Favre-Racouchot Syndrome Following Image-Guided Superficial Radiation Therapy

Background: Favre-Racouchot Syndrome (FRS) is a cutaneous disease characterized by nodules, cysts, and comedones located in sun-exposed areas of the face, such as the bilateral temporal and periorbital skin. FRS is associated with chronic sun exposure, cigarette smoking, and rarely with radiation therapy. Case Information: We present the first recorded cases of Favre-Racouchot Syndrome occurring in the setting of image-guided superficial radiation therapy (IG-SRT). A 68-year-old male with a history of nodular BCC on the forehead and right arm presented for a lesion on his forehead. The patient was being treated with IG-SRT #_msocom_1to the affected areas, and he initially noticed the lesion within the radiation treatment field during the 6th week of treatment (about 75% of the way through his treatments). Also, a 59-year-old female with a history of nodular BCC on the right nasal ala, that was treated with IG-SRT, presented for a lesion on her nose. The lesion was first noted during her 2-week follow-up visit after completing her IG-SRT treatments. Both of the patients in our cases were actively smoking tobacco products throughout their radiation treatments. Our cases differ from the prior reported cases due to the form of radiotherapy being used. It is important to note that the patient in Case 1 had additional NMSCs on the forearm and trunk. The forearm BCC was treated at the same time as the forehead lesion. The trunk lesion began treatment 6 months after the forehead and forearm lesions were treated. Neither of these treatment sites developed comedones. This shows that the location of the lesion may play a role in the development of FRS, especially in those actively smoking tobacco products during treatment. Conclusion: The combination of underlying chronic actinic damage, radiation, and tobacco use may increase the risk of developing FRS. Tobacco use in conjunction with radiation treatment may have a synergistic effect. As IG-SRT is becoming increasingly more prevalent as a treatment for non-melanoma skin cancers, it is important to monitor for adverse events and complications.