Radiodermatitis is one of the most common side effects in radiation oncology. Indeed, radiotherapy is indicated in 50% of patients suffering from cancer, with nearly 90% of patients presenting erythema in post radiotherapy and over 30% presenting moist desquamation. This explains the importance of the management of radiodermatitis, cause of alteration of the quality of life. Pathophysiologically, radiodermatitis associates varying degrees of cell damage, inflammation, hypoxia and fibrosis. According to RTOG (Radiation Therapy Oncology Group) and EORTEC (European Organisation for Research and Treament of Cancer), radiodermatitis is classified into four grades:

- Grade 1: mild
- Grade 2: moderate
- Grade 3: severe
- Grade 4: grave

 

Skin	Grade 0	Grade 1	Grade 2	Grade 3	Grade 4
Acute	-	Follicular erythema, pale or light / épilation/ dry desquamation / decrease sweating	Mild or intense erythema / plaque of moist desquamation / moderate edema	confluent moist desquamation outside the folds / pitting edema	Ulceration, hemorrhage,  necrosis
Chronic	-	Mild atrophy / pigmentary disorders / moderate hair loss	Atrophy plaques / moderate telangiectasia / total hair loss	Notable atrophy / notable telangiectasis	Ulceration

Clinical features:
- Acute radiodermatitis

Clinical aspects	RT dose
Erythema	20-40 Gy
Dry desquamation	>30 Gy
Moist desquamation	>40 Gy

- Chronic radiodermatitis

Clinical aspects	RT dose
Pigmentary disorders	30-40 Gy
Altered sweat and sebaceous gland function	>40 Gy ;  >12 Gy
Hair loss	10 -20 Gy
Telangiectasia	> 45Gy
Fibrosis	>45Gy
Atrophy	>45Gy
Ulceration	>60Gy

The management of acute radiodermatitis lesions combines the application of aqueous creams, topical corticosteroids (only in grade 1 and 2), analgesics and specific dressings (grade 3 and 4). Systemic treatments have shown their usefulness in small series: amifostine, pentoxifylline, zinc supplementation. Lifestyle is important to know: daily washing of lesions with warm water avoiding perfumed soaps, washing after swimming pool, electric razor use for hair removal, avoid rubbing, friction or traumatize the lesions (dressing, massages ...), sun exposure should be avoided and good photoprotection is recommended....

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