How to prevent, respond to, and manage acute skin reactions caused by radiation therapy?
Preface
When high-energy radiation is used to kill cancer cells in radiation therapy, it also directly affects healthy skin cells. This can cause skin detachment, itching, or injury. In most cases, skin problems caused by radiation therapy are not serious and will improve a few weeks after treatment. But skin changes such as itching during this period may be very uncomfortable. The infection or ulcer caused by radiotherapy on the skin may also cause significant pain, which may lead to interruption or suspension of radiotherapy. If skin reactions become a problem, radiation therapy doctors may need to change the patient's radiation dose or schedule until the condition improves. Some patients may experience late skin reactions that may not disappear or occur several years after radiotherapy.
However, most skin conditions caused by radiation therapy are managed through methods that effectively predict, evaluate, and manage skin related issues, which can help alleviate the pain caused by these symptoms and improve the quality of life during and after radiation therapy.
This article will help cancer patients and their families who receive radiation therapy understand what acute skin reactions radiation therapy can cause, what factors are related to the severity of skin reactions, why these skin reactions occur after radiation therapy, and how patients and their families should properly care for their skin. Subsequent articles will discuss the late stage skin reactions caused by radiotherapy.
Related medical terminology explanation: Some patients with skin damage after radiotherapy may need to seek medical attention from a specialized dermatologist. Dermatologists generally refer to skin damage after radiation therapy as "radiation dermatitis", which is similar to the "skin damage", "toxic side effects", and "skin changes" caused by radiation therapy. These medical terms correspond to various symptoms exhibited by patients after radiation therapy, such as erythema, rash, blisters, ulcers, and other symptoms of radiation dermatitis/radiation induced skin damage.
Key Information
According to literature reports, about 90% of patients undergoing radiotherapy experience varying degrees of skin damage, mostly mild to moderate.
During radiotherapy, skin changes are common and predictable. Everyone responds differently to radiation therapy.
Surgical treatment, radiation therapy, chemotherapy, targeted therapy, hormone therapy, immunotherapy, etc. may all cause skin reactions. The combination of multiple therapeutic factors may lead to more severe skin reactions during radiotherapy, such as synchronous radiotherapy and chemotherapy, synchronous targeted therapy, and radiotherapy.
Most of the time, prevention is the best way to solve skin problems caused by radiation therapy. Positive measures such as smoking cessation and weight loss can effectively reduce or prevent skin problems caused by radiation therapy.
How to manage skin reactions caused by radiotherapy is an ongoing research topic, and there are multiple management modes in clinical practice. Each radiotherapy department has different ways of managing skin, and the effectiveness varies.
Response of normal skin to radiation therapy
Skin reactions are a common side effect of radiotherapy, caused by radiation passing through rapidly dividing normal tissues such as skin and mucous membranes. The earliest reports of skin changes caused by radiation therapy can be traced back to 9 months after Roentgen discovered X-rays in 1896. Skin tolerance was once one of the limiting factors for early radiotherapy. But modern megavolt level high-energy radiotherapy equipment and increasingly complex radiotherapy planning methods not only enhance the killing power of cancer cells, but also enhance the protection ability of normal skin, reducing the incidence of serious skin complications. Therefore, concerns about skin damage caused by radiation therapy should not be a reason for fear or resistance to radiation therapy.
However, radiation therapy can still lead to certain acute and late stage side effects on the skin, which can be expected and inevitable in certain situations. As shown in the figure below, radiation must enter, exit, or deposit near the skin to reach the target volume of irradiation. Skin cells are derived from rapidly regenerating and differentiating stem cells, which are relatively sensitive to radiation. The skin reaction is the result of an inflammatory response of the skin to direct DNA damage caused by high-energy radiation (the same goes for ultraviolet sunburn in sunlight), as well as the depletion of active proliferating cells in the renewal cell population.
Skin damage caused by radiotherapy is one of the most common toxicity related to radiotherapy, and according to literature records, up to 90% of radiotherapy patients experience some degree of skin damage.
Within a few days after the first radiotherapy, skin changes caused by radiotherapy will occur. The acute phase reaction of radiotherapy occurs during and within 6 weeks after radiotherapy, and skin reactions may worsen with increasing frequency of radiotherapy. After treatment, skin damage may continue to worsen for 7-10 days. Late stage skin reactions occur from months to years of exposure to radiation. The acute response to radiotherapy is usually considered temporary, as normal cells are usually able to repair. Late stage skin reactions are usually permanent and may become more severe over time. The severity of acute and late stage reactions depends on the dose of a single radiotherapy, the total dose administered, the duration of radiotherapy, and the volume of tissue receiving radiotherapy. The presence and severity of acute skin reactions can predict the late stage skin response to radiotherapy. Late skin reactions such as tissue fibrosis or necrosis can occur independently of acute skin reactions. In the future, we will specifically discuss the response and management of skin reactions in the late stage of radiotherapy.
The skin reactions caused by radiotherapy are different from those caused by chemotherapy, targeted drugs, etc
The skin reactions caused by chemotherapy, targeted drugs, etc. are caused by drugs killing rapidly dividing skin cells or affecting the health of skin tissues. The skin reactions caused by chemotherapy, targeted therapy, and other drug treatments are systemic. The skin reaction caused by radiotherapy is caused by high-energy radiation entering and exiting the human body. The skin reaction caused by radiotherapy is local and usually only occurs in the "irradiation field" area. The irradiation field refers to the part of the body that receives radiation therapy.
What are the acute skin reactions caused by radiotherapy?
In the epidermis, dermis, and microvascular endothelial cells, there is radiation dose dependent cell loss, and radiation doses that exceed tissue tolerance may lead to skin necrosis. Acute skin reaction is an inflammatory reaction, a reaction in which skin and epidermal cells are unable to adapt to accelerated cell loss caused by radiation.
Acute skin reactions caused by radiotherapy are common, affecting 80-100% of patients receiving adjuvant or radical radiotherapy. Most patients have mild reactions and limited impact on quality of life. However, some patients, especially those who receive radiation therapy in the head, neck, or pelvic area, may experience more severe reactions. These symptoms include pain, itching, and infection, and in severe cases, radiotherapy can be interrupted.
Most skin reactions heal within 1-2 weeks after treatment. Acute skin reactions related to radiotherapy include erythema, dry peeling, pigmentation, and wet peeling. They can be mild, with skin turning light pink or brown. They may also be more severe, looking like sunburn. In some cases, the outer skin peels off, exposing a layer of moist "moist" skin. Bleeding, blisters, or scabs may occur in the relevant area.
The skin within the treated area may also become tender, dry, and itchy. This is due to the short-term closure of sebaceous and sweat gland secretion in the irradiation field. Sometimes a mild needle shaped rash may occur. Repeated radiation therapy can also cause hair loss in the radiation field. If the total dose given is high enough, hair cannot grow again after shedding.
Not all patients will experience all acute skin reactions. However, several acute phase reactions may also occur simultaneously on the skin within the irradiation field.
1. Acute skin reaction: erythema
Occurrence/Duration: Usually occurs within 4-14 days (dose 10-30 Gy) after the first radiotherapy, and reaches its peak 4-5 weeks after the start of radiotherapy. After 2 to 6 weeks of treatment, it subsided.
Clinical manifestations: The skin color of the irradiation field changes from light red to bright red, showing the outline of the irradiation field. The symptoms worsen as treatment continues, with an increase in skin temperature and mild edema.
2. Acute skin reaction: Dry peeling (peeling in a dry manner, like an old sunburn)
Occurrence/duration: It occurs as early as 3-4 weeks (40 Gy) of radiotherapy, but usually occurs in 5-6 weeks; Symptoms appear earlier when accelerated radiation therapy or synchronous chemotherapy is used. After 3 to 4 weeks of treatment, it subsides.
Clinical manifestations: Dry skin, flaky shedding, often accompanied by itching and peeling. A layer of dry, necrotic, and dark skin will accumulate on some or the entire irradiation field, eventually shedding. There will be slight pain.
3. Acute skin reaction: pigmentation
Occurrence/duration: Depending on baseline skin color, it occurs as early as 2-3 weeks after standard fractionation radiotherapy. Usually subsides within 3 months to 1 year after treatment; Occasionally, it is chronic.
Clinical manifestation: The skin looks as if it has tanned.
4. Acute skin reaction: Wet peeling (peeling in a wet manner, like a blister)
Attack/Duration: Appearing after receiving 40-50Gy radiation dose or accompanied by trauma/excessive friction, or when combined with chemotherapy.Usually, recovery occurs 2 to 6 weeks after treatment.
Clinical manifestations: bright erythema, skin detachment, dermal exposure, serous exudation and mucus exudation on the skin surface. Some of the commonly known blisters may appear, and these blisters may open to exude fluid and peel off. Moderate pain. If the exposed area is not treated, infection can occur and skin reactions can become more severe. Radiologists can help manage these signs or symptoms. If the problem becomes particularly troublesome, the doctor may suggest suspending treatment to allow the skin to recover.
Skin structure and acute skin reaction processes that may be caused by radiation therapy
The skin is the largest organ in the human body and a constantly changing dynamic organ. Basal cells divide into new cells and then continuously push upwards to form new skin, accompanied by the shedding of dead skin on the surface. The skin is composed of three layers: the epidermis, dermis, and subcutaneous tissue, each layer consisting of several sub layers.
Healthy and problem-free skin with even skin tone, smooth texture, sufficient moisture, and sensitivity to touch, pressure, and temperature. When the natural barrier of the skin is disrupted, its protective function and healthy appearance are impaired:
The skin loses moisture and elasticity, and appears and feels dry, rough, cracked, and/or uneven to the touch.
The skin becomes increasingly sensitive to external influences such as sunlight and temperature changes, making it particularly susceptible to infection. Infected skin can become inflamed, and inflammatory immune cells move towards the inflamed site in an attempt to repair damaged barriers and cure the infection.
The skin has multiple mechanisms for regeneration and repair. The basal layer ensures stable renewal of the epidermis through continuous cell division:
If the damage is limited to the top layer of the skin, it can heal without causing scars.
If the damage reaches the dermis and the basement membrane is affected (such as ulcers), scars usually form. Surgical procedures and radiation therapy may lead to the formation of scar tissue.
After radiotherapy, skin cells continuously detach from the surface of the skin, and new skin cells are produced in the basal layer below the epidermis. After receiving radiotherapy for 4 to 5 weeks, the production of new cells has decreased, and if treatment continues, the production of new cells will completely stop. Skin cells constantly detach from the surface, and no new cells are produced below. Finally, the epidermis completely disappears, with wet peeling and exposure of the basal layer and dermis. After a few weeks of treatment, the growth and transformation process of skin cells returned to normal, and the skin can heal.
The initial acute skin reaction is erythema (Figure a), which ranges from light pink to deep red skin. If the reaction continues, dry peeling will occur (Figure b and Figure c), and the skin will be damaged. The next stage is wet peeling (Figure d), which is likely to lead to infection. In very rare cases, this reaction continues and can lead to skin necrosis.
What are the factors that cause skin reactions during the acute stage of radiotherapy?
The normal skin response to radiation depends on many factors related to radiation therapy and the patient themselves. Factors related to radiotherapy include the type and energy of radiation, the use of tangent field technology, the use of tissue equivalent materials (Bolus materials), weekly dose rates, accelerated segmentation, and field size. Patient factors include skin wrinkles in the treatment volume, nutritional status, comorbidities, and irritants used in the irradiation field skin. The individual differences in radiation sensitivity and synchronous chemotherapy also affect the skin tissue's response to radiation.
Many factors related to radiotherapy affect the occurrence, duration, and intensity of acute skin reactions. These include:
The total dose of radiotherapy, especially for higher dose radical radiotherapy. Overall, the higher the total dose of radiotherapy, the higher the risk of skin reactions, which often lead to more severe skin reactions.
If the daily radiation dose exceeds 2.5Gy, the risk is higher.
Types of techniques for receiving radiation therapy: Compared to three-dimensional radiation therapy, intensity modulated radiation therapy (IMRT) can reduce the risk of severe skin reactions.
Experience level of radiation therapy doctors and teams: Overall, the higher the level of radiation therapy doctors and teams, the fewer side effects (skin and other) of radiation therapy, and the better the efficacy.
Radiotherapy radiation type: Electron beams typically increase skin reactions, while photons typically deposit beneath the skin, resulting in fewer acute skin reactions.
The shape and size of the irradiation field can also affect the severity of skin reactions.
◆Small and flat irradiation fields (such as the middle of the chest) often have little or no skin reactions. Larger radiation fields with curvature or curves (such as the pelvis and groin) often have more severe reactions.
◆If there are skin wrinkles in the irradiation field, the skin inside the wrinkles will have more severe reactions. The skin folds behind the neck or earlobes or armpits provide a warm, moist environment and exercise friction, all of which help increase the risk of acute reactions and skin rupture.
Some types of skin have stronger tolerance to radiation therapy than others. The scalp has the strongest tolerance, followed by a decrease in tolerance to the face, neck, trunk, ears, groin, and limbs.
When the expected radiotherapy target is within or near the skin surface, such as breast cancer radiotherapy.
Using tissue equivalent materials/radiotherapy site compensators (to adjust the dose received at depth and skin surface), proximity to the skin can increase the severity of skin reactions.
If the same area has received radiation therapy before, the risk of skin reactions in the irradiation field is higher when re radiation is given.
Receiving chemotherapy or concurrent chemotherapy before radiotherapy can increase skin reactions. Certain types of chemotherapy can themselves lead to acne like rashes. For example, chemotherapy drugs such as cisplatin, 5-FU, docetaxel, paclitaxel, doxorubicin, and gemcitabine. Regarding the response and management of skin reactions caused by chemotherapy, please refer to previous articlesHow to deal with various skin problems caused by tumor chemotherapy, targeted therapy, etc?
The combination of radiotherapy and targeted drugs may lead to more severe skin reactions, especially when the radiation dose is higher. The skin response mode of targeted drugs is also different from that related to radiotherapy. The skin toxicity of targeted therapy may have started earlier, and there is currently limited understanding of the late toxicity of combining targeted therapy with radiotherapy, as targeted therapy has a relatively short clinical use time.
The patient's own factors are as follows. If you have a relevant medical history, please inform the doctor in advance. These factors will increase the risk of acute skin reaction caused by radiotherapy, and make it difficult for the skin to heal. Therefore, relevant patients and families need to pay special attention to skin care and other matters (such as controlling blood sugar in diabetes patients):
Elderly people (with thinner skin) and the type of medication they take every day (some medications can cause skin thinning).
The integrity of the skin at the beginning of treatment affects skin reactions.
History of skin cancer at the irradiation site.
Smoking or excessive use of alcohol, hypertension, diabetes, kidney disease.
If the skin is particularly sensitive to soap, lotion and perfume, the patient may have a more serious reaction.
Ataxia telangiectasia, as well as Goering's syndrome, can increase patients' skin reactions.
Infected with HIV
Obesity or malnutrition
Patients with scleroderma are at risk of acute and late stage skin toxicity, and scleroderma itself is a relative contraindication to radiation therapy.
Active systemic lupus erythematosus (SLE) is also a relative contraindication of radiation therapy, increasing the risk of developing acute radiation dermatitis and advanced radiation toxicity.
Other autoimmune diseases, such as rheumatoid arthritis and polymyositis, which have been proposed in the literature, increase the risk of patients developing acute radiation reactions, including radiation dermatitis.
Genetic factors that have not been fully determined (for example, Japan found that the polymorphism of IL-12RB2 and ABCA1 loci would increase radiation dermatitis in breast cancer patients receiving radiotherapy)
Sometimes patients do not experience any skin reactions. This may be because the total treatment dose is very small (such as palliative radiotherapy), or the irradiation field is very small. In some cases, people who are believed to have a potential for severe skin reactions may not end up experiencing severe skin reactions. The reason is not entirely clear.
Acute skin reactions can cause discomfort and varying degrees of physical pain. If the reaction progresses to wet peeling, pain may increase and the risk of superficial skin infections increases. Regular skin assessment is the key to reducing and managing skin reactions, and radiation therapy patients and their families should also pay attention to it. They should communicate and check for skin changes in a timely manner during weekly outpatient visits with radiation therapy doctors.
Evaluation of acute skin reactions
Radiologists should conduct a skin assessment before starting treatment to determine factors that may increase skin reactions. The purpose of skin assessment is to establish a baseline assessment for future comparisons and determine the severity of skin changes. The frequency of evaluation varies with the patient's condition and needs; However, during the treatment period, the skin in the irradiation field should be visually examined weekly and checked at regular follow-up every time. Doctors should evaluate skin color, exudate, odor, dryness and humidity, as well as any shedding, necrosis, or infection that may occur, and ask patients if they have pain or itching.
There are several grading systems for acute radiation skin reactions. The latest Common Adverse Reaction Standards (CTCAE) 5th edition, commonly used by radiation therapy doctors for RTOG standards. There are other grading systems, such as the Society of Oncology and Nursing Standards.
CTCAE standard
RTOG standards
Preventive measures for acute skin reactions caused by radiotherapy
The goals of skin care before, during, and after radiotherapy are:
Maintain skin cleanliness
Controlling pain
Provide comfort
Avoid friction and damage caused by clothing, weather, etc
Preventing infection
Measures that help with skin care include pain management and good nutrition to support wound healing. Quitting smoking is one of the most important measures for patients to reduce the risk of severe skin reactions. Before treatment, it is important to pay attention to sunlight exposure, maintain good hygiene, and avoid using skincare products. During radiotherapy, patients should not apply makeup to the irradiated area and should use an electric shaver instead of a manual shaver.
Most of the time, prevention (and preventing deterioration) is the best way to solve skin problems. On the one hand, it is to prevent secondary skin damage caused by radiotherapy; On the other hand, it involves timely observation, evaluation, treatment of symptoms, and proper daily skin care. If the patient has any pain, wounds, rashes, or other skin problems, it is important to inform the doctor. Sometimes itching, pain, or discomfort are the first signs of skin condition. If patients encounter these problems, let the doctor know, even if some conditions are invisible to the naked eye.
The first recommended measure to prevent skin damage during radiotherapy is to use skin patches in the skin irradiation field. The skin patch can protect the lines required for radiotherapy positioning, without irritation to the skin, and is breathable and waterproof. This can also reduce secondary skin damage and prevent the occurrence of skin inflammation. There have been multiple literature reports that the use of skin patches reduces the severity and incidence of skin reactions, but only a few centers in China use this medical skin patch.
More than 20 trials have been reported in the literature evaluating potential preventive products for acute radiation dermatitis. Unfortunately, direct comparison is challenging because the patient population, methods, and medications studied are different. Another preventive measure explicitly supported in the literature is to clean the skin of the exposed area.
Wash the skin gently with water or mild soap alone (be careful not to remove the lines on the skin).
Loose fitting clothing/fabric that allows the skin to breathe naturally.
Avoid using adhesives (such as adhesive tape and plaster) on the skin of the exposed area.
During the treatment process, reduce the secondary scattering effect of skin wrinkles through patient positioning.
Avoid additional skin irritants such as talcum powder and prickly heat powder.
During and after treatment, avoid exposure to ultraviolet radiation in the exposed area and do sufficient sun protection work outdoors.
In the literature, calendula may have preventive value.
There are many case reports on the use of multiple additional skincare products to reduce radiation dermatitis, but there is no randomized data on reducing the severity or frequency of radiation dermatitis to support which skincare product can reduce radiation dermatitis.
Preventive products that have been widely used in practice but currently do not have strong random evidence:
Vaseline based emollients
Hydrogel dressing
Next generation non vaseline formulations (castor oil, Peruvian balm, trypsin)
Multiple external preparations: aloe vera, chamomile, almond ointment, D-panthenol
Management of acute skin reactions
The following are skin care guidelines for acute skin reactions, including specific situations, methods, frequency of use, reasons, and explanations.
For normal skin
1. Use gentle cleansers and moisturizers
Frequency: Daily use, or when needed.
Reason: Mild cleanser and moisturizer can promote skin health, prevent infection, help reduce the incidence rate of folliculitis, and prevent dryness.
Note: Avoid facial cleansers, perfume and deodorants with strong cleaning power, because they contain chemical substances and heavy metal ions, which may stimulate the skin and may enhance the skin reaction.
Targeting the appearance of erythema
1. Using facial cleansers and moisturizers
Frequency: From twice a day to three times a day.
Reason: To prevent dry skin in the irradiation field and reduce discomfort.
Explanation: Good skin care can minimize skin reactions
For dry scaling
1. Lubricants used: water-soluble, petroleum based products
Frequency: Twice a day or three times a day or when needed
Reason: Reduce itching, increase comfort, stimulate epithelialization, reduce the risk of skin cracking and formation of cracks
Explanation: If wet scaling occurs, discontinue use
2. Use mild topical steroids.
Frequency: usually 0.25%, twice a day
Reason: Steroids have anti-inflammatory and antipruritic effects. Use when itching may cause mechanical damage, or when itching/scratching causes sleep interruption.
Explanation: The use of topical steroids is controversial as they may cause further thinning of the epidermis, making the skin more susceptible to infection.
For wet scaling
1. Lubricant used: Vaseline or lanolin based
Frequency: Always maintain lubricant coverage of relevant parts
Reason: Reduce the impact of pain and provide a moist healing environment.
Explanation: The skin area may be easily dirty and requires cleaning and reapplying lubricant
2. Using Burn Ning
Frequency: Apply every 6 hours and can be used interchangeably with lubricants
Reason: Sealing and drying the relevant parts helps prevent infection
Explanation: Not very user-friendly. Cleaning may damage newborn skin
3. Use hydrogel contact wound dressing
Usage: Remove the film from one side and place the hydrogel part on the wound or skin. Cover with non adhesive dressings and secure with paper tape placed outside the irradiation field. Can be used after mild astringent.
Reason: Composed of 98% water and 2% cellulose fibers. Maintain a moist environment, protect newly formed epithelial cells from trauma, and increase comfort by covering exposed nerve endings. It is a mild absorbent.
Explanation: It is expensive and difficult to ensure regular use. Be careful not to dry the wound surface. However, these materials must be removed during radiotherapy to prevent them from acting as filling materials and increasing radiation damage.
4. Wound cleaning agents and epithelial irritants
Use: Clean the wound with mild spray twice a day or three times a day. Apply a sufficient amount of gel to the exposed area and cover it with a non adhesive dressing. Secure with paper tape or flexible mesh placed outside the irradiation field.
Reason: Cleaners help in debridement and maintain the pH value of the wound bed, without damaging proliferating fibroblasts. The wound gel maintains a moist environment and stimulates epithelization, covering exposed nerve endings to promote comfort.
Explanation: It is expensive and difficult to ensure regular use. To avoid drying during dressing change, gel must be used. It must be removed during radiotherapy.
5. Closed hydrocolloid dressing
Usage: Clean the wound. Choose a dressing that provides a 1.25 cm edge around the wound. Use the dressing according to the packaging instructions. The dressing can be stored for up to 7 days. Be very careful when removing to prevent damage to the newly formed skin. If necessary, a small amount of sterile saline water can be used to help remove the dressing.
Reason: Maintaining a humid environment promotes rapid epithelialization and helps in debridement. Isolate the wound from bacterial contamination. Promote comfort by covering exposed nerve endings and preventing friction. It is an absorbent.
Explanation: It is relatively economical to use. If the infection exists, do not use it. Yellow brown liquid may be produced and may be mistaken for infection. If this situation occurs, remove the dressing, clean the wound, and use a new dressing. It should not be used during the treatment process, as removing dressings every day can damage the wound bed.
Patient guidelines for skin care during and after radiation therapy
Patient education on expected skin reactions (acute and advanced), occurrence time, onset time and duration, as well as self-care guidelines, promotes the optimal outcome of skin reaction management. Below are skin care recommendations and reasons for the recommendations for patients and their families.
During radiation therapy, the skin of the treated area may become dry, red, black, and sensitive. Skin changes are usually gradual and become apparent after 2 or 3 rounds of radiation therapy, becoming more pronounced as the treatment continues. Care must be taken to protect the skin and prevent external injuries. The following guidelines are only applicable to the skin within the radiation irradiation field.
How to take care of the skin in the irradiation field during treatment:
Take a shower or shower with warm water instead of hot water. Gently rinse this area with your fingertips. After washing, pat dry the skin with a soft cloth.
Avoid high-pressure shower nozzles. They may cause further damage to the treated skin.
Avoid rough soap. If you need to use soap or shower gel, please use baking soda and water (1/2 box mixed in a bucket of water) or use cream soap specifically designed for sensitive skin.
Common skin irritants include lanolin, perfume and dyes. Camphor, menthol, zinc, and aluminum can also cause problems. Alcohol can dry the skin. It is best to avoid skincare products that contain a large amount of these items. Perfume, cologne, powder, cosmetics or household medicine. Remember to carefully read the label before using any product (although this is often unreliable).
Do not apply any ointments, moisturizers, lotions, deodorants on the skin unless explicitly instructed by a doctor
If it is necessary to reduce friction or friction within skin wrinkles, a method called ZasoRB can be used ® Absorbent powder products (seaworthy). Do not use corn starch as it may "feed" normal body microbiota and cause fungal infections.
If instructed by a doctor, mild, water-soluble lubricants can be used to reduce itching and discomfort. Apply 2-3 times a day.
If the skin itches, do not scratch. Consult a doctor on how to relieve itching.
It is best to avoid swimming in the swimming pool and avoid hot tubs. They contain rough chemicals that can dry and irritate the skin.
If possible, avoid shaving hair. If removal is necessary, use an electric razor.
Avoid extreme cold or hot skin temperatures at the radiotherapy site. Do not use water bottles, heating pads, fluorescent lamps, ice bags, etc.
Avoid applying any friction to the skin of the control field. Try not to rub or scratch the skin. Avoid rough and irritating tight fitting clothes, and avoid rubbing them back and forth on the skin. Cotton or cotton blended clothing is better than wool and polyester clothing. Soft cotton clothes washed in mild baby soap may provide comfort for the treated skin.
If the head or scalp area receives radiation therapy, gently wash the hair with a mild shampoo. Do not use hair dye or apply permanent solution to the scalp before treatment is completed.
Avoid skin exposure to sunlight. Use a wide brimmed hat, long sleeves, and gloves to prevent exposure to sunlight.
Before exposure to sunlight, even under light and thin clothing, the sun protection factor of sunscreen should be as high as 30 or above.
Do not apply tape or adhesive bandages to the skin of the radiotherapy site. Removing them can cause skin damage.
Drink at least 3 liters of liquid every day.
How to clean the skin of the irradiation field during radiotherapy?
Gently rinse the skin of the irradiation field every day. Use warm water alone or mild soapy water instead of hot water.
When cleaning, gently treat the exposed skin in the field, use your hands or a soft towel to clean the skin, and do not use brushes, loofahs, etc. If using soap, be sure to thoroughly rinse off the soap without leaving any residue. Pat dry the skin with a soft towel, which can also allow the skin to naturally dry in the air.
Before radiotherapy, doctors/technicians may mark the area to be treated with colored stroke lines for accurate positioning. Remember to protect these lines and cover them with a thin film. Avoid washing off any plastic dressings or short-term lines on the skin, as it can be very troublesome. When the doctor says it can be washed off, mineral oil can be used to remove these marks.
Breast cancer patients: It is OK to use non aluminum antiperspirants or deodorants on the treatment side.
Regarding mild soap, it can be referred to as sensitive skincare products, including some AVENEO, DOVE, Ludeqing, CETAPPHIL, etc. (remember to read the ingredient list).
After treatment
Continue to follow the above guidelines for 2-3 weeks after completing radiotherapy
Use odorless hydrophilic lotion (lotion or cream) 2-3 times a day for 1 to 2 months after treatment, and then use it once a day. After taking a shower and drying the skin, immediately applying moisturizer/lotion to still damp skin can help lock in moisture.
Try not to expose irradiated skin to sunlight as much as possible. If not possible, use sunscreen with a sun protection factor of 30 or higher.
After completing radiation therapy, the impact on the skin may last for about a week, and then the skin will begin to improve. In the first week after treatment, the deep redness and sensitivity of the skin should begin to disappear. It takes longer for the skin to fully recover its natural color. After the final radiotherapy, patients may also notice a suntanned or slightly pink appearance at the radiotherapy site for up to 6 months. If the patient's skin color is very dark, by the end of treatment, the skin will become very dark, which may take 3-6 months (sometimes longer) to change.
If the patient experiences the following symptoms, contact a doctor as soon as possible:
Body temperature of 38 ° C or higher
Shiver
Increased pain or discomfort
Skin redness or swelling increases, or feels hard or hot to the touch
Skin rash or blistering on the treated area
Seepage from the treatment site
Any new changes in the skin or any new openings or damages
Any other new symptoms or issues
Answers to common questions about skin reactions caused by radiotherapy
1. What knowledge should I know about moisturizers or lotions?
Answer: Maintaining skin cleanliness, softness, and moisture through the use of moisturizers and lotions is recognized by most radiation therapy doctors. Using moisturizers and lotions, your skin is most likely to feel soft and elastic. But using moisturizers and lotions will not reduce the severity of skin reactions. Moisturizing creams and lotions may only help the skin feel more comfortable. You can use moisturizers and lotions 1-2 hours before treatment.
Due to the common occurrence of skin reactions caused by radiation therapy, researchers have been striving to find ways to prevent or reduce the severity of skin reactions. Many studies have been conducted on many skincare products. So far, there is little data indicating that any product is better than another. There are many skincare products on the market. If they do not cause burning, stinging, itching, or rash, you can continue to use normal products on the skin of the treated area. If they begin to cause burning, stinging, itching, or rash, stop using these products. Then, you can switch to products specifically for sensitive skin and use products that do not contain any alcohol or perfume.
2. How should skin itching be handled?
Answer:Sometimes, the skin of the treated area becomes itchy. This is due to the temporary "closure" of the sebaceous and sweat glands for a period of time. If this situation occurs, please consult a doctor who will be able to assist you.
3.Can intensity modulated radiotherapy (IMRT) be more effective in preventing acute radiation induced skin reactions than three-dimensional conformal radiotherapy?
Answer: Yes, this is definitely better for the skin. But for a specific patient, many factors need to be considered, and skin reactions are influenced by multiple factors.
4. Is steroid therapy really not suitable?
Answer: Of course you can use it, but it is usually not recommended to recommend it to all patients from the beginning of treatment. There is currently no data on the long-term effects of local steroids on the skin during radiotherapy. If patients experience severe skin reactions in the early stages of treatment, or if they have other risk factors, they can consider using it. Studies have shown that it can improve quality of life and itching, but it is not recommended to use steroids for general purposes.
5.What should I do if my skin becomes "damp" or bleeds or blisters appear?
Answer: Please consult a radiation therapy doctor, who may recommend using disinfectant ointments. You can also get special antibacterial dressings. These can help skin heal and soothe it.
6. How can I maintain good nutrition and sufficient water?
Answer: During the radiotherapy process, it is crucial to have sufficient nutrition and drink a large amount of water. The body needs nutrients and water to repair treated skin and tissues. Patients who eat well and drink a large amount of liquid often feel better than those who do not eat. Doctors and nurses can help you find ways to maintain food and liquid intake, and family members can also help.
7. May I continue smoking?
Answer: Smoking is not considered a good health habit. Studies have shown that people who smoke during radiation therapy have a worse prognosis than those who do not smoke. If you smoke, please reduce smoking and preferably quit smoking.
8. Can I drink alcohol?
Answer: Generally speaking, people receiving radiation therapy should try to avoid excessive alcohol consumption. Studies have shown that people who drink alcohol during radiation therapy have a worse prognosis than those who do not.
9. How much sleep do I need?
Answer: Obtaining sufficient rest and sleep during your treatment process is crucial. In order to repair normal tissues, your body needs sleep. If you can't sleep well, consult a doctor who may prescribe some medication. Getting enough good sleep is a key factor in maintaining health.
10. How do I take care of myself and my skin during my treatment process?
Answer: During your treatment process, you can do some things to help yourself care for your skin. These include:
Gently clean and care for the skin of the irradiation field.
Maintain good nutrition and sufficient moisture.
Avoid smoking and excessive alcohol consumption.
Get sufficient rest and sleep.
Do some light exercise every day (such as walking).
These suggestions may not reduce the severity of your skin reactions, but they can help you feel better. The last four are considered healthy habits, and maintaining a healthy lifestyle can help you feel better during the treatment process.
11. How should I take care of my skin after treatment?
Answer: Most skin reactions will completely recover 1-2 weeks after treatment. But the deep parts of the skin and tissue require longer time to fully heal. In some cases, the skin of the irradiation field can change over time. The skin may darken or form brown scale like spots or ruptured blood vessels, which may occur several weeks to several months after treatment.
You should continue to clean, moisturize, and gently care for the skin for at least 6 months after treatment. When outdoors, use sunscreen (SPF30 or higher, blocking UVA and UVB) on the skin. The skin at the radiotherapy site has a higher risk of developing certain types of skin cancer.
Radiotherapy treated skin may also continue to dry and itch. You may need to continue using moisturizers or lotions. You will also find that irradiated skin is more sensitive. You may need soap and moisturizers specifically designed for sensitive skin. You should also continue to protect your skin from the effects of cold, heat, friction, or other pressures.
If there are persistent problems with the skin after radiation therapy, please consult a radiation doctor. He or she will help you develop a long-term plan to treat your skin or refer you to a dermatologist.
Reference：
RADIATION TOXICITY: A PRACTICAL GUIDE
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