Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006.

I onizing radiation is used to treat a variety of primary tumors, as well as to palliate metastatic disease. Dermatologists are no strangers to this modality of therapy and, since the discovery of x-rays by Roentgen in 1895, have incorporated radiation into their practice to treat malignant skin tumors, as well as benign skin diseases such as acne, eczema, and cutaneous fungal infections. In the past 30 years, other therapeutic modalities have largely supplanted radiation in the treatment of these benign disorders. Dermatologists today are more commonly called on to treat the cutaneous repercussions of radiation therapy (RT), which are a function of technique, target, total dose, volume, as well as individual variations. RT, either as monotherapy or in combination with other treatment modalities, is a powerful tool in tumor control, limited primarily by injury adjacent to normal tissue. Radiation-induced skin changes were recognized soon after the discovery of x-rays and were scientifically reported as early as 1902. Even when the skin is not the primary target, it may be injured as an ‘‘innocent bystander’’ and develop profound alterations on functional, gross, and molecular levels. This is not only true after therapeutic radiation, but also after interventional procedures. Serious radiationinduced skin injuries have been reported after unexpectedly high doses of kilovoltage irradiation exposure during fluoroscopic imaging, including cardiac catheterization. Increasingly sophisticated therapeutic regimens and modern equipment have improved the delivery and ameliorated, but not