Radiation Induced Dermatitis

radiation induced dermatitisI want to talk about radiation, specifically radiation dermatitis. This is a picture of radiation dermatitis. This can happen in some women when they get radiation. The skin reacts and it can become very painful and obviously, uncomfortable. So there are some things, mechanically, that are very effective at helping to reduce the risk of dermatitis.

The first one I want to mention is Calendula. So Calendula is an herb that can be used topically. There’s a very important thing I want to say which is that you’d never want to put anything topically on your skin before radiation treatments because if you moisturize your skin before you get radiation, it can actually make that dermatitis worse. So you want to go in as dry as possible. But right after radiation, if you apply Calendula ointment, then it has been shown in clinical studies to reduce the risk of developing this dermatitis. Calendula is very very indicated; very well documented therapy to help reduce this dermatitis.

Interestingly, aloe vera, which is often used, is actually not by a research perspective, effective. And clinically, I’ve not seen it to be very effective either. But, there are some oral things, some botanicals that you can take by mouth that will help to reduce radiation dermatitis as well because they kind of stimulate moisturization in the skin and repair in the skin. So one is Turmeric or Curcumin. That can be helpful.

Calendula for Radiation Dermatis

Another one is Milk Thistle. Milk Thistle is actually a very nice way to help reduce the risk of developing dermatitis. Just, again, taken orally concurrent with time of radiation. And if somebody develops radiation dermatitis, one of the treatments that can be used as a medicinal form of honey, which has been free of all microbes and is kind of very specific to medicinal use is from New Zealand originally, but purchasable here in the United States, certainly. Called Manuka Honey. Applying Manukah Honey, again, at like at night, so well after the radiation treatment can help to heal up dermatitis.

Now, clearly, talking with your oncologist about this can be difficult. Some advice that I will give you around this, one; is to really obtain support and guidance from trained integrative healthcare professionals. You know, naturopathic oncologists, or naturopathic doctors that have gone on to receive additional training and certification in naturopathic oncology and their focus is on providing this level of support. So they would sort of be at the top of the list.

Integrative HealthcareThere are also some really well trained innovative medical doctors, nurse practitioners, nutritionists, herbalists, so you want somebody that can guide you because there’s a lot of complexity to this. And those people should take over the communication. So they should be communicating with your oncologists so that your providers are talking with each other and that everybody is on the same page.

Furthermore, if you are using herbs, do tell your oncologist about it, even if your oncologist doesn’t like that you’re using herbs, it’s important for them to know that you’re using them because they need to have that information if something about the way in which you react to their treatment is different, or unexpected, they can try to help figure out what might be going on and they’re better able to do that when they know all the things that you’re taking regularly.

what is integrative oncologyIn general, you want to be conservative. So when in doubt, avoid potential interactions and don’t use herbs concurrently if you have concerns about it. There is plenty of opportunity after treatment to employ the use of herbs to help lower the risk of recurrence and recover from treatment. And, again, remember that if you’re getting chemotherapy, for example, and you’re getting it on a schedule with a couple of weeks, two to three weeks in between treatments, that affords you an opportunity to employ some of these therapies in a more safe manner.

And then, finally, do rely on good studies and expert guidance, but don’t rely on pervasive or persuasive testimonials, especially on the internet. These are just ripe for problems and are not reliable in any way.

By: Lise Alschuler

Calendula: Potential interest in oncology

The Garden (or pot) marigold (Calendula officinalis) is a plant from the daisy family (Asteraceae), whose therapeutic properties have been known for centuries. Its bright yellow or orange flowers were used as a dye, and its petals are still sometimes used in elaborate salads.

marigoldCalendula flowers contain many different active compounds:1 volatile oil; carotenoids, giving the flower its bright color; polysaccharides; flavonoids; many different terpene alcohols and saponins; and hydroxycoumarins.

The plant has been used internally (i.e., infusions and tinctures) for many different indications. Its antispasmodic effects and choleretic action have been confirmed, and it is considered generally safe.2 Its most important use, however, is as a skin healer.

Calendula extracts seem to be active at different stages of the wound healing process. They stimulate the regeneration of damaged or irritated skin during the healing phase,3-4 and they stimulate the migration and proliferation of fibroblasts, which restore the dermis’ integrity. Extracts of Calendula have been shown to stimulate the formation of new blood vessels, as well as to increase fibroblastic activity and anti-inflammatory and antibacterial properties in burns.5-6 It seems these effects are due to more intensive metabolization of glycoproteins, nucleoproteins and collagen proteins during the epithelization phase.7-8

From a clinical standpoint, several studies show topicals containing Calendula can be used on medically-induced skin irritations (i.e., radiodermatitis, dermabrasions and laser treatments) or first- and second-degree burns.9-12

As is often the case with plant extracts, cases of sensitization have been reported. They are rare and often due to applications of high concentration (more than 10%) or at a high frequency.1 It is important to apply the topical in a thin layer to allow oxygen to reach the skin or wound and to not create an occlusion that would slow down the healing process or create a favorable environment for anaerobic bacteria. A loose bandage can be applied to protect a small wound without creating occlusion.

The inactive ingredients of a Calendula topical must be chosen to maximize the moisturizing effect—to slow down the loss of water from the damaged skin. This also contributes to faster and better healing. USP petrolatum is perfectly safe because it has been highly purified.

Although Calendula extracts show a certain antiseptic activity, I am in favor of not interfering with the skin microbiome besides proper wound cleansing and disinfection. Application of antibiotics will select resistant bacteria. Topicals of different sorts should never be applied together on the skin, because the rate of absorption of the active ingredients will be modified by the other topicals’ inactive ingredients.

It is important to know Calendula topicals using homeopathic mother tinctures (4 to 10%) present three advantages. First, the tincture is prepared according to the Homeopathic Pharmacopoeia of the United States’ guidelines, which means the plant is macerated at room temperature. This method preserves the main active ingredients, especially those sensitive to heat. The solvent is purified water and ethanol (45%). Second, the Marigold plant is cultivated using organic methods, with no fertilizers or pesticides, and thoroughly controlled before and after extraction according to Pharmaceutical Good Manufacturing Practices, because homeopathic medicines are regulated as drugs in the United States. Finally, as drugs, homeopathic medicines have clear indications and drug facts, which is a definite advantage for the patient’s and the physician’s information.

by: Ronald Boyer, MD, President CEDH

1Physician Desk Reference for Herbal Medicines. 3rd Edition. Thomson PDR.

2Herbal Drugs and Phytopharmaceuticals. Max Wichtl (Ed). CRC Press Boca Raton USA 2004 (3rd US Edition)

3Fronza M., et al. Determination of the wound healing effect of Calendula extracts using the scratch assay with 3T3 fibroblasts. J. Ethnopharmacol. 2009 Dec 10; 126(3):463-7.

4Preethi KC, Kuttan R. Wound healing activity of flower extract of Calendula officinalis. J Basic Clin Physiol Pharmacol. 2009; 20(1):73-9.

5Leila Maria Leal Parente L.M et al. Wound Healing and Anti-Inflammatory Effect in Animal Models of Calendula officinalis L. Growing in Brazil. Evidence-Based Complementary and Alternative Medicine Vol. 2012, Article ID 375671, 7 pages

6Chandran PK, Kutton R. Effect of Calendula officinalis flower extract on acute phase proteins, antioxidant defense mechanism and granuloma formation during thermal burns. J Clin Biochem Nutr, 2008; 43: 58-64

7Klouchek-Popova E., et al. Influence of the physiological regeneration and epithelization using fractions isolated from Calendula officinalis. Acta Physiol Pharmacol Bulg. 1982; 8(4):63-7.

8Leach MJ. Calendula officinalis and wound healing: A systematic review. Wounds, 2008; 20(8): 1-7

9Bash E. Marigold (Calendula officinalis L.): An Evidence-Based Systematic Review by the Natural Standard Research Collaboration Journal of Herbal Pharmacotherapy, 2006 Vol. 6(3/4).

10Benomar S. et al. “Treatment and prevention of acute radiation dermatitis”. Cancer/Radiotherapie 14 (2010) 213-216.

11Chargari C. et al. “Importance of local skin treatments during radiotherapy for prevention and treatment of radio-induced epithelitis”. Cancer/Radiotherapie 13 (2010) 259-266

12Wong R. et al. “Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group”. Supportive Care Cancer (2013) 21; 2933-2948

What is Nipple-Sparing Mastectomy?

What is Nipple-Sparing Mastectomy?

Nipple-sparing mastectomy preserves the nipple and areola and all the breast skin envelope around it. Only the breast tissue under the skin and nipple-areola is removed. A skin-sparing mastectomy also preserves the breast skin envelope but unlike the nipple-sparing procedure, removes the nipple and areola.

Who is a Candidate?

Nipple-sparing mastectomy is an option for many patients with a small cancer located several centimeters away from the nipple-areola complex. Patients with ductal carcinoma in situ (DCIS) can also be candidates depending on the location and distance from the nipple-areola. Patients who need a significant breast lift for the best cosmetic results are not ideal candidates.

During the surgery, the breast tissue on the underside of the areola is shaved away. In patients that have a known breast cancer, this tissue is sent as a biopsy to pathology to make sure there is no cancer under the nipple or areola. If this biopsy is negative then the area can be preserved. If it is positive for cancer cells, the nipple and areola must be removed.

Patients seeking prophylactic mastectomy and immediate breast reconstruction due to their high risk of breast cancer (eg BRCA+ and other genetic syndromes, strong family history) are the best candidates.

What are the Benefits?

Studies show that nipple-sparing mastectomy does not compromise cancer treatment when performed in appropriate candidates. Preserving the nipple-areola complex adds to the quality of the reconstruction and makes the results even more “natural” and cosmetically pleasing. The patient also avoids the additional steps of nipple reconstruction and tattooing.

What are the Risks?

Patients must be prepared to lose all nipple sensation. In cases where some nipple-areola sensation is preserved or returns over time, the feeling is typically well short of what Mother Nature provided.

Shaving away the breast tissue from the underside of the areola can sometimes compromise the blood supply to the area. If the blood supply is damaged too much by the nipple-sparing mastectomy, part or all of the nipple-areola can die. Thankfully this is very uncommon when the procedure is performed by surgeons experienced with this technique.

At PRMA, we are able to check the blood flow intra-operatively if there is a concern that the nipple-areola may not survive. In the unlikely event the nipple-areola cannot be saved, it is removed to prevent wound healing complications and a new nipple and areola are reconstructed at a later time.

Where will the Scars be?

This depends on the size and shape of the breast, whether a small “lift” is needed, patient preference and surgeon preference. Scars can be placed around part of the areola, extend outwards or downwards from the areola, or be completely away from the areola at the breast crease.

By Minas Chrysopoulo