Expert Panel Advises Against Aloe Vera for Treating Radiation Dermatitis

The ISNCC Recommendations

The ISNCC expert panel called for additional clinical research into candidate preventive and treatment agents for radiation dermatitis. Based on the scant available research evidence, the panelists made 4 evidence-based consensus recommendations regarding aloe vera, 2 steroidal ointments, and 1 nonsteroidal silicone gel dressing. They also warned that topical steroid creams should be used “with utmost caution as panel members have advised that they should not be applied on irritated skin as it can cause a stinging or burning sensation in patients.”¹

Aloe vera: Not recommended The panel’s consensus recommendations included a unanimous strong recommendation against the use of aloe vera for managing acute radiation dermatitis.¹ “Based on previous trials, aloe vera has not been found to be effective in reducing the incidence or severity of [radiation dermatitis],” they reported.¹

Betamethasone 17-valerate cream: Best prevention practice (breast cancer) Citing findings from 2 clinical trials and a previously published systematic review that it reduces the risk of acute radiation dermatitis in patients undergoing radiotherapy for breast cancer, the expert panel reported “moderate confidence” that steroidal topical betamethasone-17 valerate cream during radiotherapy reflects a best practice for prevention of acute radiation dermatitis.¹ Recommended prophylactic therapy involved twice-daily applications of the cream to irradiated skin from day 1 of radiation therapy through the end of week 2 after the completion of radiotherapy.¹

Mometasone furoate cream: Weak prevention recommendation Three clinical trials found topical steroidal mometasone furoate cream was an effective prophylactic against high-grade radiation dermatitis in patients with head and neck cancer and breast cancer when applied once daily from day 1 of radiotherapy through the end of week 2 after completion of treatment. Based on those reports, the panel made a weak recommendation for its use.¹ However, panelists cautioned that a previous systematic review had concluded this cream is not more effective than placebo.¹

Silicone-based film forming gel dressing: Weak prevention recommendation Panelists noted that 1 clinical trial found silicone-based film forming gel dressing significantly reduced the risk of and delayed the development of grade 2 and 3 skin toxicity in patients undergoing radiotherapy for head and neck cancer when applied twice daily from day 1 of radiotherapy to 4 weeks after treatment is completed.¹ The panelists’ report notes that “unlike other dressings … silicone-based film forming gel dressing does not need to be removed prior to each fraction of radiation therapy.”¹

Expert Panel Conclusions

Panelists encouraged cancer care team members to discuss options with patients “and use an individualised [sic] approach to determine which topical agent provides the greatest symptomatic relief and is most preferred.

“It is important that topical interventions for the management of RD are continually evaluated to provide optimal patient care,” the panelists concluded.¹ “Future studies should include patient-reported experiences and outcome measures to provide further guidance for practitioners.”

References

1. International Society of Nurses in Cancer Care. Evidence-Based Guidelines for the Prevention & Management of Radiation Dermatitis Report. International Society for Nurses in Cancer Care; 2021. Accessed October 18, 2021. https://www.isncc.org/page/radiation-dermatitis.
2. Bolton L. Acute radiation therapy-related dermatitis. Wounds. 2020;32(2):66-68.
3. Rosenthal A, Israilevich R, Moy R. Management of acute radiation dermatitis: a review of the literature and proposal for treatment algorithm. J Am Acad Dermatol. 2019;81(2):558-567. doi:10.1016/j.jaad.2019.02.047
4. Spalek M. Chronic radiation-induced dermatitis: challenges and solutions. Clin Cosmet Investig Dermatol. 2016;9:473-482. doi:10.2147/CCID.S94320
5. Farrugia CJE, Burke ES, Haley ME, Bedi KT, Gandhi MA. The use of aloe vera in cancer radiation: an updated comprehensive review. Complement Ther Clin Pract. 2019;35:126-130. doi:10.1016/j.ctcp.2019.01.013