Radiation Recall Dermatitis induced by Tamoxifen

Abstract

Introduction: Radiation recall dermatitis is an inflammatory skin reaction that occurs in a previously irradiated body part subsequent to drug administration, especially chemotherapy. Clinical case: A 52-year-old woman was diagnosed with invasive ductal carcinoma of the left breast in May 2008. She initially received neoadjuvant chemotherapy with doxorubicin and cyclophosphamide in a 4 series. In October 2008 was performed left sectorectomy with axillary lymphadenectomy followed again by chemotherapy with doxorubicin and cyclophosphamide. In the period January to February 2009, the patient received radiotherapy with 50 Gy in 20 fractions and an additional dose of 10 Gy in 5 fractions on the area of the axillary lymphadenectomy. A therapy with 20 mg/day of tamoxifen was commenced in April 2009. Three weeks after the therapy with tamoxifen was started, a localized pruriginous erythematous lesion occurred in a previously irradiated area. Treatment with topical corticosteroids and oral antihistamines led to partial resolution of radiation recall dermatitis allowing the continuation of tamoxifen. Discussion: Radiation recall dermatitis may occur after several minutes or days from administration of medication and from days to years after exposure to ionizing radiation. The precise mechanism of action for radiation recall dermatitis is yet not known, it is considered either an idiosyncratic drug hypersensitivity reaction or an increase of activity of some cytokines (IL-1, IL-6, TNF, TGF) released by radiotherapy when the medication was introduced. Conclusion: Radiation recall dermatitis should be suspected in patients who develop inflammatory reactions in previously irradiated areas.