Ulff, E., Maroti, M., Serup, J., & Falkmer, U. (2013). A potent steroid cream is superior to emollients in reducing acute radiation dermatitis in breast cancer patients treated with adjuvant radiotherapy. A randomised study of betamethasone versus two moisturizing creams. Radiotherapy and Oncology, 108, 287–292.
To determine if treatment with betamethasone+Essex® cream can decrease acute radiation dermatitis in patients with breast cancer receiving radiation as compared to two emollient creams.
Patients with breast cancer receiving radiation therapy were randomized 2:1:1 to three treatment groups—betamethasone+Essex cream, Essex cream, or Canoderm® cream. Study creams were applied to the treated skin twice daily for five weeks starting the first week. Treatment continued for two weeks following completion of radiation. Physician/nurse examinations occurred weekly for the first five weeks of treatment.
The Fitzpatrick skin type scheme I–IV was used to classify patients as to skin type. Radiation dermatitis was scored using the Radiation Therapy Oncology Group (RTOG) scoring system. A colorimeter measured the redness of the skin at specific areas around the areola. Dryness of skin was measured using a Corneometer®, with scores averaged using five specific locations. Itching, burning, and skin irritation were patient-scored using a visual analog scale (VAS) of 0–10. Quality of life was determined via the Dermatology Life Questionnaire Index on the first and fifth weeks of treatment. Post-radiation follow-up was by phone with symptoms assessed using VAS.
This study found that prophylactic treatment with betamethasone cream was superior to moisturizing cream for control of acute radiation dermatitis. Because prolonged treatment with topical steroids is known to be able to harm skin integrity, use was limited to seven weeks.
Because up to 90% of patients with breast cancer treated with adjuvant radiation have some degree of skin reaction, assessing and treating according to evidence-based practices is important. This study shows use of prophylactic steroid cream to reduce the severity of skin reaction in this group of patients.