Chronic radiation-induced dermatitis: what is new in 2024? A narrative review

Radiation exposure can cause two main types of dermatitis: acute radiation dermatitis (ARD) and chronic radiation dermatitis (CRD). ARD appears days to weeks after exposure, with symptoms including redness, peeling, and blistering. At the same time, CRD develops over months to years, resulting in long-lasting skin changes such as fibrosis, pigmentation, and telangiectasia. Most studies on radiation dermatitis focus on ARD, yet doctors must update their knowledge about CRD, as it affects approximately one-third of patients. This review aims to present the current knowledge of CRD as an update to our previous work published in 2016. We focused mainly on the latest advancements and challenges in its prevention, diagnosis, and treatment as of 2024. It is even more critical to treat CRD effectively, as during the last eight years, the life expectancy of oncologic patients has significantly improved. Recent studies unraveled much about the pathophysiological mechanisms behind CRD, including the roles of micro ribonucleoacids (miRNAs), epigenetic factors, and epithelial-mesenchymal transition. Innovations in radiotherapy techniques, such as intensity-modulated radiation therapy (IMRT) and personalized protective shields, have reduced the incidence and severity of CRD. New pharmacological interventions, including topical agents and systemic medications, can manage symptoms like erythema, dryness, and fibrosis. However, there are still substantial challenges in managing the long-term effects of CRD. Combining genetic and imaging data may be a way to predict who is likely to develop CRD and to create personalized treatment plans.