Pulsed Dye Laser for Sensory Dysesthesias Associated With Chronic Radiation Dermatitis

Chronic radiation dermatitis (CRD) is a long-term complication of radiation therapy, typically manifesting as scarred atrophic plaques with telangiectasias. In some cases, patients report persistent sensory dysesthesias such as burning, stinging, and pruritus. These symptoms are underrecognized and likely underreported but can significantly impair quality of life and are often refractory to conventional therapies. Pulsed dye laser (PDL) has demonstrated efficacy in treating CRD-associated telangiectasias, but its role in alleviating sensory symptoms has not been reported. We report 2 breast cancer patients with treatment-resistant CRD and debilitating dysesthesias who experienced substantial symptom improvement following PDL therapy. The first patient presented with a decade-long nonhealing chest wall wound and refractory pruritus. She underwent ten sessions of subpurpuric PDL at 6-week intervals, in combination with advanced wound care, and achieved complete wound healing and sustained relief of pruritus and skin fragility. The second patient presented with a burning erythematous axillary plaque present for three years. She underwent four PDL sessions at five-week intervals and reported her first meaningful reduction in burning immediately after the initial treatment, with nearly complete resolution of dysesthesia by her final session despite persistent telangiectasias. These cases suggest that PDL may offer a novel therapeutic option for CRD-associated dysesthesias, particularly when integrated with multidisciplinary care involving medical dermatology, laser specialists, and wound care. Larger, prospective studies are warranted to clarify PDL efficacy for CRD-related dysesthesias.  .