Role of Topical Aloe vera Gel in the Recovery of High-grade, Radiation-induced Dermatitis

Introduction: Radiation-induced dermatitis (RID) is a common adverse effect of radiation therapy, in spite of skin-sparing effect of megavoltage. Approximately 90% of the patients who received radiation therapy may develop skin reaction of any grade during therapy, leading to therapy delays, diminution of patients' health state, and quality of life. It has been noticed by many authors that there are several topical agents available which may be used for the prevention of RID. In this study, we used topical Aloe vera gel for the treatment of high-grade radiation dermatitis. Materials and Methods: This prospective study was conducted on 85 patients of head and neck, breast, and cervical cancer during 2015-2016. All the patients have received external beam radiotherapy by cobalt-60, at least 46 Gy (dose completed with high-dose rate brachytherapy in cancer cervix). According to the Radiation Therapy Oncology Group skin reaction grading, patients with Grade III and Grade IV skin reaction were advised to use A. vera gel on irradiated area thrice daily with routine skin and nursing care. Results: In this study, head and neck cancer patients were 42%, breast 23%, and cervical 35%. Sixty-seven percent were female and 33% were male patients. The median age of the patients was 43.3 years (range, 25-70 years). The prescribed radiation doses were 46-70 Gy, 2 Gy per fraction, for treatment duration of 32-52 days, using a field size of 80-380 cm' according to the treatment site. Of 85 patients, 65 were treated with concurrent weekly chemotherapy. Grade III (65.8%) and Grade IV (34.1%) dermatitis occurred in the 5th week of radiotherapy, which causes treatment delay, ranging 2-10 days, according to the severity and patient-related factors. It has been noticed that after application of A. vera gel, dermatitis completely recovered within 3-7 days. The recovery time was prolonged in operated versus nonoperated patients of head and neck cancer. Conclusion: Rapid cell division in the skin leads to RID. 35%-40% of dose is received by the skin despite skin-sparing effect of megavoltage, and it increases in parallel opposing field. Till date, no treatment is available which can prevent RID. In our observational study, it was noticed that A. vera gel was effective in fast recovery of high-grade RID without any adverse reaction. This single-institution study is not large enough to justify its standardized use; further studies are required to establish A. vera gel as a treatment measure for RID.