Herst Patries M
Department of Radiation Therapy, University of Otago Wellington, New Zealand.
J Med Radiat Sci. 2014 Jun;61(2):119-25. doi: 10.1002/jmrs.46. Epub 2014 Apr 28.
Radiation-induced skin reactions are an unavoidable side effect of external beam radiation therapy, particularly in areas prone to friction and excess moisture such as the axilla, head and neck region, perineum and skin folds. Clinical studies investigating interventions for preventing or managing these reactions have largely focussed on formulations with moisturising, anti-inflammatory, anti-microbial and wound healing properties. However, none of these interventions has emerged as a consistent candidate for best practice. Much less emphasis has been placed on evaluating ways to protect the radiation-damaged skin from friction and excess moisture. This mini review analyses the clinical evidence for barrier products that form a protective layer by adhering very closely to the skin folds and do not cause further trauma to the radiation-damaged skin upon removal. A database search identified only two types of barrier products that fitted these criteria and these were tested in two case series and six controlled clinical trials. Friction protection was most effective when the interventions were used from the start of treatment and continued for several weeks after completion of treatment. Soft silicone dressings (Mepilex Lite and Mepitel Film) and Cavilon No Sting Barrier Film, but not Cavilon Moisturizing Barrier Cream, decreased skin reaction severity, most likely due to differences in formulation and skin build-up properties. It seems that prophylactic use of friction protection of areas at risk could be a worthwhile addition to routine care of radiation-damaged skin.
放射性皮肤反应是外照射放射治疗不可避免的副作用，尤其在易受摩擦和过度潮湿的部位，如腋窝、头颈部、会阴和皮肤褶皱处。调查预防或处理这些反应的干预措施的临床研究主要集中在具有保湿、抗炎、抗菌和伤口愈合特性的制剂上。然而，这些干预措施中没有一种成为最佳实践的一致候选方法。在评估保护受辐射损伤皮肤免受摩擦和过度潮湿影响的方法方面，所给予的关注要少得多。这篇小型综述分析了屏障产品的临床证据，这些产品通过紧密粘附于皮肤褶皱形成保护层，并且在去除时不会对受辐射损伤的皮肤造成进一步创伤。数据库搜索仅发现两种符合这些标准的屏障产品，并且在两个病例系列和六项对照临床试验中对其进行了测试。当从治疗开始就使用干预措施并在治疗完成后持续数周时，摩擦保护最为有效。柔软的硅胶敷料（美皮康轻量型和美皮贴薄膜）和皮肤保护膜，但不包括皮肤保湿防护霜，可降低皮肤反应的严重程度，这很可能是由于配方和皮肤积聚特性的差异所致。看来，对有风险的部位进行预防性摩擦保护可能是受辐射损伤皮肤常规护理中一项值得添加的措施。
