Morphea as a Consequence of Accelerated Partial Breast Irradiation

Wernicke, A. Gabriella; Goltser, Yevgeniya; Trichter, Samuel; Sabbas, Albert; Gaan, Jalong; Swistel, Alexander; Magro, Cynthia M.

doi:10.3816/cbc.2011.n.012

Cited by 15 publications

(7 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, our case had tenderness, which is not a typical feature of morphea. The presence of pain has been reported in several previous cases of radiation-induced morphea [ 5 , 6 , 8 , 13 – 16 ], indicating that pain may be a characteristic feature of radiation-induced morphea. It has been reported that 26% of patients with morphea experienced pain [ 17 ], although there are no other studies reporting the presence of pain in patients with morphea.…”

Section: Discussionmentioning

confidence: 77%

“…Little is known about treatment of radiation-induced morphea. Although the natural history of radiation-induced morphea remains obscure, in some cases skin lesions have resolved, without intervention, as morphea [ 13 , 18 ]. Topical or oral corticosteroids, topical tacrolimus, topical calcipotriol, systemic antibiotics, ultraviolet A irradiation, and methotrexate have been used with varying degrees of success [ 3 – 8 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Case of Radiation-Induced Generalized Morphea with Prominent Mucin Deposition and Tenderness

2015

View full text Add to dashboard Cite

Patient: Female, 67Final Diagnosis: DermatomyositisSymptoms: Muscle weakness • skin rash • subcutaneous nodulesMedication: —Clinical Procedure: Drug administrationSpecialty: DermatologyObjective:Rare diseaseBackground:Radiation-induced morphea is a rare complication of radiation therapy. The affected areas are generally restricted to the radiation field or to the nearby surrounding area.Case Report:A 67-year-old Japanese woman with a history of right breast cancer followed by adjuvant radiotherapy was referred our hospital because of 7-year history of symmetrical indurated erythematous plaques on her trunk. Three months after completion of irradiation, erythematous plaques developed on her right chest and gradually spread accompanied tenderness. She did not have a history of trauma to her right chest. Laboratory testing was positive for antinuclear antibody test at 1: 640 but negative for anti-SS-A/B, anti-U1-RNP, anti-DNA, anti-Sm, anticentromere, anti-topoisomerase I antibodies, and Borrelia and cytomegalovirus infection. She had no Raynaud’s phenomenon, sclerodactyly, or nail-fold bleeding. She did not have interstitial lung disease or other internal organ involvement. A biopsy specimen revealed reticular dermal fibrosis with thickened collagen bundles with superficial and deep perivascular infiltration of mononuclear cells. These findings were consistent with morphea. Furthermore, mucin deposition was present in the papillary dermis upon Alcian blue staining, which has been reported to be observed in generalized morphea. Consequently, a diagnosis of generalized morphea induced by radiotherapy was made. She had been treated with oral hydroxychloroquine sulfate, resulting in the resolution of tenderness but the erythematous plaques remained.Conclusions:To the best of our knowledge, this is the first report of radiation-induced generalized morphea with prominent mucin deposition. Hydroxychloroquine sulfate may be efficacious for radiation-induced morphea-associated tenderness.

show abstract

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

A Case of Radiation-Induced Generalized Morphea with Prominent Mucin Deposition and Tenderness

2015

View full text Add to dashboard Cite

show abstract

“…The published data show that the treatment of RIM is unsatisfactory (Table ). The natural history of RIM is unclear – in some cases the skin condition improves spontaneously, but in the majority of patients RIM is unresponsive to treatment, even after very intensive regimens . Various agents, similar to those used in the treatment for idiopathic morphea, including steroids, calcineurin inhibitors, systemic immunosuppressants, are used in this condition with poor effects .…”

Section: Treatment and Outcomementioning

confidence: 99%

“…Loss of periadnexal adipose tissue and lymphocyte infiltration; 13 inflammatory image with prominent fibrosis, sclerotized collagen fibres 33,36 Induration and violaceous discoloration of the affected skin, a peau d'orange effect, pain 22,33 Recurrent carcinoma, chronic radiation dermatitis 22 a surgical procedure. The case of morphea related to surgery only was also found in literature data.…”

Section: Inflammatory (Early)mentioning

confidence: 99%

“…The natural history of RIM is unclearin some cases the skin condition improves spontaneously, but in 1 Breast Acitretin 10 mg, UVB Significant improvement in tenderness and the range of left arm movement the majority of patients RIM is unresponsive to treatment, even after very intensive regimens. 35,36 Various agents, similar to those used in the treatment for idiopathic morphea, including steroids, calcineurin inhibitors, systemic immunosuppressants, are used in this condition with poor effects. 8,34,35 However, some authors report improvement after topical or oral steroids, antibiotics and methotrexate.…”

Section: Treatment and Outcomementioning

confidence: 99%

See 1 more Smart Citation

Radiation‐induced morphea – a literature review

Spałek

Jońska-Gmyrek

Gałecki

2014

Acad Dermatol Venereol

View full text Add to dashboard Cite

Radiation-induced morphea (RIM) is a rare and under-recognized skin complication of radiotherapy. It is commonly wrongly diagnosed as other dermatological conditions or malignancy because of similar clinical characteristics. This literature review analyses 66 cases that have been reported in the literature since 1989. The clinical appearance often includes pain and disfiguration of affected area, which may influence the patient's quality of life. There is no clear connection between the radiotherapy dose, the fractionation scheme, the use of a boost, age, the presence of other dermatological conditions or other connective tissue diseases and the occurrence of RIM. Its pathogenesis is still unclear, but several theories are proposed to explain this phenomenon. The available data suggest that the abnormally high secretion of some cytokines (interleukin 4, interleukin 5, transforming growth factor) induced by radiation causes an extensive fibrosis after an activation of fibroblasts. Histological confirmation is crucial in distinguishing RIM from similar-looking diseases, such as chronic radiation dermatitis, cancer recurrence, radiation, recall dermatitis, new carcinoma or cellulitis. There is no clear treatment regimen for this condition. Clinical outcome after therapy is often unsatisfactory. The commonly used methods and agents include: topical and systemic steroids, calcineurin inhibitors, systemic immunosuppressants including methotrexate, tacrolimus, heparin, hyaluronidase, phototherapy (UVA, UVA1, UVB, PUVA), systemic antibiotics, imiquimod, mycophenolate mofetil, photophoresis. The differential diagnosis is challenging and requires a multidisciplinary approach to avoid misdiagnosis and to plan appropriate treatment.

show abstract