorado Allergy and Asthma Centers, Fort Collins, Colo
| | - Christine Lary
- Department of Pediatrics, Maine Medical Center Research Institute, Portland, Maine
| | | | | |
Collapse
|
4
|
Lansang P, Lam JM, Marcoux D, Prajapati VH, Spring S, Lara-Corrales I. Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section III: Treatment Options for Pediatric Atopic Dermatitis. J Cutan Med Surg 2019; 23:19S-31S. [PMID: 31692376 DOI: 10.1177/1203475419882647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Because atopic dermatitis (AD) is a chronic, relapsing disease, treatment requires the use of both active therapy to control flares and preventative maintenance therapy to promote integrity of the skin barrier. In this third of four sections, important clinical considerations for the treatment of pediatric AD are reviewed. Emerging therapies in development for pediatric AD are introduced.
Collapse
Affiliation(s)
- Perla Lansang
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada.,Division of Paediatric Medicine, Section of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joseph M Lam
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Danielle Marcoux
- Division of Dermatology, Department of Paediatrics, Sainte-Justine University Hospital Center, University of Montreal, QC, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, AB, Canada.,Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, AB, Canada.,Dermatology Research Institute, Calgary, AB, Canada
| | - Shanna Spring
- Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, ON, Canada.,Division of Dermatology, Department of Medicine, University of Ottawa, ON, Canada
| | - Irene Lara-Corrales
- Division of Paediatric Medicine, Section of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada
| |
Collapse
|
5
|
Klinnert MD, Booster G, Copeland M, Darr JM, Meltzer LJ, Miller M, Oland A, Perry S, Wise BK, Bender BG. Role of behavioral health in management of pediatric atopic dermatitis. Ann Allergy Asthma Immunol 2019; 120:42-48.e8. [PMID: 29273127 DOI: 10.1016/j.anai.2017.10.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/04/2017] [Accepted: 10/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe the behavioral components and complications in treating pediatric patients with atopic dermatitis (AD) and the critical role of behavioral health professionals in addressing disease impact and behavioral aspects of disease management for these patients and families. DATA SOURCES Studies and review articles were selected from medical and psychology databases for relevance to pertinent topics. RESULTS AD has significant negative effects in affected individuals and their families on quality of life, behavioral, emotional, and sleep disturbances, and family functioning. Effective treatment strategies for AD are available, but the challenges for children and parents in coping with disease-related concerns and in following through with the multiple aspects of treatment are considerable. A biopsychosocial model, which incorporates the interplay among biological, psychological, and social dimensions of medical care, can be implemented in various treatment settings to achieve an integrated medical and behavioral health care approach. By sharing a family orientation, using a stress and coping model, and taking into account children's developmental capabilities and concerns, medical and behavioral health care providers are equipped to bring an in-depth understanding and different evidence-based therapeutic tools to address emotional, behavioral, and interpersonal challenges imposed by moderate to severe AD in children and families. CONCLUSION Behavioral health and medical providers working together to provide integrated care play a critical role in helping children and families cope with the burdens imposed by AD, successfully manage the disease, and achieve optimal quality of life for affected children and their families.
Collapse
Affiliation(s)
- Mary D Klinnert
- National Jewish Health, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
| | | | | | | | - Lisa J Meltzer
- National Jewish Health, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | | | - Alyssa Oland
- National Jewish Health, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Bruce G Bender
- National Jewish Health, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| |
Collapse
|
6
|
Izadi N, Leung DYM. Clinical approach to the patient with refractory atopic dermatitis. Ann Allergy Asthma Immunol 2019; 120:23-33.e1. [PMID: 29273125 DOI: 10.1016/j.anai.2017.09.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/15/2017] [Accepted: 09/17/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Neema Izadi
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado; Department of Pediatrics, University of Colorado at Denver Health Sciences Center, Aurora, Colorado.
| |
Collapse
|
7
|
Tsakok T, Woolf R, Smith CH, Weidinger S, Flohr C. Atopic dermatitis: the skin barrier and beyond. Br J Dermatol 2018; 180:464-474. [PMID: 29969827 DOI: 10.1111/bjd.16934] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Atopic dermatitis is the most common chronic inflammatory skin disorder, affecting up to 20% of children and 10% of adults in industrialized countries. This highly debilitating condition poses a considerable burden to both the individual and society at large. The pathophysiology of atopic dermatitis is complex, encompassing both genetic and environmental risk factors. METHODS This is a narrative review based on a systematic literature search. CONCLUSIONS Dysregulation of innate and adaptive immunity plays a key role; however, recent epidemiological, genetic and molecular research has focused interest on skin barrier dysfunction as a common precursor and pathological feature. Current understanding of the aetiology of atopic dermatitis highlights disruption of the epidermal barrier leading to increased permeability of the epidermis, pathological inflammation in the skin, and percutaneous sensitization to allergens. Thus, most novel treatment strategies seek to target specific aspects of the skin barrier or cutaneous inflammation. Several studies have also shown promise in preventing atopic dermatitis, such as the early use of emollients in high-risk infants. This may have broader implications in terms of halting the progression to atopic comorbidities including food allergy, hay fever and asthma.
Collapse
Affiliation(s)
- T Tsakok
- St John's Institute of Dermatology, King's College London, London, U.K
| | - R Woolf
- St John's Institute of Dermatology, King's College London, London, U.K
| | - C H Smith
- St John's Institute of Dermatology, King's College London, London, U.K
| | - S Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - C Flohr
- St John's Institute of Dermatology, King's College London, London, U.K
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW The skin barrier is a dynamic innate immune organ. This review summarizes the current understanding of how deficiencies associated with atopic dermatitis invite other atopic disorders of the allergic march. RECENT FINDINGS Atopic dermatitis is characterized by skin barrier defects (such as mutations in filaggrin), intrinsic proallergic T-helper cell 2 immune dysregulation, and skin microbiome alterations. These factors promote the development of food allergy and asthma. Prevention of atopic dermatitis may involve topical emollients and oral probiotic supplementation, while some food allergies can be prevented by early introduction of potential food allergens to at-risk infants. Traditional therapies for atopic dermatitis involve skin hydration, emollients, and anti-inflammatory topical therapies including topical corticosteroids and calcineurin inhibitors. Dupilumab is a new and promising targeted biologic medication approved for use in adults with more severe atopic dermatitis; however, additional research is needed to determine whether this medication should be incorporated more broadly into management of severe childhood atopic dermatitis. SUMMARY Atopic dermatitis management involves early diagnosis, skin barrier function support, mitigation of cutaneous inflammation, and concomitant risk stratification for the development of food allergy, asthma, allergic rhinitis, and environmental allergies.
Collapse
|
9
|
Kim BE, Leung DYM. Significance of Skin Barrier Dysfunction in Atopic Dermatitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:207-215. [PMID: 29676067 PMCID: PMC5911439 DOI: 10.4168/aair.2018.10.3.207] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/31/2017] [Accepted: 11/08/2017] [Indexed: 12/13/2022]
Abstract
The epidermis contains epithelial cells, immune cells, and microbes which provides a physical and functional barrier to the protection of human skin. It plays critical roles in preventing environmental allergen penetration into the human body and responsing to microbial pathogens. Atopic dermatitis (AD) is the most common, complex chronic inflammatory skin disease. Skin barrier dysfunction is the initial step in the development of AD. Multiple factors, including immune dysregulation, filaggrin mutations, deficiency of antimicrobial peptides, and skin dysbiosis contribute to skin barrier defects. In the initial phase of AD, treatment with moisturizers improves skin barrier function and prevents the development of AD. With the progression of AD, effective topical and systemic therapies are needed to reduce immune pathway activation and general inflammation. Targeted microbiome therapy is also being developed to correct skin dysbiosis associated with AD. Improved identification and characterization of AD phenotypes and endotypes are required to optimize the precision medicine approach to AD.
Collapse
Affiliation(s)
- Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, CO, USA.
| |
Collapse
|
10
|
Patients with atopic dermatitis who wish to bathe may generally do so, but there is a lack of consensus regarding the optimal bathing regimen. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0414-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Abstract
Atopic dermatitis is one of the most common complaints presenting to dermatologists, and patients typically inquire as to appropriate bathing recommendations. Although many dermatologists, allergists, and primary-care practitioners provide explicit bathing instructions, recommendations regarding frequency of bathing, duration of bathing, and timing related to emollient and medication application relative to bathing vary widely. Conflicting and vague guidelines stem from knowledge related to the disparate effects of water on skin, as well as a dearth of studies, especially randomized controlled trials, evaluating the effects of water and bathing on the skin of patients with atopic dermatitis. We critically review the literature related to bathing and associated atopic dermatitis treatments, such as wet wraps, bleach baths, bath additives, and balneotherapy. We aim to provide readers with a comprehensive understanding of the impact of water and related therapies on atopic dermatitis as well as recommendations based upon the published data.
Collapse
Affiliation(s)
- Julia K Gittler
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA
| | - Jason F Wang
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA.
| |
Collapse
|