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edema&#44; and tiny papules&#44; followed by blisters and erosions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The dermoscopy showed multiple brown circles along with the hair follicles as well as scales &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The histopathology revealed intraepidermal vesiculation&#44; papillary dermal edema&#44; and perivascular inflammatory infiltrate in the upper dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A diagnosis of radiation recall dermatitis &#40;RRD&#41; induced by ibuprofen was made&#46; The patient was relieved after 1 week of treatment with oral loratadine and topical 0&#46;05&#37; halometasone cream&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">RRD is an uncommon acute dermatitis at regions of the previous radiotherapy in response to drug administration&#46; The most commonly implicated medications are anticancer drugs&#44; in particular cytotoxics&#44; but other drugs can also induce RRD&#44; including antibiotics&#44; antituberculosis drugs&#44; nimesulide&#44; phentermine&#44; and simvastatin&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Chu et al&#46; reported only one case of RRD following topical agents&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> RRD can occur at any time between days to years after radiation exposure&#46; The time to develop the reaction may be longer for oral than intravenously administered drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> RRD is drug-specific for any individual&#59; it is impossible to predict which individuals will react to which drugs&#44; and rechallenge does not uniformly cause a reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Several possible explanations for the pathogenesis of RRD have been proposed including memory reaction of surviving epithelial stem cells&#44; radiation-induced mutation&#44; post-radiation vascular damage&#44; and hypersensitivity reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Most of the time&#44; RRD presents as erythema&#44; papules&#44; edema&#44; vesicles&#44; desquamation&#44; or even ulceration&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The area affected by RRD corresponds to the site previously irradiated&#44; although may occasionally become generalized&#46; The histological appearance is nonspecific and sometimes overlaps with acute radiation dermatitis&#46; It is important to note however&#44; radiation recall reactions may involve deep tissues and organs&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">To our knowledge&#44; there have been no reports of RRD induced by ibuprofen&#46; This is the second case of RRD following a non-steroidal anti-inflammatory drug&#44; and the first was induced by nimesulide&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The dermoscopic manifestation shows a brown circle around the hair follicle that is similar to the dermoscopic appearance of lichen pilaris&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Li-wen Zhang and Juan Wu contributed equally to this work&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Li-wen Zhang&#58; Study conception and planning&#59; preparation and writing of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Juan Wu&#58; Literature review&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Lu Zheng&#58; Acquisition of data&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Tao Chen&#58; Approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Letter - Clinical
Radiation recall dermatitis induced by ibuprofen
Li-wen Zhanga, Juan Wub, Lu Zhenga, Tao Chena,
Corresponding author
13980427003@163.com

Corresponding author.
a Department of Dermatovenereology, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
b Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The histopathology revealed intraepidermal vesiculation&#44; papillary dermal edema&#44; and perivascular inflammatory infiltrate in the upper dermis &#40;Hematoxylin &#38; eosin&#44; &#215;100&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 31-year-old female presented with a 1-week history of burning&#44; painful and pruritic skin eruptions affecting the left chest and axillary region&#46; She had previously undergone a modified radical mastectomy and lymph node dissection for ductal breast carcinoma 1 year ago&#46; Then&#44; the patient has prescribed 24 weeks of chemotherapy with doxorubicin&#44; cyclophosphamide&#44; and paclitaxel&#46; Two months ago&#44; she was treated with 3-dimensional conformal radiation therapy &#40;50&#8239;Gy&#58; 25 fractions for five weeks&#41;&#46; Mild erythema and scales with pruritus were observed at the end of radiotherapy and subsided with 0&#46;05&#37; desonide cream within several days&#46; Six days before the eruptions appeared&#44; she had taken ibuprofen orally for arthralgia&#46; The inflammatory eruptions involved the areas previously treated with radiation and initially manifested well-demarcated rectangular erythema&#44; edema&#44; and tiny papules&#44; followed by blisters and erosions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The dermoscopy showed multiple brown circles along with the hair follicles as well as scales &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The histopathology revealed intraepidermal vesiculation&#44; papillary dermal edema&#44; and perivascular inflammatory infiltrate in the upper dermis &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A diagnosis of radiation recall dermatitis &#40;RRD&#41; induced by ibuprofen was made&#46; The patient was relieved after 1 week of treatment with oral loratadine and topical 0&#46;05&#37; halometasone cream&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">RRD is an uncommon acute dermatitis at regions of the previous radiotherapy in response to drug administration&#46; The most commonly implicated medications are anticancer drugs&#44; in particular cytotoxics&#44; but other drugs can also induce RRD&#44; including antibiotics&#44; antituberculosis drugs&#44; nimesulide&#44; phentermine&#44; and simvastatin&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Chu et al&#46; reported only one case of RRD following topical agents&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> RRD can occur at any time between days to years after radiation exposure&#46; The time to develop the reaction may be longer for oral than intravenously administered drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> RRD is drug-specific for any individual&#59; it is impossible to predict which individuals will react to which drugs&#44; and rechallenge does not uniformly cause a reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Several possible explanations for the pathogenesis of RRD have been proposed including memory reaction of surviving epithelial stem cells&#44; radiation-induced mutation&#44; post-radiation vascular damage&#44; and hypersensitivity reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Most of the time&#44; RRD presents as erythema&#44; papules&#44; edema&#44; vesicles&#44; desquamation&#44; or even ulceration&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The area affected by RRD corresponds to the site previously irradiated&#44; although may occasionally become generalized&#46; The histological appearance is nonspecific and sometimes overlaps with acute radiation dermatitis&#46; It is important to note however&#44; radiation recall reactions may involve deep tissues and organs&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">To our knowledge&#44; there have been no reports of RRD induced by ibuprofen&#46; This is the second case of RRD following a non-steroidal anti-inflammatory drug&#44; and the first was induced by nimesulide&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The dermoscopic manifestation shows a brown circle around the hair follicle that is similar to the dermoscopic appearance of lichen pilaris&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Li-wen Zhang and Juan Wu contributed equally to this work&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Li-wen Zhang&#58; Study conception and planning&#59; preparation and writing of the manuscript&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Juan Wu&#58; Literature review&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Lu Zheng&#58; Acquisition of data&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Tao Chen&#58; Approval of the final version of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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