Radiation recall dermatitis L30.8 + T66

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

radatio-recall dermatitis; Radiation Recall Dermatitis; Radiatio Recall Dermatitis; Radio Recall; RRD

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

Etiopathogenesis
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Despite many case descriptions, the etiology remains unclear. Diverse hypotheses ranging from allergic reactions to degraded epithelial stem cells are propagated.

Manifestation
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The occurrence of RRD has been described in case studies following the use of chemotherapeutic agents (e.g. methotrexate, doxorubicin, gemcitabine, tamoxifen and bleomycin). The disease can occur within a few days to years after the end of radiotherapy. Intervals of a few minutes to 14 days have been described for intravenously administered drugs.

Localization
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The disease occurs exclusively in the irradiated areas.

Clinical features
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Chronic, flat, mostly itchy erythema or reddened plaques located on a radiation field. Healing with scaling and spotty hypo- or hyperpigmentation. Severe progression of ulceration has been described.

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

Therapy
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Omission of the causally accused drug is recommended. A treatment with steroids and/or antihistamines is controversially discussed in the literature.

Note(s)
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Remarkable is the occurrence of a radio recall morphea (Spalek M et al. 2015).

Methotrexate can trigger a UV recall in a similar way, but UV irradiation should not be more than 5 days ago

Apart from the skin, other organs can also be affected by radio recall reactions (e.g. heart organ).

Literature
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  1. Clark E et al (2015) Chlorambucil-Induced Radiation Recall Dermatitis. Skinmed 13:317-319
  2. Delavan JA et al (2015) Gemcitabine-induced radiation recall myositis. Skeletal radiol 44:451-455.
  3. Haraldsdottir S et al. (2016) Radiation Recall Dermatitis With Concomitant Dabrafenib and Pazopanib Therapy. JAMA Dermatol doi: 10.1001/jamadermatol.2015.5366
  4. Kandemir EG et al (2005) Docetaxel-induced radiation recall dermatitis. Swiss med Wkly 135: 35-35
  5. Prindaville B et al (2016) Radiation Recall Dermatitis Secondary to Dactinomycin. Pediatric Dermatol 33:e278-279.
  6. Putnik K et al (2006) Enhanced radiation sensitivity and radiation recall dermatitis (RRD) after hypericin therapy - case report and review of literature. Radiat Oncol 1: 32-37
  7. Spalek M et al (2015) Radiation-induced morphea - a literature review. J Eur Acad Dermatol Venereol 29:197-202.

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Last updated on: 29.10.2020