Radiation recall dermatitis L30.8 + T66

Local inflammatory reaction of the previously irradiated skin areas after the start of a mostly cytostatic systemic therapy of an underlying tumor.

The actual incidence of RRD is not known and may depend on several factors, such as: the radiotherapy dose, the type of systemic therapy, the time between the end of radiotherapy and the administration and dose of systemic therapy (Bhangoo RS et al. 2022).

Despite many case descriptions, the etiology remains unclear. Various hypotheses ranging from allergic reactions to trained immunity through activated epithelial stem cells are propagated.

The occurrence of RRD has been described in case studies following the use of chemotherapeutic agents (e.g. actinomycin D (dactinomycin), docetaxel, methotrexate, doxorubicin, gemcitabine, tamoxifen and bleomycin), but also antibiotics (e.g. Ceftriaxone: RRD 6 months after radiotherapy and a single intramuscular dose of ceftriaxone -Patel NV et al. 2020; nitrofurantoin:RDD 8 years after radiotherapy- Garrahy I et al. 2019), tyrosine kinase inhibitors or aromatase inhibitors (Sweren E et al. 2021). The disease can occur within a few days, weeks or years after radiotherapy. Intervals of a few minutes to 14 days have been described for intravenously administered drugs. Docetaxel and gemcitabine were the two drugs most frequently associated with RRD (Bhangoo RS et al. 2022).

The disease occurs exclusively in the pre-irradiated areas.

Chronic, flat, mostly itchy erythema or reddened plaques sharply limited to a radiation field. Healing with scaling and patchy hypo- or hyperpigmentation. Severe courses with the formation of ulcerations have been described.

The early phases of the inflammatory reaction are characterized by interface dermatitis and cannot be distinguished from acute radiation dermatitis.

Radiation recall morphea must be distinguished (Spalek M et al. 2015).

UV recall dermatitis: Methotrexate can trigger UV recall dermatitis in a similar way, although it is unclear how long ago the UV irradiation should have occurred.

In addition to the skin, other organs can also be affected by radiation recall reactions (e.g. heart, muscles (recall myositis), lungs(radiation recall pneumonitis).

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