Mepilex Lite: The Effect of Mepilex Lite Dressings on Acute Radiation-Induced Skin Reactions in Women Receiving Post-Mastectomy Irradiation

Abstract

Acute radiation-induced skin reactions are a common side effect of breast radiation therapy. Reactions range from erythema, through dry desquamation to moist desquamation and can be a source of significant pain, discomfort and psychological distress, sometimes resulting in a treatment break. There is no standard method for the prophylaxis or management of these reactions. Practice is often based on historical or anecdotal evidence and considerable variation in skin care practices exist.

The aim of this trial was to investigate whether Mepilex Lite dressings are superior to standard care in reducing the extent of acute radiation-induced skin reactions in patients receiving treatment for breast cancer post-mastectomy. Mepilex Lite (Mölnlycke Health Care AB, Göteborg, Sweden) is a thin, self-adhering, absorbent, soft silicone dressing designed for the management of wounds and burns. It was hypothesised that Mepilex Lite would reduce reactions by protecting the irradiated skin against mechanical damage caused by friction and abrasion from clothing or adjacent tissue.

A multicentre, open-label, randomised, intra-individual comparison of 80 patients is being conducted. This thesis analyses a subset of 10 patients recruited at the Wellington Blood and Cancer Centre. At the first sign of erythema, the erythematous patch was divided into two equal halves; one half was covered in Mepilex Lite, the other treated with aqueous cream. In the event of moist desquamation, Mepilex Lite continued over the intervention patch and the department’s standard dressing was used as the control. The Modified Radiation-Induced Skin Reaction Assessment Scale (RISRAS) was used to assess the outward signs (researcher component) and subjective symptoms (patient component) of the skin reaction three times a week during radiation therapy and once a week post-treatment until the reaction resolved. Patients also filled out an exit questionnaire on different aspects of the trial and the skin care agents.

Mepilex Lite dressings produced a significant decrease in the peak (p=0.019) and average (p=0.031) patient component of the RISRAS. This aligned with reports from the exit questionnaire. An anecdotal reduction in redness was supported by lower average (p=0.012) erythema RISRAS scores under the Mepilex Lite dressings. However, the decrease in peak erythema score and total researcher scores did not reach statistical significance in this small cohort. The impact of Mepilex Lite on moist desquamation could not be assessed in this small cohort due to the low incidence of moist desquamation in the study patches.

The results suggest that regardless of whether Mepilex Lite dressings reduce the visible signs of radiation-induced skin reactions in the final analysis of all 80 patients, its use may be justified based on the symptomatic relief it appears to provide in this small cohort.