clobetasol and Radiodermatitis

Radiation dermatitis often presents as a problem for patients and radiotherapists during treatment. Topical corticosteroids have been shown to have an anti-inflammatory effect in the treatment of many skin diseases and are commonly prescribed during a course of radiation treatment. A comparison of two different steroid creams, 1% hydrocortisone cream and 0.05% clobetasone butyrate (Eumovate), in a double blind trial was carried out in 54 patients undergoing radiation therapy for breast cancer. 'The cream' was administered when patients reached a given dose of 2000 rad (or earlier if required) whether a skin reaction was present or not. The aim of the trial was to evaluate the general effectiveness of steroids in controlling radiation dermatitis and whether one type of cream was superior to the other. The majority of patients using either cream derived benefit in its soothing effect. There was, however, a significant difference in the intensity of reactions seen, patients using clobetasone butyrate developed more severe radiation reactions despite both groups having similar radiation doses. The possibility of two differing populations having different responses to radiation is discussed as is the 'breakthrough phenomenon' described in the literature. It is concluded that neither cream should be used as first choice in the control of radiation dermatitis.

Topics: Administration, Topical; Anti-Inflammatory Agents; Betamethasone; Breast Neoplasms; Clinical Trials as Topic; Clobetasol; Double-Blind Method; Female; Humans; Hydrocortisone; Male; Radiodermatitis; Radiotherapy; Radiotherapy Dosage; Random Allocation; Time Factors

Corticosteroids and vitamin D3 analogues inhibit proliferation, enhance normal keratinisation and interfere with cutaneous inflammation in in vitro systems. Both treatments are effective in psoriasis, although several reports suggest that vitamin D3 is less effective in reducing the inflammatory changes compared to its potent effect on keratinocyte growth and differentiation. The aim of the present study was to compare and contrast the effects of the vitamin D3 analogue calcipotriol, clobetasol-17-propionate and a placebo on immunohistochemical markers for epidermal growth, keratinisation and inflammation induced by a standardised single challenge with ultraviolet B (UVB) radiation in normal human skin. Clobetasol proved to inhibit UVB-induced proliferation of epidermal cells, tenascin induction, keratin 16 induction and the accumulation of T lymphocytes and CD1a-positive cells. Epidermal thinning due to clobetasol was also observed. No effect of clobetasol was shown on the enhanced terminal differentiation following UVB challenge. In contrast, calcipotriol reduced the member of transglutaminase-positive cells following UVB challenge but increased the thickness of the epidermis without a significant effect on other markers for keratinisation, epidermal proliferation and inflammation. The present study reconfirms the potent effect of topical corticosteroids on various aspects of UVB-challenged skin. In contrast, calcipotriol interfered especially with one differentiation pathway (transglutaminase) without modulation of other UVB-induced changes.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Calcitriol; Cell Differentiation; Cell Division; Clobetasol; Dermatologic Agents; Erythema; Glucocorticoids; Humans; Immunohistochemistry; Ki-67 Antigen; Male; Ointments; Radiodermatitis; Regression Analysis; Skin; Ultraviolet Rays