Efficacy of potent topical corticosteroid (betamethasone valerate 0.1%) compared with mild topical corticosteroid (hydrocortisone 1%) in the management of acute radiodermatitis

Abstract

Background In clinical radiotherapy, most of the patients tolerate dosage of radiation without any side effects. However, some patients develop adverse effects, which may be mild or moderate in severity. Approximately 5-10% of the subjects do show acute or chronic reactions. The acute skin reaction begins during the first 7-10 days following radiotherapy. Epilation and desquamation follow with increasing dosage. There is a substantial lack of evidence-based treatments for this condition.Objective The study was targeted at determining the comparative efficacy of potent topical corticosteroid (betamethasone valerate 0.1%) cream and mild potency topical corticosteroid (hydrocortisone 1%) cream in the management of acute radiation dermatitis.Patients and methods The current study was carried out in the follow up clinic of Karachi Institute of Radiotherapy and Nuclear Medicine, over a period of 3 months from 1st October 2004 to 31st December 2004. All patients presenting with the features of acute radiation dermatitis during the above period fulfilling the selection criteria were enrolled. All these patients were on photon or/and electron therapy. The patients were studied in 2 groups labeled A and B. The patients in the group A were given once daily application of hydrocortisone 1% cream, while the group B subjects were managed with betamethasone valerate 0.1% cream applied once daily. The patients were followed up on 5th, 7th, 10th and 15th day of therapy.Results A total of 50 patients were included in the study comprising 28 females (56%) and 22 males (44%). Both the groups i.e. A and B contained 14 females and 11 males each. The age range was 25-70 years, the mean being 48.2 years. In group B, all the patients responded with a significant decrease in the erythema and exudation by the 5th day (p<0.001). The patients in the group A showed a little improvement by the end of 5th day, but definite improvement by the 7th day (p<0.001). By the 10th day, patients in group B were left with residual pigmentation while group A subjects had mild erythema. Both the groups had residual pigmentation at the end of 15th day.Conclusion Both potent and mild potency topical corticosteroids are effective in the management of acute radiation dermatitis, but potent steroids produce an earlier response.