INTRODUCTION
Chronic radiation dermatitis (CRD) is a long-term complication of radiation therapy and usually presents as atrophic plaques with telangiectasias. In some cases, CRD can be associated with persistent sensory dysesthesias such as burning, stinging, and pruritus. These underrecognized and likely underreported symptoms can impair quality of life as they can cause discomfort, sleep disturbance, and emotional distress.1 In many cases, they are refractory to conventional therapies.
Pulsed dye laser (PDL) has been shown to improve telangiectasias in CRD; however, its potential to relieve CRD-associated dysesthesias has not been reported. Similar to rosacea, where neurovascular dysregulation is thought to contribute to burning and stinging sensations, CRD-related dysesthesias may also have a similar pathophysiology. In this small case series, we describe 2 breast cancer patients with treatment-resistant CRD whose sensory dysesthesias improved following a series of PDL treatments.
Pulsed dye laser (PDL) has been shown to improve telangiectasias in CRD; however, its potential to relieve CRD-associated dysesthesias has not been reported. Similar to rosacea, where neurovascular dysregulation is thought to contribute to burning and stinging sensations, CRD-related dysesthesias may also have a similar pathophysiology. In this small case series, we describe 2 breast cancer patients with treatment-resistant CRD whose sensory dysesthesias improved following a series of PDL treatments.
CASE SERIES
Case 1:
A 63-year-old woman with Fitzpatrick skin type III and stage IIB invasive ductal carcinoma of the left breast underwent modified radical mastectomy and adjuvant radiation therapy. The first course delivered 50.4 Gy in 28 fractions to the left chest wall, with adjacent supraclavicular and medial parasternal regions each receiving 45 Gy in 25 fractions. Six years later, she received a second course of 50 Gy in 20 fractions to the sternum due to recurrence. Two years after her second treatment, she developed CRD with telangiectatic plaques and recurrent skin breakdown with a persistent non-healing wound. Her associated symptoms included pruritus. A biopsy was performed given persistent ulceration to rule out malignancy, which showed epidermal ulceration with mixed inflammation and focal cytologic atypia compatible with chronic radiation changes.
Over seven years, she was evaluated at more than 50 dermatology visits and failed topical corticosteroids, calcineurin inhibitors, antifungals, doxepin, ruxolitinib, and intralesional triamcinolone.
A 63-year-old woman with Fitzpatrick skin type III and stage IIB invasive ductal carcinoma of the left breast underwent modified radical mastectomy and adjuvant radiation therapy. The first course delivered 50.4 Gy in 28 fractions to the left chest wall, with adjacent supraclavicular and medial parasternal regions each receiving 45 Gy in 25 fractions. Six years later, she received a second course of 50 Gy in 20 fractions to the sternum due to recurrence. Two years after her second treatment, she developed CRD with telangiectatic plaques and recurrent skin breakdown with a persistent non-healing wound. Her associated symptoms included pruritus. A biopsy was performed given persistent ulceration to rule out malignancy, which showed epidermal ulceration with mixed inflammation and focal cytologic atypia compatible with chronic radiation changes.
Over seven years, she was evaluated at more than 50 dermatology visits and failed topical corticosteroids, calcineurin inhibitors, antifungals, doxepin, ruxolitinib, and intralesional triamcinolone.
