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Evolution of radiation-induced dermatitis treatment

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Abstract

Radiation-induced skin damage (RID) is the most prevalent, significant side effect of radiotherapy (RT). Nearly 95% of patients experience moderate to severe skin reactions after receiving radiation therapy. However, criteria for acute radiation dermatitis (ARD) treatment remain unavailable. Topical agents with anti-inflammatory properties may protect the skin and facilitate tissue regeneration in patients with RID. Many of these topical agents function through nuclear factor kappa B pathway regulation. They either reduce the levels of inflammatory factors or elicit anti-inflammatory properties of their own, thus preventing oxidative stress and inflammatory responses and thus enabling RID prevention and management. Herein, we explore the 25 topical agents investigated for RID prevention and management thus far and evaluate their mechanisms of action. These agents include 11 natural agents, 3 miscellaneous agents, 9 topical nonsteroidal agents, and 2 topical corticosteroids.

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References

  1. Fuzissaki MA, Paiva CE, Oliveira MA, Lajolo Canto PP, Paiva Maia YC. The impact of radiodermatitis on breast cancer patients’ quality of life during radiotherapy: a prospective cohort study. J Pain Symptom Manage. 2019. https://doi.org/10.1016/j.jpainsymman.2019.03.017.

    Article  PubMed  Google Scholar 

  2. Yokota T, Zenda S, Ota I, Yamazaki T, Yamaguchi T, Ogawa T, et al. Phase 3 randomized trial of topical steroid versus placebo for prevention of radiation dermatitis in patients with head and neck cancer receiving chemoradiation. Int J Radiat Oncol Biol Phys. 2021;111(3):794–803. https://doi.org/10.1016/j.ijrobp.2021.05.133.

    Article  PubMed  Google Scholar 

  3. Yang X, Ren H, Guo X, Hu C, Fu J. Radiation-induced skin injury: pathogenesis, treatment, and management. Aging (Albany NY). 2020. https://doi.org/10.18632/aging.103932.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Najafi M, Motevaseli E, Shirazi A, Geraily G, Rezaeyan A, Norouzi F, et al. Mechanisms of inflammatory responses to radiation and normal tissues toxicity: clinical implications. Int J Radiat Biol. 2018;94(4):335–56. https://doi.org/10.1080/09553002.2018.1440092.

    Article  CAS  PubMed  Google Scholar 

  5. Wei J, Meng L, Hou X, Qu C, Wang B, Xin Y, et al. Radiation-induced skin reactions: mechanism and treatment. Cancer Manag Res. 2019. https://doi.org/10.2147/CMAR.S188655.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Behroozian T, Bonomo P, Patel P, Kanee L, Finkelstein S, van den Hurk C, et al. Multinational association of supportive care in cancer (MASCC) clinical practice guidelines for the prevention and management of acute radiation dermatitis: international delphi consensus-based recommendations. Lancet Oncol. 2023;24(4):e172–85. https://doi.org/10.1016/S1470-2045(23)00067-0.

    Article  PubMed  Google Scholar 

  7. Baharara H, Rahsepar S, Emami SA, Elyasi S, Mohammadpour AH, Ghavami V, et al. The efficacy of medicinal plant preparations in the alleviation of radiodermatitis in patients with breast cancer: a systematic review of clinical trials. Phytother Res. 2023. https://doi.org/10.1002/ptr.7894.

    Article  PubMed  Google Scholar 

  8. Karbasforooshan H, Hosseini S, Elyasi S, Fani Pakdel A, Karimi G. Topical silymarin administration for prevention of acute radiodermatitis in breast cancer patients: a randomized, double-blind, placebo-controlled clinical trial. Phytother Res. 2019;33(2):379–86. https://doi.org/10.1002/ptr.6231.

    Article  CAS  PubMed  Google Scholar 

  9. Gillessen A, Schmidt HH. Silymarin as supportive treatment in liver diseases: a narrative review. Adv Ther. 2020;37(4):1279–301. https://doi.org/10.1007/s12325-020-01251-y.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cruceriu D, Balacescu O, Rakosy E. Calendula officinalis: potential roles in cancer treatment and palliative care. Integr Cancer Ther. 2018;17(4):1068–78. https://doi.org/10.1177/1534735418803766.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Koukourakis G, Pissakas G, Ganos CG, Sivolapenko G, Kardamakis D. Effectiveness and tolerability of natural herbal formulations in the prevention of radiation-Induced skin toxicity in patients undergoing radiotherapy. Int J Low Extrem Wounds. 2022;21(1):75–86. https://doi.org/10.1177/1534734620923912.

    Article  CAS  PubMed  Google Scholar 

  12. Kole AJ, Kole L, Moran MS. Acute radiation dermatitis in breast cancer patients: challenges and solutions. Breast Cancer (Dove Med Press). 2017. https://doi.org/10.2147/BCTT.S109763.

    Article  PubMed  Google Scholar 

  13. Rosenthal A, Israilevich R, Moy R. Management of acute radiation dermatitis: A review of the literature and proposal for treatment algorithm. J Am Acad Dermatol. 2019;81(2):558–67. https://doi.org/10.1016/j.jaad.2019.02.047.

    Article  PubMed  Google Scholar 

  14. Shahane K, Kshirsagar M, Tambe S, Jain D, Rout S, Ferreira MKM, et al. An updated review on the multifaceted therapeutic potential ofcalendula officinalis L. Pharmaceuticals (Basel). 2023;16(4):611. https://doi.org/10.3390/ph16040611.

    Article  CAS  PubMed  Google Scholar 

  15. Givol O, Kornhaber R, Visentin D, Cleary M, Haik J, Harats M. A systematic review of calendula officinalis extract for wound healing. Wound Repair Regen. 2019;27(5):548–61. https://doi.org/10.1111/wrr.12737.

    Article  PubMed  Google Scholar 

  16. Ferreira AS, Macedo C, Silva AM, Delerue-Matos C, Costa P, Rodrigues F. Natural products for the prevention and treatment of oral mucositis-a review. Int J Mol Sci. 2022;23(8):4385. https://doi.org/10.3390/ijms23084385.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Yang K, Kim SY, Park JH, Ahn WG, Jung SH, Oh D, et al. Topical application of phlorotannins from brown seaweed mitigates radiation dermatitis in a mouse model. Mar Drugs. 2020;18(8):377. https://doi.org/10.3390/md18080377.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Besednova NN, Andryukov BG, Zaporozhets TS, Kuznetsova TA, Kryzhanovsky SP, Ermakova SP, et al. Molecular targets of brown algae phlorotannins for the therapy of inflammatory processes of various origins. Mar Drugs. 2022;20(4):243. https://doi.org/10.3390/md20040243.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Maleki M, Mardani A, Manouchehri M, Ashghali Farahani M, Vaismoradi M, Glarcher M. Effect of chamomile on the complications of cancer: a systematic review. Integr Cancer Ther. 2023. https://doi.org/10.1177/15347354231164600.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bhaskaran N, Shukla S, Srivastava JK, Gupta S. Chamomile: an anti-inflammatory agent inhibits inducible nitric oxide synthase expression by blocking RelA/p65 activity. Int J Mol Med. 2010;26(6):935–40. https://doi.org/10.3892/ijmm_00000545.

    Article  CAS  PubMed  Google Scholar 

  21. Sah A, Naseef PP, Kuruniyan MS, Jain GK, Zakir F, Aggarwal G. A comprehensive study of therapeutic applications of chamomile. Pharmaceuticals (Basel). 2022;15(10):1284. https://doi.org/10.3390/ph15101284.

    Article  CAS  PubMed  Google Scholar 

  22. Rafati M, Ghasemi A, Saeedi M, Habibi E, Salehifar E, Mosazadeh M, et al. Nigella sativa L. for prevention of acute radiation dermatitis in breast cancer: a randomized, double-blind, placebo-controlled, clinical trial. Complement Ther Med. 2019. https://doi.org/10.1016/j.ctim.2019.102205.

    Article  PubMed  Google Scholar 

  23. Nasiri N, Ilaghi Nezhad M, Sharififar F, Khazaneha M, Najafzadeh MJ, Mohamadi N. The therapeutic effects of nigella sativa on skin disease: A systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2022. https://doi.org/10.1155/2022/7993579.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Majdalawieh AF, Fayyad MW, Nasrallah GK. Anti-cancer properties and mechanisms of action of thymoquinone, the major active ingredient of Nigella sativa. Crit Rev Food Sci Nutr. 2017;57(18):3911–28. https://doi.org/10.1080/10408398.2016.1277971.

    Article  CAS  PubMed  Google Scholar 

  25. Hossen MJ, Yang WS, Kim D, Aravinthan A, Kim JH, Cho JY. Thymoquinone: An IRAK1 inhibitor with in vivo and in vitro anti-inflammatory activities. Sci Rep. 2017. https://doi.org/10.1038/srep42995.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Talebi M, Farkhondeh T, Samarghandian S. Biological and therapeutic activities of thymoquinone: Focus on the Nrf2 signaling pathway. Phytother Res. 2021;35(4):1739–53. https://doi.org/10.1002/ptr.6905.

    Article  CAS  PubMed  Google Scholar 

  27. Memarzia A, Khazdair MR, Behrouz S, Gholamnezhad Z, Jafarnezhad M, Saadat S, et al. Experimental and clinical reports on anti-inflammatory, antioxidant, and immunomodulatory effects of Curcuma longa and curcumin, an updated and comprehensive review. BioFactors. 2021;47(3):311–50. https://doi.org/10.1002/biof.1716.

    Article  CAS  PubMed  Google Scholar 

  28. Palatty PL, Azmidah A, Rao S, Jayachander D, Thilakchand KR, Rai MP, et al. Topical application of a sandal wood oil and turmeric based cream prevents radiodermatitis in head and neck cancer patients undergoing external beam radiotherapy: a pilot study. Br J Radiol. 2014;87(1038):20130490. https://doi.org/10.1259/bjr.20130490.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Ryan JL, Heckler CE, Ling M, Katz A, Williams JP, Pentland AP, et al. Curcumin for radiation dermatitis: a randomized, double-blind, placebo-controlled clinical trial of thirty breast cancer patients. Radiat Res. 2013;180(1):34–43. https://doi.org/10.1667/RR3255.1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Ryan Wolf J, Gewandter JS, Bautista J, Heckler CE, Strasser J, Dyk P, et al. Utility of topical agents for radiation dermatitis and pain: a randomized clinical trial. Support Care Cancer. 2020;28(7):3303–11. https://doi.org/10.1007/s00520-019-05166-5.

    Article  PubMed  Google Scholar 

  31. Akbari S, Kariznavi E, Jannati M, Elyasi S, Tayarani-Najaran Z. Curcumin as a preventive or therapeutic measure for chemotherapy and radiotherapy induced adverse reaction: a comprehensive review. Food Chem Toxicol. 2020. https://doi.org/10.1016/j.fct.2020.111699.

    Article  PubMed  Google Scholar 

  32. Derosa G, Maffioli P, Simental-Mendia LE, Bo S, Sahebkar A. Effect of curcumin on circulating interleukin-6 concentrations: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2016. https://doi.org/10.1016/j.phrs.2016.07.004.

    Article  PubMed  Google Scholar 

  33. Han S, Xu J, Guo X, Huang M. Curcumin ameliorates severe influenza pneumonia via attenuating lung injury and regulating macrophage cytokines production. Clin Exp Pharmacol Physiol. 2018;45(1):84–93. https://doi.org/10.1111/1440-1681.12848.

    Article  CAS  PubMed  Google Scholar 

  34. Kao YS, Ma KS, Wu MY, Wu YC, Tu YK, Hung CH. Topical prevention of radiation dermatitis in head and neck cancer patients: a network meta-analysis. In Vivo. 2022. https://doi.org/10.21873/invivo.12851.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Cui Z, Xin M, Yin H, Zhang J, Han F. Topical use of olive oil preparation to prevent radiodermatitis: results of a prospective study in nasopharyngeal carcinoma patients. Int J Clin Exp Med. 2015;8(7):11000–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Chitapanarux I, Tovanabutra N, Chiewchanvit S, Sripan P, Chumachote A, Nobnop W, et al. Emulsion of olive oil and calcium hydroxide for the prevention of radiation dermatitis in hypofractionation post-mastectomy padiotherapy: a randomized controlled trial. Breast Care (Basel). 2019;14(6):394–400. https://doi.org/10.1159/000496062.

    Article  PubMed  Google Scholar 

  37. Robijns J, Becherini C, Caini S, Wolf JR, van den Hurk C, Beveridge M, et al. Natural and miscellaneous agents for the prevention of acute radiation dermatitis: a systematic review and meta-analysis. Support Care Cancer. 2023;31(3):195. https://doi.org/10.1007/s00520-023-07656-z.

    Article  PubMed  Google Scholar 

  38. Hendawy OM, Al-Sanea MM, Elbargisy RM, Rahman HU, Mohamed AAB, Kamal I, et al. Phenylboronic acid-grafted chitosan nanocapsules for effective delivery and controllable release of natural antioxidants: Olive oil and hydroxytyrosol. Pharmaceutics. 2022. https://doi.org/10.3390/pharmaceutics15010081.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Thanthong S, Nanthong R, Kongwattanakul S, Laebua K, Trirussapanich P, Pitiporn S, et al. Prophylaxis of radiation-induced dermatitis in patients with breast cancer using herbal creams: a prospective randomized controlled trial. Integr Cancer Ther. 2020. https://doi.org/10.1177/1534735420920714.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Mukherjee PK, Nema NK, Maity N, Sarkar BK. Phytochemical and therapeutic potential of cucumber. Fitoterapia. 2013. https://doi.org/10.1016/j.fitote.2012.10.003.

    Article  PubMed  Google Scholar 

  41. Vats M, Bhardwaj S, Chhabra A. Green synthesis of copper oxide nanoparticles using Cucumis sativus (cucumber) extracts and their bio-physical and biochemical characterization for cosmetic and dermatologic applications. Endocr Metab Immune Disord Drug Targets. 2021;21(4):726–33. https://doi.org/10.2174/1871530320666200705212107.

    Article  CAS  PubMed  Google Scholar 

  42. Charalambous M, Raftopoulos V, Paikousis L, Katodritis N, Lambrinou E, Vomvas D, et al. The effect of the use of thyme honey in minimizing radiation - induced oral mucositis in head and neck cancer patients: A randomized controlled trial. Eur J Oncol Nurs. 2018. https://doi.org/10.1016/j.ejon.2018.04.003.

    Article  PubMed  Google Scholar 

  43. Yang C, Gong G, Jin E, Han X, Zhuo Y, Yang S, et al. Topical application of honey in the management of chemo/radiotherapy-induced oral mucositis: A systematic review and network meta-analysis. Int J Nurs Stud. 2019. https://doi.org/10.1016/j.ijnurstu.2018.08.007.

    Article  PubMed  Google Scholar 

  44. Rao S, Hegde SK, Rao P, Dinkar C, Thilakchand KR, George T, et al. Honey mitigates radiation-induced oral mucositis in head and neck cancer patients without affecting the tumor response. Foods. 2017;6(9):77. https://doi.org/10.3390/foods6090077.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Hawley P, Hovan A, McGahan CE, Saunders D. A randomized placebo-controlled trial of manuka honey for radiation-induced oral mucositis. Support Care Cancer. 2014;22(3):751–61. https://doi.org/10.1007/s00520-013-2031-0.

    Article  PubMed  Google Scholar 

  46. Samarghandian S, Farkhondeh T, Samini F. Honey and health: a review of recent clinical research. Pharmacognosy Res. 2017;9(2):121–7. https://doi.org/10.4103/0974-8490.204647.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Ahmed S, Sulaiman SA, Baig AA, Ibrahim M, Liaqat S, Fatima S, et al. Honey as a potential natural antioxidant medicine: An insight into its molecular mechanisms of action. Oxid Med Cell Longev. 2018. https://doi.org/10.1155/2018/8367846.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Rekik DM, Ben Khedir S, Daoud A, Ksouda Moalla K, Rebai T, Sahnoun Z. Wound healing effect of lawsonia inermis. Skin Pharmacol Physiol. 2019;32(6):295–306. https://doi.org/10.1159/000501730.

    Article  CAS  PubMed  Google Scholar 

  49. Tungkasamit T, Chakrabandhu S, Samakgarn V, Kunawongkrit N, Jirawatwarakul N, Chumachote A, et al. Reduction in severity of radiation-induced dermatitis in head and neck cancer patients treated with topical aloe vera gel: a randomized multicenter double-blind placebo-controlled trial. Eur J Oncol Nurs. 2022. https://doi.org/10.1016/j.ejon.2022.102164.

    Article  PubMed  Google Scholar 

  50. Karbasizade S, Ghorbani F, Ghasemi Darestani N, Mansouri-Tehrani MM, Kazemi AH. Comparison of therapeutic effects of statins and aloe vera mouthwash on chemotherapy induced oral mucositis. Int J Physiol Pathophysiol Pharmacol. 2021;13(4):110–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Sahebjamee M, Mansourian A, Hajimirzamohammad M, Zadeh MT, Bekhradi R, Kazemian A, et al. Comparative efficacy of Aloe vera and benzydamine mouthwashes on radiation-induced oral mucositis: a triple-blind, randomised, controlled clinical trial. Oral Health Prev Dent. 2015;13(4):309–15. https://doi.org/10.3290/j.ohpd.a33091.

    Article  PubMed  Google Scholar 

  52. Wang T, Liao J, Zheng L, Zhou Y, Jin Q, Wu Y. Aloe vera for prevention of radiation-induced dermatitis: A systematic review and cumulative analysis of randomized controlled trials. Front Pharmacol. 2022. https://doi.org/10.3389/fphar.2022.976698.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Sanchez M, Gonzalez-Burgos E, Iglesias I, Gomez-Serranillos MP. Pharmacological update properties of aloe vera and its major active constituents. Molecules. 2020. https://doi.org/10.3390/molecules25061324.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Liu FW, Liu FC, Wang YR, Tsai HI, Yu HP. Aloin protects skin fibroblasts from heat stress-induced oxidative stress damage by regulating the oxidative defense system. PLoS ONE. 2015;10(12): e0143528. https://doi.org/10.1371/journal.pone.0143528.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Bala S, Chugh NA, Bansal SC, Garg ML, Koul A. Radiomodulatory effects of Aloe vera on hepatic and renal tissues of X-ray irradiated mice. Mutat Res. 2018. https://doi.org/10.1016/j.mrfmmm.2018.07.001.

    Article  PubMed  Google Scholar 

  56. Wahedi HM, Jeong M, Chae JK, Do SG, Yoon H, Kim SY. Aloesin from Aloe vera accelerates skin wound healing by modulating MAPK/Rho and Smad signaling pathways in vitro and in vivo. Phytomedicine. 2017. https://doi.org/10.1016/j.phymed.2017.02.005.

    Article  PubMed  Google Scholar 

  57. Kong M, Hwang DS, Lee JY, Yoon SW. The efficacy and safety of Jaungo, a traditional medicinal ointment, in preventing radiation dermatitis in patients with breast cancer: a prospective, single-Blinded, randomized pilot study. Evid Based Complement Alternat Med. 2016. https://doi.org/10.1155/2016/9481413.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Park JY, Kwak JH, Kang KS, Jung EB, Lee DS, Lee S, et al. Wound healing effects of deoxyshikonin isolated from Jawoongo: In vitro and in vivo studies. J Ethnopharmacol. 2017. https://doi.org/10.1016/j.jep.2016.10.031.

    Article  PubMed  Google Scholar 

  59. Kim EH, Kim W. Post treatment application of Jaungo after a combined therapy of carbon dioxide laser and trichloroacetic acid in a case of vulvar syringoma. J Pharmacopuncture. 2019;22(3):200–3. https://doi.org/10.3831/KPI.2019.22.027.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Franco P, Rampino M, Ostellino O, Schena M, Pecorari G, Garzino Demo P, et al. Management of acute skin toxicity with Hypericum perforatum and neem oil during platinum-based concurrent chemo-radiation in head and neck cancer patients. Med Oncol. 2017;34(2):30. https://doi.org/10.1007/s12032-017-0886-5.

    Article  CAS  PubMed  Google Scholar 

  61. Franco P, Potenza I, Moretto F, Segantin M, Grosso M, Lombardo A, et al. Hypericum perforatum and neem oil for the management of acute skin toxicity in head and neck cancer patients undergoing radiation or chemo-radiation: a single-arm prospective observational study. Radiat Oncol. 2014. https://doi.org/10.1186/s13014-014-0297-0.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Anderson PM, Lalla RV. Glutamine for amelioration of radiation and chemotherapy associated mucositis during cancer therapy. Nutrients. 2020. https://doi.org/10.3390/nu12061675.

    Article  PubMed  PubMed Central  Google Scholar 

  63. de Sousa MA, de Lima Dantas JB, Medrado A, Lima HR, Martins GB, Carrera M. Nutritional supplements in the management of oral mucositis in patients with head and neck cancer: narrative literary review. Clin Nutr ESPEN. 2021. https://doi.org/10.1016/j.clnesp.2021.03.030.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Yarom N, Hovan A, Bossi P, Ariyawardana A, Jensen SB, Gobbo M, et al. Correction to: Systematic review of natural and miscellaneous agents, for the management of oral mucositis in cancer patients and clinical practice guidelines–part 1: vitamins, minerals and nutritional supplements. Support Care Cancer. 2021;29(7):4175–6. https://doi.org/10.1007/s00520-021-06141-9.

    Article  PubMed  Google Scholar 

  65. Konuk Sener D, Aydin M, Cangur S, Guven E. The effect of oral care with chlorhexidine, vitamin E and honey on mucositis in pediatric intensive care patients: A randomized controlled trial. J Pediatr Nurs. 2019. https://doi.org/10.1016/j.pedn.2019.02.001.

    Article  PubMed  Google Scholar 

  66. Pessoa AF, Florim JC, Rodrigues HG, Andrade-Oliveira V, Teixeira SA, Vitzel KF, et al. Oral administration of antioxidants improves skin wound healing in diabetic mice. Wound Repair Regen. 2016;24(6):981–93. https://doi.org/10.1111/wrr.12486.

    Article  PubMed  Google Scholar 

  67. Cinausero M, Aprile G, Ermacora P, Basile D, Vitale MG, Fanotto V, et al. New frontiers in the pathobiology and treatment of cancer regimen-related mucosal injury. Front Pharmacol. 2017. https://doi.org/10.3389/fphar.2017.00354.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Higgins MR, Izadi A, Kaviani M. Antioxidants and exercise performance: With a focus on vitamin E and C supplementation. Int J Environ Res Public Health. 2020;17(22):8452. https://doi.org/10.3390/ijerph17228452.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Jacobs C, Hutton B, Ng T, Shorr R, Clemons M. Is there a role for oral or intravenous ascorbate (vitamin C) in treating patients with cancer? A systematic review. Oncologist. 2015;20(2):210–23. https://doi.org/10.1634/theoncologist.2014-0381.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Sio TT, Le-Rademacher JG, Leenstra JL, Loprinzi CL, Rine G, Curtis A, et al. Effect of doxepin mouthwash or diphenhydramine-lidocaine-antacid mouthwash vs placebo on radiotherapy-related oral mucositis pain: The alliance a221304 randomized clinical trial. JAMA. 2019;321(15):1481–90. https://doi.org/10.1001/jama.2019.3504.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Shariati L, Amouheidari A, Naji Esfahani H, Abed A, Haghjooy Javanmard S, Laher I, et al. Protective effects of doxepin cream on radiation dermatitis in breast cancer: A single arm double-blind randomized clinical trial. Br J Clin Pharmacol. 2020;86(9):1875–81. https://doi.org/10.1111/bcp.14238.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Tao F, Zhu J, Duan L, Wu J, Zhang J, Yao K, et al. Anti-inflammatory effects of doxepin hydrochloride against LPS-induced C6-glioma cell inflammatory reaction by PI3K-mediated Akt signaling. J Biochem Mol Toxicol. 2020;34(2): e22424. https://doi.org/10.1002/jbt.22424.

    Article  CAS  PubMed  Google Scholar 

  73. Zabihi M, Hajhashemi V, Minaiyan M, Talebi A. Evaluation of the central and peripheral effects of doxepin on carrageenan-induced inflammatory paw edema in rat. Res Pharm Sci. 2017;12(4):337–45. https://doi.org/10.4103/1735-5362.212052.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Kondziołka J, Wilczyński S. Overview of the activei ingredients in cosmetic products for the care of skin that has been exposed to ionizing radiation - Analysis of their effectiveness in breast cancer radiotherapy. Clin Cosmet Investig Dermatol. 2021. https://doi.org/10.2147/ccid.s322228.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Pinnix C, Perkins GH, Strom EA, Tereffe W, Woodward W, Oh JL, et al. Topical hyaluronic acid vs. standard of care for the prevention of radiation dermatitis after adjuvant radiotherapy for breast cancer: single-blind randomized phase III clinical trial. Int J Radiat Oncol Biol Phys. 2012. https://doi.org/10.1016/j.ijrobp.2011.09.021.

    Article  PubMed  Google Scholar 

  76. Rahimi A, Mohamad O, Albuquerque K, Kim DWN, Chen D, Thomas K, et al. Novel hyaluronan formulation for preventing acute skin reactions in breast during radiotherapy: a randomized clinical trial. Support Care Cancer. 2020;28(3):1481–9. https://doi.org/10.1007/s00520-019-04957-0.

    Article  PubMed  Google Scholar 

  77. Fatima S, Hirakawa S, Marta GN, Caini S, Beveridge M, Bonomo P, et al. Topical non-steroidal agents for the prevention of radiation dermatitis: a systematic review and meta-analysis. Support Care Cancer. 2023;31(4):217. https://doi.org/10.1007/s00520-023-07677-8.

    Article  PubMed  Google Scholar 

  78. Presta G, Puliatti A, Bonetti L, Tolotti A, Sari D, Valcarenghi D. Effectiveness of hyaluronic acid gel (Jalosome soothing gel) for the treatment of radiodermatitis in a patient receiving head and neck radiotherapy associated with cetuximab: a case report and review. Int Wound J. 2019;16(6):1433–9. https://doi.org/10.1111/iwj.13210.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Lee CJ, Fang HF, Wang CY, Chou KR, Huang TW. Effect of hyaluronic acid on radiodermatitis in patients with breast cancer: a meta-analysis of randomized controlled trials. Support Care Cancer. 2022;30(5):3965–75. https://doi.org/10.1007/s00520-022-06828-7.

    Article  PubMed  Google Scholar 

  80. Juncan AM, Moisa DG, Santini A, Morgovan C, Rus LL, Vonica-Tincu AL, et al. Advantages of hyaluronic acid and its combination with other bioactive ingredients in cosmeceuticals. Molecules. 2021;26(15):4429. https://doi.org/10.3390/molecules26154429.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Ghasemi A, Ghashghai Z, Akbari J, Yazdani-Charati J, Salehifar E, Hosseinimehr SJ. Topical atorvastatin 1% for prevention of skin toxicity in patients receiving radiation therapy for breast cancer: a randomized, double-blind, placebo-controlled trial. Eur J Clin Pharmacol. 2019;75(2):171–8. https://doi.org/10.1007/s00228-018-2570-x.

    Article  CAS  PubMed  Google Scholar 

  82. Zhao H, Zhu W, Zhao X, Li X, Zhou Z, Zheng M, et al. Efficacy of Epigallocatechin-3-Gallate in preventing dermatitis in patients with breast cancer receiving postoperative radiotherapy: a double-blind, placebo-controlled, phase 2 randomized clinical trial. JAMA Dermatol. 2022;158(7):779–86. https://doi.org/10.1001/jamadermatol.2022.1736.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Zhao H, Zhu W, Jia L, Sun X, Chen G, Zhao X, et al. Phase I study of topical epigallocatechin-3-gallate (EGCG) in patients with breast cancer receiving adjuvant radiotherapy. Br J Radiol. 2016;89(1058):20150665. https://doi.org/10.1259/bjr.20150665.

    Article  PubMed  Google Scholar 

  84. Kim SR, Seong KJ, Kim WJ, Jung JY. Epigallocatechin gallate protects against hypoxia-induced inflammation in microglia via NF-kappaB suppression and Nrf-2/HO-1 activation. Int J Mol Sci. 2022;23(7):4004. https://doi.org/10.3390/ijms23074004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Zhu W, Xu J, Ge Y, Cao H, Ge X, Luo J, et al. Epigallocatechin-3-gallate (EGCG) protects skin cells from ionizing radiation via heme oxygenase-1 (HO-1) overexpression. J Radiat Res. 2014;55(6):1056–65. https://doi.org/10.1093/jrr/rru047.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Musial C, Kuban-Jankowska A, Gorska-Ponikowska M. Beneficial properties of green tea catechins. Int J Mol Sci. 2020;21(5):1744. https://doi.org/10.3390/ijms21051744.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Yang HL, Lin MW, Korivi M, Wu JJ, Liao CH, Chang CT, et al. Coenzyme Q0 regulates NFkappaB/AP-1 activation and enhances Nrf2 stabilization in attenuation of LPS-induced inflammation and redox imbalance: Evidence from in vitro and in vivo studies. Biochim Biophys Acta. 2016;1859(2):246–61. https://doi.org/10.1016/j.bbagrm.2015.11.001.

    Article  CAS  PubMed  Google Scholar 

  88. Ronchetti D, Impagnatiello F, Guzzetta M, Gasparini L, Borgatti M, Gambari R, et al. Modulation of iNOS expression by a nitric oxide-releasing derivative of the natural antioxidant ferulic acid in activated RAW 264.7 macrophages. Eur J Pharmacol. 2006. https://doi.org/10.1016/j.ejphar.2005.12.034.

    Article  PubMed  Google Scholar 

  89. Chan RJ, Mann J, Tripcony L, Keller J, Cheuk R, Blades R, et al. Natural oil-based emulsion containing allantoin versus aqueous cream for managing radiation-induced skin reactions in patients with cancer: a phase 3, double-blind, randomized, controlled trial. Int J Radiat Oncol Biol Phys. 2014;90(4):756–64. https://doi.org/10.1016/j.ijrobp.2014.06.034.

    Article  CAS  PubMed  Google Scholar 

  90. Abtahi-Naeini B, Saffaei A, Sabzghabaee AM, Amiri R, Hosseini NS, Niknami E, et al. Topical sucralfate for treatment of mucocutaneous conditions: A systematic review on clinical evidences. Dermatol Ther. 2022;35(4): e15334. https://doi.org/10.1111/dth.15334.

    Article  PubMed  Google Scholar 

  91. Abbas H, Bensadoun RJ. Trolamine emulsion for the prevention of radiation dermatitis in patients with squamous cell carcinoma of the head and neck. Support Care Cancer. 2012;20(1):185–90. https://doi.org/10.1007/s00520-011-1110-3.

    Article  PubMed  Google Scholar 

  92. Simões FV, Santos VO, Silva RND, Silva RCD. Effectiveness of skin protectors and calendula officinalis for prevention and treatment of radiodermatitis: an integrative review. Rev Bras Enferm. 2020;73(suppl 5): e20190815. https://doi.org/10.1590/0034-7167-2019-0815.

    Article  PubMed  Google Scholar 

  93. Krausz AE, Adler BL, Landriscina A, Rosen JM, Musaev T, Nosanchuk JD, et al. Biafine topical emulsion accelerates excisional and burn wound healing in mice. Arch Dermatol Res. 2015;307(7):583–94. https://doi.org/10.1007/s00403-015-1559-x.

    Article  CAS  PubMed  Google Scholar 

  94. Geara FB, Eid T, Zouain N, Thebian R, Andraos T, Chehab C, et al. Randomized, prospective, open-label phase III trial comparing mebo ointment with biafine cream for the management of acute dermatitis during radiotherapy for breast cancer. Am J Clin Oncol. 2018;41(12):1257–62. https://doi.org/10.1097/COC.0000000000000460.

    Article  CAS  PubMed  Google Scholar 

  95. Tam S, Zhou G, Trombetta M, Caini S, Ryan Wolf J, van den Hurk C, et al. Topical corticosteroids for the prevention of severe radiation dermatitis: a systematic review and meta-analysis. Support Care Cancer. 2023;31(7):382. https://doi.org/10.1007/s00520-023-07820-5.

    Article  PubMed  Google Scholar 

  96. Spada F, Barnes TM, Greive KA. Comparative safety and efficacy of topical mometasone furoate with other topical corticosteroids. Australas J Dermatol. 2018;59(3):e168–74. https://doi.org/10.1111/ajd.12762.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Holmes CJ, Plichta JK, Gamelli RL, Radek KA. Burn injury alters epidermal cholinergic mediators and increases HMGB1 and Caspase 3 in autologous donor skin and burn margin. Shock. 2017;47(2):175–83. https://doi.org/10.1097/SHK.0000000000000752.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Liao Y, Feng G, Dai T, Long F, Tang J, Pu Y, et al. Randomized, self-controlled, prospective assessment of the efficacy of mometasone furoate local application in reducing acute radiation dermatitis in patients with head and neck squamous cell carcinomas. Medicine (Baltimore). 2019;98(52): e18230. https://doi.org/10.1097/MD.0000000000018230.

    Article  CAS  PubMed  Google Scholar 

  99. Behroozian T, Goldshtein D, Ryan Wolf J, van den Hurk C, Finkelstein S, Lam H, et al. MASCC clinical practice guidelines for the prevention and management of acute radiation dermatitis: part 1 systematic review. Clin Med. 2023. https://doi.org/10.1016/j.eclinm.2023.101886.

    Article  Google Scholar 

  100. Erridge SC, McCabe M, Porter MK, Simpson P, Stillie AL. Prospective audit showing improved patient-assessed skin toxicity with use of betamethasone cream for those at high risk of radiation dermatitis. Radiother Oncol. 2016;121(1):143–7. https://doi.org/10.1016/j.radonc.2016.07.005.

    Article  CAS  PubMed  Google Scholar 

  101. Menon A, Prem SS, Kumari R. Topical betamethasone valerate as a prophylactic agent to prevent acute radiation dermatitis in head and neck malignancies: A randomized, open-Label, phase 3 trial. Int J Radiat Oncol Biol Phys. 2021;109(1):151–60. https://doi.org/10.1016/j.ijrobp.2020.08.040.

    Article  PubMed  Google Scholar 

  102. Uysal B, Gamsiz H, Dincoglan F, Demiral S, Sager O, Dirican B, et al. Comparative evaluation of topical corticosteroid and moisturizer in the prevention of radiodermatitis in breast cancer radiotherapy. Indian J Dermatol. 2020;65(4):279–83. https://doi.org/10.4103/ijd.IJD_607_18.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank the native English speaking scientists of Elixigen Company (Huntington Beach, California) for editing our manuscript.

Funding

This work was supported by a grant from the Funding for Chinese Medicine Service System and Capacity Building (Key Project with Chinese Medicine Characteristics and Advantages, Ruikang Hospital, 2023).

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  1. Graduate School, Guangxi University of Chinese Medicine, Nanning, Guangxi, China

    Deng Guangmei, He Weishan & Liu Wenya

  2. Ruikang Hospital, Guangxi University of Chinese Medicine, Nanning, Guangxi, China

    Wu Fasheng & Chen Jibing

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Guangmei, D., Weishan, H., Wenya, L. et al. Evolution of radiation-induced dermatitis treatment. Clin Transl Oncol (2024). https://doi.org/10.1007/s12094-024-03460-1

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