radiation dermatitisradiotherapyRTOGrecallfibrosis

Radiation Dermatitis

דרמטיטיס מקרינה

📖 מבוא

Radiation dermatitis — נזק עורי מקרינה מייננת (radiotherapy). Acute (hours-weeks after RT) vs Chronic (months-years). שכיחות: 95% מחולי RT מפתחים acute changes. Chronic: dermal fibrosis, telangiectasia, SCC risk. Bologna Ch 127.

📝 אנמנזה

טיפול בקרינה — לאן, מתי, כמה fractions, total dose? שינויים עוריים — erythema, בועות, כאב? מתי הופיעו (acute vs chronic)? שימוש בתרופות radiosensitizing (doxorubicin, 5-FU, taxanes)?

🔍 בדיקה

Acute: Grade 1 — faint erythema, epilation, dry desquamation. Grade 2 — tender erythema, moist desquamation (folds). Grade 3 — confluent moist desquamation >1.5 cm. Grade 4 — ulceration, hemorrhage, necrosis. Chronic: atrophy, fibrosis/induration, telangiectasia, hypo/hyperpigmentation, ulceration. ⚠️ Radiation recall — re-activation of dermatitis triggered by drug (methotrexate, taxanes).

📋 סיכום

ממצאים מתאימים לדרמטיטיס מקרינה. טיפול תומך.

💊 המלצות

📋 מידע כללי

-DDx: Contact dermatitis (bolus materials), infection (bacterial/candidal in moist areas), tumor recurrence (in chronic field), morphea (radiation-induced — localized to field), angiosarcoma (Stewart-Treves syndrome — post-radiation/lymphedema).

🔬 בירור

-Chronic management: Fibrosis — pentoxifylline 400 מ"ג x3/d + vitamin E 1000 IU/d (PENTOCLO protocol — evidence for fibrosis regression). Telangiectasia — PDL (pulsed dye laser). Chronic ulcers — wound care, consider hyperbaric oxygen. ⚠️ SCC risk in chronic radiation dermatitis (years-decades later) — biopsy non-healing ulcers.

-Radiation recall: Drug-triggered reactivation of dermatitis in previous RT field (weeks-years after RT). Common triggers: methotrexate, doxorubicin, taxanes, gemcitabine, capecitabine, pembrolizumab. Management: discontinue trigger temporarily, TCS, usually self-limited.

💊 טיפול

-Acute management (RTOG grading): Grade 1-2 — moisturizers (aquaphor, calendula), TCS (mometasone 0.1% — evidence-based prevention), gentle cleansing, avoid friction. Moist desquamation — hydrogel/silver sulfadiazine/foam dressing. ⚠️ Do NOT apply products immediately before RT. Avoid adhesive dressings on irradiated skin.

📅 מעקב

-תיאום עם אונקולוגיית קרינה. ביקורת בעוד שבוע (acute) או חודש (chronic).

⚗ מרשם

-Topical MOMETASONE 0.1% Crm x1/d (prevention + treatment acute RT dermatitis) - 1OP

-Topical AQUAPHOR Oint as needed for skin barrier - OTC

-PO PENTOXIFYLLINE 400 mg x3/d + Vitamin E 1000 IU/d (chronic fibrosis, PENTOCLO) - 1OP