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Radiation-induced eosinophilic, polymorphic, and pruritic eruption in a pig skin model


Eosinophilic, polymorphic and pruritic eruption associated with radiotherapy (EPPER) can occur in cancer patients after irradiation. In this study, we characterized the clinical and histopathological features of pig skin that developed widespread polymorphic and pruritic skin lesions following localized 50 Gy gammairradiation. The pigs developed pruritus 5–7 weeks after irradiation, and infiltration of the dermis by eosinophils was detected 4–7 weeks after irradiation. The irradiated animals also showed transiently increased numbers of peripheral eosinophils 5–7 weeks after treatment. Irradiation induced desquamation after 2–4 weeks, which and the desquamation gradually resolved after 7 weeks. These pathological changes correspond to those seen in irradiated human skin, indicating that this model could be useful for elucidating the pathogenesis of EPPER and for developing therapeutic and prophylactic methods.


  1. Davis J, Pack GT. Erythema multiforme following deep x-ray therapy. AMA Arch Derm Syphilol 1952; 66(1): 41–48.

    Article  CAS  Google Scholar 

  2. Dedick AP Jr, Whelan VM. Generalized skin reaction following deep x-ray therapy. Radiology 1959; 72(5): 751–753.

    Article  Google Scholar 

  3. Duschet P, Schwarz T, Gschnait F. Bullous pemphigoid after radiation therapy. J Am Acad Dermatol 1988; 18(2): 441–444.

    Article  CAS  Google Scholar 

  4. García-Donoso C, Tardío JC, Arias D, Romero A, Borbujo JM. Eosinophilic, polymorphic and pruritic eruption associated with radiotherapy (EPPER) in two patients with breast tumour. J Eur Acad Dermatol Venereol 2007; 21(8): 1102–1104.

    Article  Google Scholar 

  5. Lee DJ, Kim YC. A pustular form of eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy. J Am Acad Dermatol 2011; 65(2): e51–53.

    Article  Google Scholar 

  6. Rueda RA, Valencia IC, Covelli C, Escobar C, Alzate A, Saldarriaga B, Sanclemente G, Blank A, Falabella R. Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy. Arch Dermatol 1999; 135(7): 804–810.

    Article  CAS  Google Scholar 

  7. Lam Cham Kee HX, Charra-Brunaud C, Cuny JF, Reigneau M, Vogin G, Peiffert D. [Case report of EPPER Syndrome (eosinophilic polymorphic pruritic eruption associated with radiotherapy) in a patient treated against endometrial cancer]. Cancer Radiother 2013; 17(1): 54–57.

    Article  Google Scholar 

  8. Shimamoto N, Shirase T, Yoshikawa Y. Vesicular form of eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy confined to the irradiated area. J Dermatol 2013; 40(3): 228–229.

    Article  Google Scholar 

  9. Sullivan TP, Eaglstein WH, Davis SC, Mertz P. The pig as a model for human wound healing. Wound Repair Regen 2001; 9(2): 66–76.

    Article  CAS  Google Scholar 

  10. Kim JS, Rhim KJ, Jang WS, Lee SJ, Son Y, Lee SS, Park S, Lim SM. β-irradiation (¹Ho patch)-induced skin injury in mini-pigs: effects on NF-κB and COX-2 expression in the skin. J Vet Sci 2015; 16(1): 1–9.

    Article  Google Scholar 

  11. Hill PB, Lau P, Rybnicek J. Development of an owner-assessed scale to measure the severity of pruritus in dogs. Vet Dermatol 2007; 18(5): 301–308.

    Article  CAS  Google Scholar 

  12. Spry CJ, Davies J, Tai PC, Olsen EG, Oakley CM, Goodwin JF. Clinical features of fifteen patients with the hypereosinophilic syndrome. Q J Med 1983; 52(205): 1–22.

    CAS  PubMed  Google Scholar 

  13. van den Hoogenband HM. Skin lesions as the first manifestation of the hypereosinophilic syndrome. Clin Exp Dermatol 1982; 7(3): 267–271.

    Article  Google Scholar 

  14. Kurohara SS, Hempelmann LH, Englander CL, Fuller LM, Rubin P. Eosinophilia after exposure to ionizing radiation. Radiat Res 1964; 23(3): 357–368.

    Article  CAS  Google Scholar 

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Correspondence to Joong Sun Kim or Seung Sook Lee.

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Kim, J.S., Jang, W.S., Bae, M.J. et al. Radiation-induced eosinophilic, polymorphic, and pruritic eruption in a pig skin model. Lab Anim Res 31, 204–208 (2015).

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