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Calendula for radiotherapy-induced skin reactions

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A 2016 review discusses the controversy surrounding the efficacy of topical calendula applications in treating and/or preventing radiodermatitis.

Calendula officinalis (calendula) contains various polyphenolic antioxidants that have been researched and reviewed in clinical settings. Studies have found inconclusive data that discusses the ability of calendula in the treatment or prevention of radiotherapy-induced skin reactions.[1]

Up to 95% of patients receiving radiotherapy suffer from radiation-induced skin damage.[1] Due to the significant prevalence rate of reactions, dosage constraints are strict to limit erythema, desquamation and skin toxicity reactions. The National Cancer Institute ranks severity of dermatitis on a scale of 1 to 4.[2]

Effective management if these types of skin reactions is crucial to a patient’s quality of life. Current medical models for treatment and management include barrier dressings (silicon based, Mepilex dressings) that are designed to be utilised after a skin reaction has already occurred[3]: Cavilon films which have shown some prophylaxis effects[4]; aqueous creams; washing skin; corticosteroids; and topical sucralfate.[1]

Due to the significantly high incidence of radiotherapy-induced skin reactions, patients are searching complementary therapies (CAM) to provide a safe solution. A 2003 study showed 49% of 200 cancer patients in regional New Zealand were using CAM.(5) At a radiation clinic in QLD Australia, 38% of 101 patients were utilising CAM.[6]

Calendula’s antioxidant, anti-inflammatory and vulunary capacity have been demonstrated effectiveness in reducing grade 2 or greater skin toxicity reactions in patients undergoing breast irradiation.[1] Calendula is capable of preventing oxidative stress, and has shown positive results in laboratory studies on increased survival rates of human skin when exposed to stressors.[1] Skin architecture, distensibility, firmness and viscoelasticity significantly improved with the application of calendula.

A randomised controlled trial compared calendula against prophylactic trolamine in preventing acute dermatitis grade 2 or greater in breast cancer patients receiving radiotherapy. Results indicated that calendula significantly decreased acute dermatitis, interruptions to radiation schedule and radiation-induced pain compared to the trolamine.[7]

The review highlighted interesting points about calendula’s capacity to heal and protect the dermis and epidermis after and during major exposure to radiation. Patients are seeking alternatives in complementary therapies to relieve pain and improve quality of life that is seriously impeded by radiotherapy-induced skin reactions and calendula may very well make a huge difference.

References:

  1. Kodiyan J, Amber KT. A review of the use of topical calendula in the prevention and treatment of radiotherapy-induced skin reactions. Antioxidant (Basel) 2015;4(2):293-303 [Full Text]
     
  2. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31:1341-1346. [Abstract]
     
  3. Paterson DB, Poonam P, Bennett NC, et al. Randomized intra-patient controlled trial of Mepilex Lite dressings versus aqueous cream in managing radiation-induced skin reactions postmastectomy. J Cancer Sci Ther 2012;4:347-356. [Full Text]
     
  4. Herst P. Protecting the radiation-damaged skin from friction: A mini review. J Med Radiat Sci 2014;61:119-125. [Full Text]
     
  5. Chrystal K, Allan S, Forgeson G, et al. The use of complementary/alternative medicine by cancer patients in a New Zealand regional cancer treatment centre. NZ Med J 2003;116:U296. [Abstract]
     
  6. Gillett J, Ientile C, Hiscock J, et al. Complementary and alternative medicine use in radiotherapy: What are patients using? J Altern Complement Med 2012;18:1014-1020. [Abstract]
     
  7. Pommier P, Gomez F, Sunyach MP, et al. Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol 2004;22:1447-1453. [Full Text]

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Paige Cowley

Paige Cowley studied nursing before finding her calling in natural medicine. Now a bachelor qualified naturopath working in clinical practice. Find her at paigecowley.com