Table 8.

Management of chronic radiation dermatitis and radiation-induced fibrosis

Late reaction or complication	Management
Ulcers and erosions	Non-specific, follows general wound care guidelines, including
	Hydrophilic or lipophilic barrier creams with or without hydrogel or hydrocolloid dressings
	Careful and selective debridement, eschar removal
	For infected or at-risk wounds, antibacterial agents as needed and silver-based dressings
	Surgical intervention for nonhealing ulcers with skin flaps, less commonly with staged skin-muscle or axial-pedical flaps
	Grade D
	Artificial or bioengineered skin
	Low-intensity helium laser
Fibrosis	Supportive measures: physical therapy, massage, and pain management
	Grade 2C
	Pentoxifylline with or without tocopherol
	Grade D
	Superoxide dismutase
	Interferon gamma (IFNγ)
	Hyperbaric oxygen therapy
	Laser therapy with epidermal grafting
Telangiectasias	Grade D  Pulse dye laser
Secondary skin cancers and radiation-induced keratoses	Surgical excision preferred for skin cancers
	Grade 2C
	Radiation-induced keratoses:
	Cryosurgery
	Mechanical destruction (peel, laser, or dermabrasion)
	Grade D
	Topical 5-fluorouracil
	Diclofenac
	Photodynamic therapy
	Imiquimod