Relationship between severe radiodermatitis and skin barrier functions in patients with head and neck cancer: A prospective observational study

Objective: Severe radiodermatitis with erosion is a painful condition that affects quality of life; therefore, developing methods for its prevention is an urgent issue. Therefore, this study aimed to determine the morphological characteristics of the development and healing processes of severe radiodermatitis in patients with head and neck cancer and to explore the association between skin barrier function and development of severe radiodermatitis.

Methods: In this prospective observational study, the cervical regions of patients with head and neck cancer who underwent radiotherapy at a university hospital from October 2022 to March 2023 were photographed, and morphological characteristics of the development and healing process of severe radiodermatitis were extracted using the qualitative sketch method. Skin barrier function, including skin microbiota and dermal echogenicity, was investigated before initiating radiotherapy, and its relationship with radiodermatitis was examined using the Mann-Whitney U test or Fisher's exact probability test.

Results: Nine patients were followed for a median of 61 (range 55-87) days with a total of 88 observations. The morphological characteristics of severe radiodermatitis were "localized erosion-epithelialization" and "widespread erosion-crusting," and compared to non-severe radiodermatitis, with low levels of Staphylococcus aureus (P ​= ​0.024), Staphylococcus hominis (P ​= ​0.024), and reduced dermal echogenicity (P ​= ​0.036). Furthermore, the "widespread erosion-crusting" was associated with a subepidermal low echogenic band.

Conclusions: To prevent severe radiodermatitis, in addition to moisturizing the irradiated area and protecting it from mechanical irritation, improving skin barrier function before radiotherapy initiation may be effective.