Care of Patient with Radiation-Induced Skin Reactions

【Major points】

Radiation therapy may induce skin reactions such as skin redness, dry desquamation, moist desquamation, etc.
Use neutral, fragrance-free soap to gently pat or low pressure rinse the skin whenever taking a bath.
During treatment course, it is better to wear loose-fitting cotton clothing to avoid irritating the skin.
If you intend to use any lotion or skincare products, please discuss it with your doctor first.

Why is self-care necessary for managing skin reactions during radiation therapy?

Radiotherapy utilizes high-energy radiation to destroy tumor cells, preventing them from replicating and causing cell death. In each radiation therapy fraction, the radiation penetrates the skin in the treatment area, resulting in damage to the skin.

Skin reactions induced by radiation therapy are classified into the following four categories based on severity:
1. Skin redness: It occurs 2 to 3 weeks after radiation exposure. The skin in the irradiated area becomes red and warm. At this point, the skin experiences mild damaged, and treatment can still continue.
2. Dry desquamation: Typically happens around 3 weeks after first fraction of radiation treatment. The sebaceous glands in the treatment area are damaged, resulting in dry and sensitive skin with erythema, scaly desquamation, itching, and burning sensation. Despite these symptoms, radiation therapy can still proceed.
3. Moist desquamation: It occurs about 4 weeks after first fraction of radiation therapy. The damaged skin exhibits swelling, pain, or might develop blisters or severe skin peeling. At this stage, the doctor will carefully considerate whether it is necessary to temporarily suspend radiation therapy.
4. Skin necrosis: Involves atrophy of sweat glands and sebaceous glands, hair loss, dilation of capillaries, pigmentation, fibrosis, ulceration, bleeding and necrosis. At this time, radiation therapy should be halted.
The following factors could influence the degree of skin damage caused by radiation therapy:
1. The irradiated area has previously undergone radiation therapy.
2. Receive radiation therapy and chemotherapy at the same period of time.
3. Poor nutrition.
4. Advanced age, smoking, obesity, use of blood sugar-lowering medications or steroids, etc.

Who needs to use it?

For patients before, during, and after receiving radiation therapy, it is important to self-care for radiation-induced skin reactions daily in the correct manner. This can alleviate the severity of skin reactions, prevent and avoid acute skin injuries, severe moist desquamation, or skin necrosis, and enhance the patient's quality of life.

What items do I need to prepare?

Everyday personal hygiene items: Warm water, temperature below 40°C, unscented neutral soap, soft towels.
Moisturizing creams or skincare products: Calendula ointment, hyaluronic acid, hydrating lotions, hydrogel, etc.
Electric shaver: For male patients with irradiated areas on the head or neck, it's recommended to use an electric shaver instead of blades.
Prescription ointments: If dry or moist desquamation occurs, use prescription ointments as instructed by the doctor after each session.
Sterile gauze, sterile cotton swabs, saline solution or boiled and cooled water, silicone tape, silicone dressings, low-adherent or non-adherent dressings, moisturizing dressings: Use in case of moist desquamation.
Sitz bath: If the affected area is in the perineal region, use a warm sitz bath to promote cleanliness and comfort.

How should I proceed?

The skin care for the irradiated areas during each stage of radiation therapy is as follows:

After radiation simulation:
1. Please do not remove the marked lines on the treatment area . If the markings become unclear, they must be redrawn by the medical staff to ensure the correctness of the irradiation position, so as not to affect the treatment effect.
2. Minimize skin irritation, such as too cold or hot water; using skin products with perfume, fruit acid or alcohol, and refraining from using products that are difficult to clean thoroughly, such as Vaseline and baby powder, etc.
During treatment period:
1. Before each treatment, please clean the residual lotion or ointment on the skin.
2. Avoid swimming and hot spring to prevent skin damage from microorganisms or chlorine and other chemical substances in the water.
3. In the case of dry desquamation, after each irradiation, use the prescribed ointment under the instructions of your doctor and apply a thin layer evenly. Please avoid scratching or massaging the areas with desquamation.
4. In the case of moist desquamation, use saline solution or boiled cold water to apply wet compresses 3-4 times a day to soothe the skin reactions. Maintain good ventilation in the affected area as much as possible. If there is a significant amount of discharge from the affected skin, daily observation for signs of infection is necessary, including changes in the color, amount, nature, and odor of the secretion. Depending on the need, silicone tape, silicone dressings, low-adherent or non-adherent dressings, moisturizing dressings, etc., can be used for dressing changes. Dressings should be changed immediately if they become wet. Consultation with a wound care specialist may be necessary when needed.
After completing the course of radiation therapy:
1. After completing the treatment, the marked skin can be gently cleaned with water. Avoid scrubbing the skin too vigorously to prevent peeling.
2. Avoid cleaning and rubbing the treatment area with irritating disinfectants or detergents. Cleaning the area in a regular manner only when the skin has fully recovered.
3. Skin pigmentation may occur after treatment, and the color will gradually fade or diminish over time.

What should I pay attention to?

Please shower with water below 40℃. Avoid water that is too cold or too hot, and keep the shower time as short as possible.
Use neutral, unscented soap, and wash gently by patting with your palm or rinsing with low pressure. Then, pat dry with a soft towel.
If the skin in the irradiated area is intact without damage, after bathing or cleaning the area, you can apply moisturizing creams such as calendula ointment, hyaluronic acid, hydrophilic emulsion, or hydrogel. These can alleviate skin reactions like erythema and dry desquamation. If the skin is damaged, stop using these products and consult with your doctor before resuming.
For male patients with irradiated areas on the head and neck, it is recommended to use an electric razor for shaving. Do not use aftershave lotion after shaving.
If the irradiated area is in the perineal region, you can use a warm water sitz bath to promote cleanliness and comfort. (Further reading: Care for warm water sitz baths)
Clothing precautions:
1. During radiation therapy, it is adviced to wear loose-fitting cotton clothing to prevent synthetic fibers from irritating the skin.
2. Avoid direct exposure of the irradiated skin to sunlight. If exposure to sunlight exceeds fifteen minutes, you should wear long-sleeved clothes, pants, a hat, use an umbrellas, or other sun protection measures. Additionally, you can use sunscreen with UVA/UVB protection and an SPF of 30 or higher.
3. For those who receiving radiation on the neck, it is recommended to avoid wearing earrings, necklaces or stiff collars to minimize potential damage or friction to the irradiated skin.
Dietary considerations: Consume a diet rich in high-protein, high-calories food, and include foods high in vitamins B1, C, as well as magnesium, zinc, and other essential nutrients. This helps to improve nutrition and promote the repair of skin tissue. Food choices such as brown rice, whole wheat bread, oats, cereals germ, broccoli, kale sprouts, sesame seeds, peanuts, soy and its products, liver, oysters, lean pork, egg yolks, mushrooms, kiwi fruit, papaya, etc.

References

Chang, S.L., Wang, Y.C.L.(2023). Principles of the Management of Radiation-Induced Dermatitis. Formosa Journal of Clinical Pharmacy, 31(3), 178-188. https://doi.org/10.6168/FJCP.202307_31(3).0004
Finkelstein, S., Kanee, L., Behroozian, T., Wolf, J. R., van den Hurk, C., Chow, E., & Bonomo, P. (2022). Comparison of clinical practice guidelines on radiation dermatitis: a narrative review. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, 30(6), 4663–4674. https://doi.org/10.1007/s00520-022-06829-6
Song, Y., Zhang, R., Yao, T., Zhu, X., Liu, J., Deng, L., & Chen, P. (2021). Effect of team health education on radiodermatitis in patients with head and neck tumor radiotherapy under the joint committee international standards. Seminars in Oncology Nursing, 37(3), 151148. https://doi-org.vgharpa.vghtpe.gov.tw/10.1016/j.soncn.2021.151148

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