In addition, all the patients in both arms were recommended to perform daily chest wall simple washing with mild soap. Three patients were excluded from the study: one developed grade IV dermatitis in the first week of intervention and did not meet the inclusion criteria, and two patients developed severe pain following topical application and declined

to participate Inhibitors,research,lifescience,medical (selleck kinase inhibitor figure 1). Figure 1 This is a depiction of the CONSORT flow diagram of 60 breast cancer patients, who developed chest wall radiation dermatitis Dermatitis grade was determined according to the Common Terminology Criteria for Adverse Events (version 4.0). Dermatitis grade 2 was defined as moderate to brisk erythema, patchy moist desquamation mostly confined to skin folds and creases, and moderate edema of the irradiated chest wall. Dermatitis grade 3 was defined as moist desquamation in areas other than skin folds and creases, bleeding induced Inhibitors,research,lifescience,medical by minor trauma, or abrasion of the chest wall.11 Radiation portals were composed of chest wall fields in all the patients and supraclavicular, post-axillary, and internal mammary fields in most of them. Optimization of the skin dose to reach the prescribed total radiation Inhibitors,research,lifescience,medical dose was achieved by treating the chest wall fields in

all the patients in both arms with superficial X-ray (120 KV, 10 mA, 2 mm Al filtration, 4 mm Al half-value layer) and with a daily fraction of 1.8-2 Gy (five fractions per week). All the patients had to receive a total dose of 45-50.4 Inhibitors,research,lifescience,medical Gy. In the control arm, topical hydrocortisone cream (1%) was used with daily washing of the chest wall area; and in the study arm, topical Alpha ointment was used in a similar manner. Detailed instructions on topical hydrocortisone cream (1%) and topical Alpha ointment were given to each patient as

follows: the patients in both arms were instructed to apply a thin layer of the topical agents twice a day over the chest wall field, beginning on the day of Inhibitors,research,lifescience,medical the last session of radiotherapy and continuing every day for 3 weeks. Alpha ointment is a combination of Lawson (natural Henna) and unsaturated fatty acids. Lawson is the main component of Alpha ointment extracted from Lawsonia inermis. All of the patients were followed up for 3 weeks after ALOX15 developing radiation dermatitis. During this period, each patient was examined every week. Dermatitis grade, patients’ age, breast cancer stage, and dermatitis area (cm2) were recorded in our data sheet before the commencement of intervention. Subsequently, the dermatitis area (cm2) was measured independently by 2 physicians in each examination until 3 weeks after the start of intervention. Irregular dermatitis area was estimated in each patient using a grid paper.