Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
American Journal of Clinical Dermatology
Published in: American Journal of Clinical Dermatology 3/2016

01-06-2016 | Review Article

Radiodermatitis: A Review of Our Current Understanding

Authors: Manni Singh, Afsaneh Alavi, Rebecca Wong, Sadanori Akita

Published in: American Journal of Clinical Dermatology | Issue 3/2016

Login to get access

Abstract

Radiodermatitis (radiation dermatitis, radiation-induced skin reactions, or radiation injury) is a significant side effect of ionizing radiation delivered to the skin during cancer treatment as well as a result of nuclear attacks and disasters, such as that which occurred in Fukushima in 2011. More specifically, 95 % of cancer patients receiving radiation therapy will develop some form of radiodermatitis, including erythema, dry desquamation, and moist desquamation. These radiation skin reactions result in a myriad of complications, including delays in treatment, diminished aesthetic appeal, and reduced quality of life. Recent technological advancements and novel treatment regimens have only been successful in partly ameliorating these adverse side effects. This article examines the current knowledge surrounding the pathogenesis, clinical manifestations, differential diagnoses, prevention, and management of radiodermatitis. Future research should examine therapies that incorporate the current understanding of the pathophysiology of radiodermatitis while measuring effectiveness using objective and universal outcome measures.
Literature
1.
Siegel R, Desantis C, Virgo K, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62(4):220–41.CrossRefPubMed
2.
McQuestion M. Evidence-based skin care management in radiation therapy: clinical update. Semin Oncol Nurs. 2011;27(2):e1–17.CrossRefPubMed
3.
4.
Hymes SR, Strom EA, Fife C. Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006. J Am Acad Dermatol. 2006;54(1):28–46.CrossRefPubMed
5.
Feight D, Baney T, Bruce S, McQuestion M. Putting evidence into practice: evidence-based interventions for radiation dermatitis. Clin J Oncol Nurs. 2011;15(5):481–92.CrossRefPubMed
6.
Dendaas N. Toward evidence and theory-based skin care in radiation oncology. Clin J Oncol Nurs. 2012;16(5):520–5.CrossRefPubMed
7.
Salvo N, Barnes E, van Draanen J, Stacey E, Mitera G, Breen D, et al. Prophylaxis and management of acute radiation-induced skin reactions: a systematic review of the literature. Curr Oncol. 2010;17(4):94–112.PubMedPubMedCentral
8.
Hindley A, Zain Z, Wood L, Whitehead A, Sanneh A, Barber D, et al. Mometasone furoate cream reduces acute radiation dermatitis in patients receiving breast radiation therapy: results of a randomized trial. Int J Radiat Oncol Biol Phys. 2014;90(4):748–55.CrossRefPubMed
9.
Radvansky LJ, Pace MB, Siddiqui A. Prevention and management of radiation-induced dermatitis, mucositis, and xerostomia. Am J Health Syst Pharm. 2013;70(12):1025–32.CrossRefPubMed
10.
Chan RJ, Larsen E, Chan P. Re-examining the evidence in radiation dermatitis management literature: an overview and a critical appraisal of systematic reviews. Int J Radiat Oncol Biol Phys. 2012;84(3):e357–62.CrossRefPubMed
11.
Chan RJ, Webster J, Chung B, Marquart L, Ahmed M, Garantziotis S. Prevention and treatment of acute radiation-induced skin reactions: a systematic review and meta-analysis of randomized controlled trials. BMC Cancer. 2014;14:53.CrossRefPubMedPubMedCentral
12.
Morgan K. Radiotherapy-induced skin reactions: prevention and cure. Br J Nurs. 2014;23(16):S24, S26–32.
13.
Freedman GM, Anderson PR, Li J, Eisenberg DF, Hanlon AL, Wang L, et al. Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer. Am J Clin Oncol. 2006;29(1):66–70.CrossRefPubMed
14.
Pignol J-P, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol. 2008;26(13):2085–92.CrossRefPubMed
15.
Freedman GM, Li T, Nicolaou N, Chen Y, Ma CCM, Anderson PR. Breast intensity-modulated radiation therapy reduces time spent with acute dermatitis for women of all breast sizes during radiation. Int J Radiat Oncol Biol Phys. 2009;74(3):689–94.CrossRefPubMedPubMedCentral
16.
Vano-Galvan S, Fernandez-Lizarbe E, Truchuelo M, Diaz-Ley B, Grillo E, Sanchez V, et al. Dynamic skin changes of acute radiation dermatitis revealed by in vivo reflectance confocal microscopy. J Eur Acad Dermatol Venereol. 2013;27(9):1143–50.CrossRefPubMed
17.
Glover D, Harmer V. Radiotherapy-induced skin reactions: assessment and management. Br J Nurs. 2014;23(4):S28, S30–5.
18.
Hu SC-S, Hou M-F, Luo K-H, Chuang H-Y, Wei S-Y, Chen G-S. Changes in biophysical properties of the skin following radiotherapy for breast cancer. J Dermatol. 2014;41(12):1087–94.CrossRefPubMed
19.
Trueman E, Taylor L. Using a soft-silicone dressing to treat moist desquamation. Br J Nurs. 2014;23(10):S32, S34–7.
20.
Amber KT, Shiman MI, Badiavas EV. The use of antioxidants in radiotherapy-induced skin toxicity. Integr Cancer Ther. 2014;13(1):38–45.CrossRefPubMed
21.
Kim JH, Kolozsvary AJJ, Jenrow KA, Brown SL. Mechanisms of radiation-induced skin injury and implications for future clinical trials. Int J Radiat Biol. 2013;89(5):311–8.CrossRefPubMed
22.
Müller K, Meineke V. Radiation-induced mast cell mediators differentially modulate chemokine release from dermal fibroblasts. J Dermatol Sci. 2011;61(3):199–205.CrossRefPubMed
23.
Akita S, Yoshimoto H, Akino K, Ohtsuru A, Hayashida K, Hirano A, et al. Early experiences with stem cells in treating chronic wounds. Clin Plast Surg. 2012;39(3):281–92.CrossRefPubMed
24.
25.
Akita S, Yoshimoto H, Ohtsuru A, Hirano A, Yamashita S. Autologous adipose-derived regenerative cells are effective for chronic intractable radiation injuries. Radiat Prot Dosimetry. 2012;151(4):656–60.CrossRefPubMed
26.
Roche S, Delorme B, Oostendorp RAJ, Barbet R, Caton D, Noel D, et al. Comparative proteomic analysis of human mesenchymal and embryonic stem cells: Towards the definition of a mesenchymal stem cell proteomic signature. Proteomics. 2009;9(2):223–32.CrossRefPubMed
27.
Strem BM, Hicok KC, Zhu M, Wulur I, Alfonso Z, Schreiber RE, et al. Multipotential differentiation of adipose tissue-derived stem cells. Keio J Med. 2005;54(3):132–41.CrossRefPubMed
28.
Meyer F, Fortin A, Wang CS, Liu G, Bairati I. Predictors of severe acute and late toxicities in patients with localized head-and-neck cancer treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2012;82(4):1454–62.CrossRefPubMed
29.
De Langhe S, Mulliez T, Veldeman L, Remouchamps V, van Greveling A, Gilsoul M, et al. Factors modifying the risk for developing acute skin toxicity after whole-breast intensity modulated radiotherapy. BMC Cancer. 2014;14:711.CrossRefPubMedPubMedCentral
30.
Spalek M, Jonska-Gmyrek J, Gałecki J. Radiation-induced morphea: a literature review. J Eur Acad Dermatol Venereol. 2015;29(2):197–202.CrossRefPubMed
31.
Piérard GE, Piérard-Franchimont C, Paquet P, Quatresooz P. Emerging therapies for ionizing radiation-associated skin field carcinogenesis. Expert Opin Pharmacother. 2009;10(5):813–21.CrossRefPubMed
32.
Wong RKS, Bensadoun RJ, Boers-Doets CB, Bryce J, Chan A, Epstein JB, et al. Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group. Support Care Cancer. 2013;21(10):2933–48.CrossRefPubMed
33.
Yoshida EJ, Chen H, Torres M, Andic F, Liu H, Chen Z, et al. Reliability of quantitative ultrasonic assessment of normal-tissue toxicity in breast cancer radiotherapy. Int J Radiat Oncol Biol Phys. 2012;82(2):724–31.CrossRefPubMedPubMedCentral
34.
Rizza L, D’Agostino A, Girlando A, Puglia C. Evaluation of the effect of topical agents on radiation-induced skin disease by reflectance spectrophotometry. J Pharm Pharmacol. 2010;62(6):779–85.CrossRefPubMed
35.
Simonen P, Hamilton C, Ferguson S, Ostwald P, O’Brien M, O’Brien P, et al. Do inflammatory processes contribute to radiation induced erythema observed in the skin of humans? Radiother Oncol. 1998;46(1):73–82.CrossRefPubMed
36.
Piérard GE. EEMCO guidance for the assessment of skin colour. J Eur Acad Dermatol Venereol. 1998;10(1):1–11.PubMed
37.
Wengström Y, Forsberg C, Näslund I, Bergh J. Quantitative assessment of skin erythema due to radiotherapy—evaluation of different measurements. Radiother Oncol. 2004;72(2):191–7.CrossRefPubMed
38.
Coleman CN, Turrisi AT. Radiation and chemotherapy sensitizers and protectors. Crit Rev Oncol Hematol. 1990;10(3):225–52.CrossRefPubMed
39.
Azria D, Gourgou S, Sozzi WJ, Zouhair A, Mirimanoff RO, Kramar A, et al. Concomitant use of tamoxifen with radiotherapy enhances subcutaneous breast fibrosis in hypersensitive patients. Br J Cancer. 2004;91(7):1251–60.CrossRefPubMedPubMedCentral
40.
41.
Casamiquela KM, Cohen PR. Radiation port dermatophytosis: Tinea corporis occurring at the site of irradiated skin. Dermatol Online J. 2012;18(1):5.
42.
Urosevic-Maiwald M, Harr T, French L, Dummer R. Stevens–Johnson syndrome and toxic epidermal necrolysis overlap in a patient receiving cetuximab and radiotherapy for head and neck cancer. Int J Dermatol. 2012;51:864–7.CrossRefPubMed
43.
Haas RLM, de Klerk G. An illustrated case of doxorubicin-induced radiation recall dermatitis and a review of the literature. Neth J Med. 2011;69(2):72–5.PubMed
44.
Levy A, Hollebecque A, Bourgier C, Loriot Y, Guigay J, Robert C, et al. Targeted therapy-induced radiation recall. Eur J Cancer. 2013;49(7):1662–8.CrossRefPubMed
45.
Azad A, Maddison C, Stewart J. Radiation recall dermatitis induced by pazopanib. Onkologie. 2013;36(11):674–6.CrossRefPubMed
46.
Shukla PN, Gairola M, Mohanti BKRG. Prophylactic beclomethasone spray to the skin during postoperative radiotherapy of carcinoma breast: a prospective randomized study. Indian J Cancer. 2006;43:180–4.CrossRefPubMed
47.
Schmuth M, Wimmer MA, Hofer S, Sztankay A, Weinlich G, Linder DM, et al. Topical corticosteroid therapy for acute radiation dermatitis: a prospective, randomized, double-blind study. Br J Dermatol. 2002;146(6):983–91.CrossRefPubMed
48.
Miller RC, Schwartz DJ, Sloan JA, Griffin PC, Deming RL, Anders JC, et al. Mometasone furoate effect on acute skin toxicity in breast cancer patients receiving radiotherapy: a phase III double-blind, randomized trial from the North Central Cancer Treatment Group N06C4. Int J Radiat Oncol Biol Phys. 2011;79(5):1460–6.CrossRefPubMedPubMedCentral
49.
Hemati S, Asnaashari O, Sarvizadeh M, Motlagh BN, Akbari M, Tajvidi M, et al. Topical silver sulfadiazine for the prevention of acute dermatitis during irradiation for breast cancer. Support Care Cancer. 2012;20(8):1613–8.CrossRefPubMed
50.
Elliott EA, Wright JR, Swann RS, Nguyen-Tân FTC, et al. Phase III trial of an emulsion containing trolamine for the prevention of radiation dermatitis in patients with advanced squamous cell carcinoma of the head and neck: results of Radiation Therapy Oncology Group Trial 99-13. J Clin Oncol. 2006;24:2092–7.CrossRefPubMed
51.
Pommier P, Gomez F, Sunyach MP, D’Hombres A, Carrie C, Montbarbon X. Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol. 2004;22(8):1447–53.CrossRefPubMed
52.
Fenig E, Brenner B, Katz A, Sulkes J, Lapidot M, Schachter J, et al. Topical Biafine and Lipiderm for the prevention of radiation dermatitis: a randomized prospective trial. Oncol Rep. 2001;8(2):305–9.PubMed
53.
Fisher J, Scott C, Stevens R, Marconi B, Champion L, Freedman GM, et al. Randomized phase III study comparing best supportive care to biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation: radiation therapy oncology group (RTOG) 97-13. Int J Radiat Oncol Biol Phys. 2000;48(5):1307–10.CrossRefPubMed
54.
Abbas H, Bensadoun RJ. Trolamine emulsion for the prevention of radiation dermatitis in patients with squamous cell carcinoma of the head and neck. Support Care Cancer. 2012;20(1):185–90.CrossRefPubMed
55.
Nymann P, Hedelund L, Hædersdal M. Intense pulsed light vs. long-pulsed dye laser treatment of telangiectasia after radiotherapy for breast cancer: a randomized split-lesion trial of two different treatments. Br J Dermatol. 2009;160(6):1237–41.CrossRefPubMed
56.
Delanian S, Balla-Mekias S, Lefaix JL. Striking regression of chronic radiotherapy damage in a clinical trial of combined pentoxifylline and tocopherol. J Clin Oncol. 1999;17(10):3283–90.PubMed
57.
Kouvaris JR, Kouloulias VE, Plataniotis GA, Balafouta EJ, Vlahos LJ. Dermatitis during radiation for vulvar carcinoma: prevention and treatment with granulocyte-macrophage colony-stimulating factor impregnated gauze. Wound Repair Regen. 2001;9(3):187–93.CrossRefPubMed
58.
Ajani JA, Winter KA, Gunderson LL, Pedersen J, Benson AB, Thomas CR, et al. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA. 2008;299(16):1914–21.CrossRefPubMed
59.
Roy I, Fortin A, Larochelle M. The impact of skin washing with water and soap during breast irradiation: a randomized study. Radiother Oncol. 2001;58(3):333–9.CrossRefPubMed
60.
Westbury C, Hines F, Hawkes E, Ashley S, Brada M. Advice on hair and scalp care during cranial radiotherapy: a prospective randomized trial. Radiother Oncol. 2000;54(2):109–16.CrossRefPubMed
61.
Campbell IR, Illingworth MH. Can patients wash during radiotherapy to the breast or chest wall? A randomized controlled trial. Clin Oncol (R Coll Radiol). 1992;4(2):78–82.CrossRef
62.
Watson LC, Gies D, Thompson E, Thomas B. Randomized control trial: evaluating aluminum-based antiperspirant use, axilla skin toxicity, and reported quality of life in women receiving external beam radiotherapy for treatment of stage 0, I, and II breast cancer. Int J Radiat Oncol. 2012;83(1):e29–34.CrossRef
63.
Bennett C. An investigation into the use of a non-metallic deodorant during radiotherapy treatment: a randomised controlled trial. J Radiother Pract. 2009;8(01):3.CrossRef
64.
Théberge V, Harel F, Dagnault A. Use of Axillary deodorant and effect on acute skin toxicity during radiotherapy for breast cancer: a prospective randomized noninferiority trial. Int J Radiat Oncol Biol Phys. 2009;75(4):1048–52.CrossRefPubMed
65.
Gee A, Moffitt D, Churn M, Errington RD. A randomised controlled trial to test a non-metallic deodorant used during a course of radiotherapy. J Radiother Pract. 2000;1(04):205–12.CrossRef
66.
Omidvari S, Saboori H, Mohammadianpanah M, Mosalaei A, Ahmadloo N, et al. Topical betamethasone for prevention of radiation dermatitis. Indian J Dermatol Venereol Leprol. 2007;73(3):209.CrossRefPubMed
67.
Boström Å, Lindman H, Swartling C, Berne B, Bergh J. Potent corticosteroid cream (mometasone furoate) significantly reduces acute radiation dermatitis: results from a double-blind, randomized study. Radiother Oncol. 2001;59(3):257–65.CrossRefPubMed
68.
Kirova YM, Fromantin I, De Rycke Y, Fourquet A, Morvan E, Padiglione S, et al. Can we decrease the skin reaction in breast cancer patients using hyaluronic acid during radiation therapy? Results of phase III randomised trial. Radiother Oncol. 2011;100(2):205–9.CrossRefPubMed
69.
Primavera G, Carrera M, Berardesca E, Pinnaró P, Messina MGAG. A double-blind, vehicle-controlled clinical study to evaluate the efficacy of MAS065D (XClair), a hyaluronic acid-based formulation, in the management of radiation-induced dermatitis. Cutan Ocul Toxicol. 2006;25:165–71.CrossRefPubMed
70.
Liguori V, Guillemin C, Pesce GF, Mirimanoff RO, Bernier J. Double-blind, randomized clinical study comparing hyaluronic acid cream to placebo in patients treated with radiotherapy. Radiother Oncol. 1997;42(2):155–61.CrossRefPubMed
71.
Heggie S, Bryant GP, Tripcony L, Keller J, Rose P, Glendenning M, et al. A Phase III study on the efficacy of topical aloe vera gel on irradiated breast tissue. Cancer Nurs. 2002;25(6):442–51.CrossRefPubMed
72.
Williams MS, Burk M, Loprinzi CL, Hill MSP, et al. Phase III double-blind evaluation of an aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Radiat Oncol Biol Phys. 1996;36:345–9.CrossRefPubMed
73.
Wells M, Macmillan M, Raab G, MacBride S, Bell N, MacKinnon K, et al. Does aqueous or sucralfate cream affect the severity of erythematous radiation skin reactions? A randomised controlled trial. Radiother Oncol. 2004;73(2):153–62.CrossRefPubMed
74.
Evensen JF, Bjordal K, Jacobsen AB, Løkkevik E, Tausjø JE. Effects of Na-sucrose octasulfate on skin and mucosa reactions during radiotherapy of head and neck cancers—a randomized prospective study. Acta Oncol. 2001;40(6):751–5.CrossRefPubMed
75.
Lievens Y, Haustermans K, Van den Weyngaert D, Van den Bogaert W, Scalliet P, Hutsebaut L, et al. Does sucralfate reduce the acute side-effects in head and neck cancer treated with radiotherapy? A double-blind randomized trial. Radiother Oncol. 1998;47(2):149–53.CrossRefPubMed
76.
Maiche A, Isokangas OP, Gröhn P. Skin protection by sucralfate cream during electron beam therapy. Acta Oncol. 1994;33(2):201–3.CrossRefPubMed
77.
Dale PS, Tamhankar CP, George D, Daftary GV. Co-medication with hydrolytic enzymes in radiation therapy of uterine cervix: evidence of the reduction of acute side effects. Cancer Chemother Pharmacol. 2001;47(Suppl):S29–34.CrossRefPubMed
78.
Gujral MS, Patnaik PM, Kaul R, Parikh HK, Conradt C, Tamhankar CP, et al. Efficacy of hydrolytic enzymes in preventing radiation therapy-induced side effects in patients with head and neck cancers. Cancer Chemother Pharmacol. 2001;47(Suppl):S23–8.CrossRefPubMed
79.
Halperin EC, Gaspar L, George S, Darr DPS. A double-blind, randomized, prospective trial to evaluate topical vitamin C solution for the prevention of radiation dermatitis. Int J Radiat Oncol Biol Phys. 1993;26:413–6.CrossRefPubMed
80.
Röper B, Kaisig D, Auer F, Mergen E, Molls M. Thêta-Cream® versus Bepanthol® Lotion in breast cancer patients under radiotherapy: a new prophylactic agent in skin care? Strahlentherapie und Onkol. 2004;180(5):315–22.CrossRef
81.
Lin LC, Que J, Lin LK, Lin FC. Zinc supplementation to improve mucositis and dermatitis in patients after radiotherapy for head-and-neck cancers: a double-blind, randomized study. Int J Radiat Oncol Biol Phys. 2006;65(3):745–50.CrossRefPubMed
82.
Aygenc E, Celikkanat S, Kaymakci M, Aksaray F, Ozdem C. Prophylactic effect of pentoxifylline on radiotherapy complications: a clinical study. Otolaryngol Head Neck Surg. 2004;130(3):351–6.CrossRefPubMed
83.
Niazi TM, Vuong T, Azoulay L, Marijnen C, Bujko K, Nasr E, et al. Silver clear nylon dressing is effective in preventing radiation-induced dermatitis in patients with lower gastrointestinal cancer: results from a phase III study. Int J Radiat Oncol Biol Phys. 2012;84(3):e305–10.CrossRefPubMed
84.
Aquino-Parsons C, Lomas S, Smith K, Hayes J, Lew S, Bates AT, et al. Phase III study of silver leaf nylon dressing vs standard care for reduction of inframammary moist desquamation in patients undergoing adjuvant whole breast radiation therapy. J Med Imaging Radiat Sci. 2010;41(4):215–21.CrossRef
85.
Diggelmann KV, Zytkovicz AE, Tuaine JM, Bennett NC, Kelly LE, Herst PM. Mepilex Lite dressings for the management of radiation-induced erythema: a systematic inpatient controlled clinical trial. Br J Radiol. 2010;83(995):971–8.CrossRefPubMedPubMedCentral
86.
Lanigan SW, Joannides T. Pulsed dye laser treatment of telangiectasia after radiotherapy for carcinoma of the breast. Br J Dermatol. 2003;148(1):77–9.CrossRefPubMed
87.
Løkkevik E, Skovlund E, Reitan JB, Hannisdal E, Tanum G. Skin treatment with bepanthen cream versus no cream during radiotherapy: a randomized controlled trial. Acta Oncol. 1996;35(8):1021–6.CrossRefPubMed
Metadata
Title
Radiodermatitis: A Review of Our Current Understanding
Authors
Manni Singh
Afsaneh Alavi
Rebecca Wong
Sadanori Akita
Publication date
01-06-2016
Publisher
Springer International Publishing
Published in
American Journal of Clinical Dermatology / Issue 3/2016
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI
https://doi.org/10.1007/s40257-016-0186-4

Other articles of this Issue 3/2016

American Journal of Clinical Dermatology 3/2016 Go to the issue

Original Research Article

Moderate and Severe Inflammatory Acne Vulgaris Effectively Treated with Single-Agent Therapy by a New Fixed-Dose Combination Adapalene 0.3 %/Benzoyl Peroxide 2.5 % Gel: A Randomized, Double-Blind, Parallel-Group, Controlled Study

Letter to the Editor

Author’s Reply to Embi: “Oxidative Stress in Alopecia Areata: A Case–Control Study”

Current Opinion

Novel Oral Therapies for Psoriasis and Psoriatic Arthritis

Erratum

Erratum to: Neonatal Junctional Epidermolysis Bullosa: Treatment Conundrums and Ethical Decision Making

Review Article

The Role of the Nervous System in the Pathophysiology of Psoriasis: A Review of Cases of Psoriasis Remission or Improvement Following Denervation Injury

Review Article

Cutaneous T-Cell Lymphoma: A Review with a Focus on Targeted Agents