Topical glyceryl trinitrate treatment in chronic radiation dermatitis

Chronic radiation dermatitis is a common long term functional and cosmetic sequelae of radiation therapy and can pose a persistent therapeutic challenge. The condition is characterised by persistent poikilodermatous changes including subcutaneous fibrosis, skin atrophy, pigmentation changes, ulceration and recalcitrant telangiectasia. Treatment modalities are diverse including topical corticosteroids, hyperbaric oxygen, recombinant PDGF and Pentoxifylline in combination with Vitamin E. These management options have been associated with variable levels of success but significant financial cost.
We present two cases of biopsy proven cutaneous radiation dermatitis with ulceration treated successfully with topical glyceryl trinitrate. Both patients were followed up for a period of 18 months with complete resolution of ulceration and significant textural improvement in the surrounding areas of fibrosis. The well documented vasodilation effects of glyceryl trinitrate, when applied topically to skin acts to reverse the processes of dermal ischaemia, microvascular occlusion and fibrosis seen in chronic radiation dermatitis.
Therefore, we propose topical glyceryl trinitrate as a low-cost and effective alternate treatment option for cutaneous chronic radiation dermatitis. However, the success of treatment is subject to patient compliance given the time-frame required for clinical improvement.

Dr. Justin Bui

Department of Dermatology, Fiona Stanley Hospital, Murdoch, Western Australia

Justin is the dermatology resident at Fiona Stanley Hospital in Western Australia. He also the Chair of the Postgraduate Medical Council of Western Australia JMO Forum and recipient of the 2016 Junior Doctor of the Year Award for outstanding contribution to prevocational medical education