Radiation dermatitis, burns, and recall phenomena: Meaningful instances of immunocompromised district

Ruocco, Eleonora; Maio, Rosa Di; Caccavale, Stefano; Siano, Maria; Schiavo, Ada Lo

doi:10.1016/j.clindermatol.2014.04.014

Cited by 41 publications

(42 citation statements)

References 45 publications

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“…Additionally, CRS also impairs the immunological barrier function of the skin, resulting in a suppressed immune environment. Most studies pertaining to the effects of radiation on the skin focus on ultraviolet (UV) exposure where the initial inflammatory state is followed by a loss of Langerhans cells, a subpopulation of dendritic cells (DCs) that can serve as antigen-presenting cells (APCs), only to be replaced by other APCs that preferentially activate suppressive regulatory T cells (T Reg ) (6). Much less is known about the effect of ionizing radiation on the skin, however, in a few reported studies, an increase in the ratio of T Reg to T effector (T Eff ) cells was observed (7, 8) in irradiated skin.…”

Section: Introductionmentioning

confidence: 99%

Total-Body Irradiation Exacerbates Dissemination of Cutaneous Candida Albicans Infection

et al. 2016

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Exposure to radiation, particularly a large or total-body dose, weakens the immune system through loss of bone marrow precursor cells, as well as diminished populations of circulating and tissue-resident immune cells. One such population is the skin-resident immune cells. Changes in the skin environment can be of particular importance as the skin is also host to a number of commensal organisms, including Candida albicans, a species of fungus that causes opportunistic infections in immunocompromised patients. In a previous study, we found that a 6 Gy sublethal dose of radiation in mice caused a reduction of cutaneous dendritic cells, indicating that the skin may have a poorer response to infection after irradiation. In this study, the same 6 Gy sublethal radiation dose led to a weakened response to a C. ablicans cutaneous infection, which resulted in systemic dissemination from the ear skin to the kidneys. However, this impaired response was mitigated through the use of interleukin-12 (IL-12) administered to the skin after irradiation. Concomitantly with this loss of local control of infection, we also observed a reduction of CD4+ and CD8+ T cells in the skin, as well as the reduced expression of IFN-γ, CXCL9 and IL-9, which influence T-cell infiltration and function in infected skin. These changes suggest a mechanism by which an impaired immune environment in the skin after a sublethal dose of radiation increases susceptibility to an opportunistic fungal infection. Thus, in the event of radiation exposure, it is important to include antifungal agents, or possibly IL-12, in the treatment regimen, particularly if wounds are involved that result in loss of the skin’s physical barrier function.

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Section: Introductionmentioning

confidence: 99%

Total-Body Irradiation Exacerbates Dissemination of Cutaneous Candida Albicans Infection

et al. 2016

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“…These changes can interfere with the local immune responses of the irradiated skin, whereby the area becomes an ICD [5]. …”

Section: Discussionmentioning

confidence: 99%

Prurigo Nodularis after Radiotherapy: An Isoradiotopic Response?

Krammer

Ibrahim

2018

Case Reports in Dermatological Medicine

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Prurigo nodularis is a rare and chronic skin disorder with multiple, pruritic, and firm nodules. The exact pathophysiology is still unknown. Skin disorders appearing at sites of radiation can be defined as isoradiotopic. A 35-year-old male had developed a skin lesion in the left submandibular area on a base of irradiated skin which was initially suspected as a skin malignancy. The patient had a history of undifferentiated nasopharyngeal cancer with lymph node involvement which was treated by radiochemotherapy thirteen years previously. Histological examination confirmed that it was a case of prurigo nodularis which subsequently evolved at distant sites. This presentation may suggest a case of an isoradiotopic response.

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“…Ionizing and ultraviolet radiations as well as burns can selectively damage and immunologically mark the cutaneous area they act upon through direct and indirect mechanisms . After the causing event has disappeared, the affected skin district may appear clinically normal, but its immune behavior is often compromised forever.…”

Section: Otherwise Damaged Areasmentioning

confidence: 99%

“…In addition, in recall phenomena, the damaged skin area usually behaves as an ICD with an exaggerated immune response toward a wide range of drugs (particularly chemotherapeutic agents) that prove harmless on the undamaged skin surface . The pathomechanisms involved in any secondary disorder occurring on irradiated or burnt skin areas may be linked to locally decreased or altered lymph flow (with dysfunction of lymph drainage) on the one hand, and to fibrotic throttling or reduction of peptidergic nerve fibers (with dysfunction of neuroimmune signaling) on the other hand, resulting in a significant dysregulation of the local immune response …”

Section: Otherwise Damaged Areasmentioning

confidence: 99%

Ruocco's immunocompromised cutaneous district

et al. 2015

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The concept of 'locus minoris resistentiae' (lmr) is an old but still effective way of thinking in Medicine. In Dermatology, there are many reports of privileged localization of cutaneous diseases on injured skin, which therefore represents a typical condition of lmr. Lately the innovative concept of immunocompromised cutaneous district (ICD) has been introduced to explain why a previously injured cutaneous site may become in time a privileged location for the outbreak of opportunistic infections, tumors, and immune reactions. An ample documentation of multifarious disorders (infectious, neoplastic, immune) appearing in ICDs was delineated by Ruocco et al. in 2009. These cases were grouped according to the clinical settings responsible for the local immune imbalance: regional chronic lymphedema; herpes-infected sites, which feature the well-known Wolf's isotopic response; and otherwise damaged areas, comprising sites of vaccination, ionizing or UV radiation, thermal burns, and traumas. In the following five years, what was a "novel" pathogenic concept has been extended to an enlarging variety of clinical conditions. This paper focuses on ICD and the expanding spectrum of this now established pathogenic concept.

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Radiation dermatitis, burns, and recall phenomena: Meaningful instances of immunocompromised district

Cited by 41 publications

References 45 publications

Total-Body Irradiation Exacerbates Dissemination of Cutaneous Candida Albicans Infection

Total-Body Irradiation Exacerbates Dissemination of Cutaneous Candida Albicans Infection

Prurigo Nodularis after Radiotherapy: An Isoradiotopic Response?

Ruocco's immunocompromised cutaneous district

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