What is radiotherapy?
Radiotherapy is the use of high-energy radiation that destroys tumor cells to prevent them from replicating. In each radiotherapy, the radiation will pass through the skin of the treated area, resulting in skin damage.
What are the symptoms of skin reactions to radiotherapy?
The skin reaction symptoms caused by radiotherapy can be divided into the following four categories, according to their severity:
  1. Skin redness: It occurs within 2 to 3 weeks after radiation exposure. The skin of the treated area appears reddish and has a fever reaction. Although the skin is slightly injured at this time, the treatment can still be continued.
  2. Dry desquamation: It occurs within 3 weeks after radiotherapy. The sebaceous glands in the treated area are destroyed, resulting in dry skin, mild to moderate erythema, moderate sensitivity, scaly desquamation, and itching and burning sensation. Nevertheless, radiotherapy can still be continued.
  3. Wet desquamation: It occurs within about 4 weeks after radiotherapy, and the damaged skin begins to show symptoms, such as edema and pain. If the skin of the treated area is blistered or severely peeled off, there is a need to consider suspending radiotherapy for the skin cells in the treated area to repair.
  4. Skin necrosis: The symptoms include atrophy of sweat and sebaceous glands, hair loss, telangiectasia, pigmentation, fibrosis, and ulcer necrosis. The radiotherapy needs to be stopped at this time.
What conditions will aggravate the skin reaction during radiotherapy?
The severity of skin reactions depends on the area and scope of treatments and the total dose of radiotherapy. The following factors will also affect the level of skin damage in radiotherapy:
  1. Concurrently receiving radiotherapy and chemotherapy.
  2. The treated area has been treated with radiotherapy.
  3. Malnutrition.
  4. Age, smoking, obesity, and the use of hypoglycemic medications or steroids can also affect skin reactions.
Reminders for self-care during radiotherapy:
  1. Daily personal cleaning: 
    1. Please shower with warm water below 40℃. The water temperature should not be too cold or too hot. Use neutral, non-scented soap and wash the skin with a gentle palm or low-pressure rinse. Then, pat dry the skin with a soft towel—avoid directly rubbing the skin of the treated area.
    2. If the treated area of a male patient is the head and neck, it is recommended to use an electric razor instead of razor blades and use moisturizer after shaving.
  2. Reminders for clothing:
    1. Patients with breast cancer should not wear a bra during radiotherapy and should only wear cotton underwear to avoid excessive skin stimulation on the treated area.
    2. Choose loose and soft cotton clothes, and avoid synthetic fiber clothes.
    3. Avoid directly exposing the treated area to the sun. If exposed to the sun for more than 15 minutes, patients may apply sunscreen with UVA/UVB, SPF30, or higher for protection. Patients should wear long-sleeved clothes, hats, and umbrellas to avoid direct exposure to sunlight.
    4. For patients with treatments on the neck, it is recommended not to wear earrings, necklaces, or a hard-collared shirt to reduce friction and damage to the treated area.
  3. Skincare for the treated area:
    1. The markings of the radiotherapy range cannot be removed without the permission of the physician. If the markings are blurred, they must be redrawn by the healthcare staff to ensure the correctness of the markings and the accuracy of the treatment. Inaccuracy of the treated area may affect the effectiveness of the treatment.
    2. Do not use topical skin products containing irritating ingredients such as perfume, fruit acid, or alcohol on the treated area to avoid skin sensitivity. Do not use petroleum jelly or baby powder, which is difficult to remove and may cause infection.
    3. Preventive use of the painless protective film 2-3 times a week can reduce the occurrence of wet desquamation skin reactions. On the other hand, use the moisturizing calendula ointment, hyaluronic acid, hydrophilic cream, and hydrogel 3 times a day to reduce skin reactions, such as erythema and dry desquamation. Discuss with the attending physician before using these products. If the skin is damaged, the use of such products should be suspended.
    4. Avoid using creams before radiotherapy to avoid increased radiation dose to the epidermis.
    5. Avoid exposing the skin of the treated area to stimuli of excessive coldness or heat, such as ice water, ice packs or hot water, hot water bottles, thermos bottles, and lamps.
    6. It is forbidden to stick tape on the skin of the treated area.
    7. Avoid swimming in lakes, hot springs, and swimming pools to prevent microbes or chemicals, such as chlorine in the water, from irritating the treated area and causing skin damage.
  4. In case of dry desquamation in the skin of the treated area, attention should be paid to the following matters:
    1. A prescription ointment can be used under the instructions of the physician. When using it, only apply a thin layer of ointment to the treated area after each radiotherapy. Do not apply a thick layer of ointment.
    2. Remember not to scratch or massage the area that has skin reactions.
  5. In case of wet desquamation of the skin, attention should be paid to the following matters:
    1. Saline or cooled boiled water can be used 3-4 times a day as a wet compress to soothe skin reactions. Keep the treated area as ventilated as possible.
    2. If there is a large amount of secretion on the skin of the treated area, it should be kept clean and dry. Observation must be made every day for signs of infection, such as changes in the color, volume, nature, and smell of the secretion. If the dressing is wet, it must be replaced immediately. If the treated area is on the perineum, it can be rinsed with warm water to improve cleanliness and comfort.
    3. Ingest more high-protein, high-calorie, vitamin B1, vitamin C, and foods rich in magnesium and zinc to supplement nutrition and improve skin tissue repair.
Self-care of skin reactions after radiotherapy: 
  1. After the treatment, the skin markings can be washed slowly with water. However, avoid excessive washing to prevent peeling.
  2. The treated area should not be cleaned and rubbed with irritating disinfectants or detergents. The skin can be cleaned in the usual way only when fully restored to its normal state.
  1. Lam, E., Yee, C., Wong, G., Popovic, M., Drost, L., Pon, K., Danny Vesprini, D., Lam, H., Aljabri, S., Soliman, H., DeAngelis, C., & Chow, E. (2020). A systematic review and meta-analysis of clinician-reported versus patient-reported outcomes of radiation dermatitis. The Breast, 50, 125-134. https://doi.org/10.1016/j.breast.2019.09.009
  2. Ferreira, E. B., Ciol, M. A., Vasques, C. I., Bontempo, P. D. S. M., Vieira, N. N. P., Silva, L. F. O. E., Avelino, S.R., Santos, M. A.D., & Dos Reis, P. E. D. (2016). Gel of chamomile vs. urea cream to prevent acute radiation dermatitis in patients with head and neck cancer: A randomized controlled trial. Journal of Advanced Nursing, 72(8), 1926-1934. https://doi.org/10.1111/jan.12955
  3. Tseng, Y. H., Hsu, M. Y., Lin, Y. P., Hsu, H. H., Yang, P. W., Wang, S. C., Chung, H. C. (2018). A Project to Improve Skin Self-Care for Patients Receiving Radiation Therapy.  Tzu Chi Nursing Journal, 17(5), 77-88〪https://doi.org/10.6974/TCNJ
  4. Wolf, J. R., Gewandter, J. S., Bautista, J., Heckler, C. E., Strasser, J., Dyk, P., Anderson, T., Gross, H., Speer, T., Dolohanty, L., Bylund, K., Pentland, A.P., & Morrow, G. R. (2020). Utility of topical agents for radiation dermatitis and pain: A randomized clinical trial. Supportive Care in Cancer, 28(7), 3303-3311. https://doi.org/10.1007/s00520-019-05166-5
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