Skin creams, light sources aid pigmentation problems

St. Thomas, U.S. Virgin Islands - Effective treatments for pigment problems caused by radiation treatments include a variety of skin creams and light sources, experts tell Dermatology Times.

She says that, at higher doses of radiation, about two weeks after treatment begins, patients first tend to develop red, dry, itchy skin somewhat like a suntan. This process peaks around two weeks later, when patients often develop hyperpigmentation, Dr. Williamson adds.

Devices improve

Michael H. Gold, M.D., says he doesn't see radiation-induced hypopigmentation as often as he used to because radiation devices have improved greatly over the years. To treat this problem, he says, "I would use either a targeted phototherapy device such as the ReLume (Lumenis) or an excimer laser (EX-308, Ra Medical Systems)." Dr. Gold is medical director at Gold Skin Care Center and at the Tennessee Clinical Research Center, Nashville.

He says excimer lasers work by stimulating what few melanocytes remain in the skin to grow new melanocytes. Such devices work well, he says, "but their biggest drawback is that sometimes it takes four treatments, sometimes 44. So one must be patient, and the patient must know that there's no guarantee of how fast or how well a device is going to work."

Different types of radiation work at different levels, Dr. Williamson says. Since photons (X-rays) penetrate more deeply than electrons, she says radiation oncologists usually choose photons when treating internal cancers such as those afflicting the pancreas. Conversely, she says, "We would most commonly use electrons for skin cancers."

Successfully treating radiation burns requires timely recognition of symptoms, Dr. Williamson says.

"When we see that patients are starting to get any discomfort at all, such as redness and itching, one of the typical treatments we would use is Aquaphor (Beiersdorf-Futuro)," she says.

For more intense symptoms, she says radiation oncologists employ preparations such as Biafine RE (Biapharm SAS/Johnson & Johnson), which can be used while radiation treatments are ongoing.

"It actually will heal the skin within about a week," Dr. Williamson says. As such, she adds, "It has revolutionized radiation oncology. We have many creams to give patients, but I find that this one helps them heal much faster."

Additional creams include RadiaCare (Carrington Laboratories) and Silvadene ointment (silver sulfadiazine, Hoechst Marion Roussel). She says radiation oncologists commonly use Silvadene on patients allergic to Biafine, and vice versa.

"But we don't like to use Silvadene during radiation treatment because it has metals in it," which can cause reactions such as blistering, Dr. Williamson says.

Other treatments

Other treatments include Vigilon (Bard/Seton Healthcare Group PLC), which Dr. Williamson describes as a water-based dressing on a hydrogel sheet that patients undergoing breast cancer treatments can place under the breast to help soothe skin reactions in this area. Conversely, she says products for helping wounds to dry, and, therefore, heal faster also are available.

As for chemotherapy, Dr. Williamson says certain agents used for this purpose, such as Adriamycin (doxorubicin, Pharmacia & Upjohn), can cause localized radiation recall even months after a patient has had radiation treatments. To treat this problem, she recommends using the same creams one would use for radiation burns.