Scoring systems for acute radiation dermatitis

Classification scale	Scores	Clinical description
RTOG	0	No change
	1	Erythema; dry desquamation, epilation
	2	Bright erythema, moist desquamation, edema
	3	Confluent moist desquamation, pitting edema
	4	Ulceration, hemorrhage, necrosis
NCI CTCAE	0	No change
	1	Faint erythema or dry desquamation
	2	Moderate to brisk erythema; patchy, moist desquamation, mostly confined to skin folds and creases; moderate edema
	3	Moist desquamation in areas other than skin folds and creases; bleeding induced by minor trauma or abrasion
	4	Life-threatening consequences; skin necrosis or ulceration of full thickness dermis; spontaneous bleeding from involved site; skin graft indicated
Radiation dermatitis severity	0.0	None
	0.5	Patchy or faint erythema; faint hyperpigmentation
	1.0	Faint, diffuse erythema; diffuse hyperpigmentation; mild epilation
	1.5	Definite erythema; extreme darkening/hyperpigmentation
	2.0	Definite erythema/hyperpigmentation with fine dry desquamation and mild edema
	2.5	Definite erythema/hyperpigmentation with branny/scaly desquamation
	3.0	Deep red erythema with diffuse dry desquamation; peeling in sheets
	3.5	Violaceous erythema with early moist desquamation; peeling in sheets; patchy crusting
	4.0	Violaceous erythema with diffuse moist desquamation; patchy crusting; ulceration; necrosis

RTOG: Radiation Therapy Oncology Group; NCI CTCAE: National Cancer Institute Common Terminology Criteria for Adverse Events.

References:

Ryan JL. Ionizing radiation: the good, the bad, and the ugly. J Invest Dermatol 2012; 132:985.
Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0, November 2017, National Institutes of Health, National Cancer Institute. Available at: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf (Accessed March 27, 2018).
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.
Okunieff P, Xu J, Hu D, et al. Curcumin protects against radiation-induced acute and chronic cutaneous toxicity in mice and decreases mRNA expression of inflammatory and fibrogenic cytokines. Int J Radiat Oncol Biol Phys 2006; 65:890.
Ryan JL, Ling M, Williams JP, et al. Curcumin intervention and plasma biomarkers for radiation dermatitis in breast cancer patients. J Invest Dermatol 2011; 131:S90.

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