A randomized, prospective study using the LPG technique in treating radiation-induced skin fibrosis: clinical and profilometric analysis.

Background/purpose: Cutaneous fibrosis is the quite mandatory sequela after a breast cancer treated by radiotherapy and it induces more or less important functional troubles. The LPG technique is a technique of mechanical massage that allows skin mobilization by folding/unfolding. The aim of this study was to evaluate the changes on irradiated skin before and after LPG treatment by clinical and skin replica analysis.

Methods: Twenty women, 43-55 years old, who had been treated from 6 to 16 months before, for breast cancer with a conservative surgery and radiotherapy, had been enrolled in the trial. They were divided into two groups after randomization: the first group was LPG treated three times a week for 1 month; the second group was only placed under medical supervision. The clinical criteria studied were systematically studied before (T0), at the end of treatment (T1) and 1 month after the end of treatment (T2): pain, itching, skin dryness, erythema, skin infiltration, feeling of tightness and of induration of the skin. Softening of the skin was assessed at T1 and T2. Cutaneous replica was performed on the internal upper 1/4 of each breast with silicone material before, after and 1 month later after the end of the treatment. After polymerization, the replica was stored and then blindly analyzed by image analysis software. The following parameters were systematically measured: average skin roughness, average of wrinkles' depth and residual length, wrinkle number and the space between them.

Results: Clinically, the LPG treatment induced a decrease of erythema (10% of the patients vs. 40% before treatment), a decrease of pain and pruritus (10% vs. 20% and 40%, respectively) and a decrease of the feeling of induration of the skin (10% of the patients vs. 70% before treatment). Furthermore, a skin-softening sensation was noted by seven patients vs. one in the control group. Replica shows an increase of roughness and of furrow depth without any change in the residual length and an increase in the space between the wrinkles, whose number decreases.

Conclusion: This study confirms the impact of the clinical sequelae induced on skin after radiotherapy and shows improvement of the clinical signs after treatment by the LPG technique. The latter induces changes of micro relief, suggesting a softening effect on the skin. These preliminary results have to be confirmed on a more important group of patients.