A randomized, double-blind trial on the use of 1% hydrocortisone cream for the prevention of acute radiation dermatitis

ABSTRACT

Background: To determine whether the application of 1% hydrocortisone cream during radiation therapy can prevent the occurrence of moist desquamation.

Methods: Fifty adult female breast carcinoma patients were randomized after modified radical mastectomy and chemotherapy to receive prophylactic placebo cream (n = 27) or 1% hydrocortisone cream (n = 23) during radiation therapy. The patients, caregiver and assessor were all blinded to the treatment received. Occurrence of moist desquamation, severity of acute radiation dermatitis (ARD) and hyperpigmentation were evaluated weekly until the end of radiotherapy.

Results & conclusion: Five patients in each group developed moist desquamation; however, its extent and severity were milder in the steroid group. Mean ARD scores were also lower in the steroid group (0.713 vs. 0.874, p = 0.024). A lower incidence of Grades 1 and 2 radiation dermatitis was also noted in the steroid group at weeks 2 and 4, respectively, indicating prophylactic use of steroids delayed the onset of radiodermatitis.

KEYWORDS:

• Radiation dermatitis
• topical corticosteroid
• moist desquamation
• prevention
• randomized controlled trial

Financial & competing interests disclosure

Part of the expenses for this study was sponsored by a research grant from the Philippine Dermatological Society while the remainder was shouldered by the primary investigators. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Prophylactic use of mild topical corticosteroid was able to delay the onset of radiation dermatitis and reduce the overall acute radiation dermatitis (ARD) scores.

• Even though the incidence of moist desquamation was not decreased, the extent and severity of radiation dermatitis were milder in the steroid group. In clinical practice, we recommend the use of a more potent topical steroid in order to prevent moist desquamation.

• Toward the end of the radiotherapy treatment, pruritus was noted to be significantly less in the steroid arm compared to placebo.

• Patients with a darker phototype had earlier onset and a higher grade of hyperpigmentation.

• Patients with a darker phototype had a higher incidence of Grade 2 radiation dermatitis at the end of treatment.

• Limitations in our study were the small sample size and differences in total field size irradiated between the treatment groups.

• Further studies are needed to confirm the correlation between skin phototype and radiation dermatitis.