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Fractionated irradiation with X-rays or megavoltage is an important therapeutic option in the palliative treatment of Kaposi's sarcoma. We report on three HIV patients demonstrating bullous cutaneous eruptions in the irradiation field. Three homosexual men (age 45-60 y) stage of disease CDC 3C, were treated with fractionated soft X-rays with the scheme conventionally used by us (total dose 30 Gy, single doses 3 Gy). Immediately to three days after completion of treatment large blisters appeared within the irradiation field, resolving after 2-4 weeks, leaving post-inflammatory hyperpigmentation. The cause of this rare reaction to soft X-ray therapy, potentially suggesting an individually altered radiation sensitivity, is so far unknown. Controlled prospective studies applying different fractionation schemes will be necessary to better elucidate this issue.
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