Kedge, E.M. (2009). A systematic review to investigate the effectiveness and acceptability of interventions for moist desquamation in radiotherapy patients. Radiography, 15, 247–257.

To systematically review the currently available high-quality evidence evaluating treatments for moist desquamation in patients receiving radiotherapy

Databases used were AMED, BIOMED, BIOSIS, BNI, British Library Integrated Catalogue, CINAHL, Cochrane, Current Controlled Trials, DARE, Dissertation Abstracts, DoH Research Findings Register, EMBASE, HSRProj, IBSS, Index to Theses, ISI Wok, Medline, National Cancer Research Network, National Register of Cancer Trials, National Research Register, PROQUEST, and ZETOC. Keywords searched were radiotherapy, radiation therapy, deep x-ray therapy, irradiation, wounds, moist desquamation, desquamation burns, radiation burns, radiotherapy burns, broken skin, ulcers, wound healing, skin care, wound care, and epithelial. Studies were included if they

• Were randomized controlled trials or controlled clinical trials
• Investigated the impact of one or more interventions for moist desquamation in patients of any diagnosis receiving radiation therapy
• Included measurements of wound healing time or other skin integrity measures and some form of patient comfort or acceptability measure.

Studies were excluded if they

• Were not in a language where translation was available to the author
• Were published before 1990
• Did not have a control
• Investigated prophylactic agents or preventive interventions only.

The search returned 166 articles. Of these, 20 were relevant. Only 10 were included in the review. Studies were evaluated for quality using the CASP guidelines for clinical trials. Of the 10 studies that met inclusion criteria, none were judged to be of very poor quality, so all were included in the review. Studies were not homogenous in interventions or variables examined, so no meta-analysis was undertaken. A qualitative overview of results is presented.

• The total sample size across 10 studies was approximately 575.
• Some studies did not specify the number of patients in a control group.
• Most studies did not find a significant difference associated with interventions; two studies showed a statistically significant reduction in healing time in their intervention group (studies using gentian violet), and one study showed a significantly increased healing time in their intervention group (hydrogel).
• All studies examined the use of some type of topical skin treatment.

• Hydrogel and hydrocolloid dressings have been recommended by professional groups and are founded on moist wound healing principles; however, this review found conflicting evidence to support the use of either of these. It was noted that these can be very expensive and can leak.
• Limited evidence supports the effectiveness of other types of dressing.
• Limited evidence supports creams and other topical agents.
• Gentian violet was the most frequently used control substance. It was noted that this is no longer recommended by the department of health in the UK because of its carcinogenic potential.

No convincing evidence for any intervention was found. Evidence was mixed concerning the use of hydrogel and hydrocolloid dressings; however, improved patient comfort was sometimes seen with these. Other dressings studied did not show positive results and comparison dry dressings may cause injury of granulating tissue with daily removal for treatment. A number of other types of dressings that might be useful were briefly identified, but there are no reports of research using these yet. Limited evidence supports other interventions. Most findings with topical agents were equivocal. In one study, hydrocortisone cream appeared to reduce healing time (abstract only).

Although the author states that the 10 studies included were all of sufficient quality for use according to the guidelines used, results reported per study indicate that one study may have reported information that was untrue, one study was identified as being poorly reported with insufficient information, and one study was identified as fairly low quality.

Well-designed research in this area is urgently needed.