While undergoing radiation treatment, you will likely notice a change in the color of your skin. If you’re African American or have a dark brown or black skin tone, the skin change can be harder to see but you may still have other symptoms, such as soreness or dry skin.
The skin also may be dry, sore, and more sensitive to touch, just as in the case of sunburn. The skin can sometimes start to peel in a dry way or in a wet way (like a blister). Peelings usually tend to be toward the last third of your treatments or later.
This peelings of the skin will probably be limited to a few areas of the skin, and if the blister opens, the exposed raw area can be quite painful and weepy. Skin reaction can become more serious if the exposed area is not treated and infection can develop.
These skin changes happen gradually and can be predicted in your weekly exams by your radiation oncologist and caretaker. This post is to make you aware of the range of possible skin reactions so that you’re not surprised by them.
Fortunately, skin irritation caused by radiation is temporary, and there are salves, medications, and prescriptions to ease any discomfort. Talk to your doctor if you find that the pain and irritation are not getting better.
Radiotherapy-Related Skin Reactions
Toxicity related to radiation therapy occurs because of the effect of radiotherapy on normal tissue that divides rapidly, such as the skin and mucous membranes.
Acute toxicity mostly occurs during treatment and 2–3 weeks after completing radiotherapy. Late toxicity occurs from weeks to years after treatment.
Skin tolerance was one of the limiting factors in the early days of radiation therapy and can still cause treatment interruptions. However, despite fractionation, there are still problems with skin tolerance, and it remains a reason for treatment interruptions, which can negatively affect treatment outcome with radiation therapy.
Most patients have mild reactions with limited impact on their quality of life, while some patients experience more severe reactions that are associated with symptoms including pain, itching and infections, and in the worst cases, treatment interruptions.
At four to five weeks into radiation therapy, the production of new cells is reduced, and it stops altogether if treatment continues. Skin cells keep peeling off from the surface, with no new cells produced.
This results in the whole of the epidermis being lost, and moist desquamation occurs, with the basal layer and dermis exposed. It takes a few weeks after treatment ends before the process of skin cell growth returns to normal and the skin can heal.
Risk factors to Radiation-Related Skin Reactions
Risk factors for acute radiation skin reactions include:
- Radiotherapy-related factors like dose (the higher the dose, the higher the risk), overall treatment time, volume treated and radiation therapy technique employed.
- There may be risk factors related to previous or simultaneous chemotherapy, hormone therapy, or targeted therapy. Some studies have shown these treatments to be risk factors.
- Quite a few studies have shown a high body mass index (BMI), as well as smoking, to be risk factors for acute radiation skin reactions.
- Weak evidence has suggested that age, skin type, genetic variation, co-morbidity, and alcohol consumption may all be risk factors.
Using intensity-modulated radiation therapy (IMRT) reduces the risk of severe skin reactions, while the risk is increased by using bolus or by boosting the dose to a specific part of the irradiated area, or using an immobilization device.
Bolus is a material applied to the irradiated area to adjust the dose received at depth and on the skin surface.
Management Of Radiotherapy-Related Skin Reactions
Studies for the past 10 to 15 years has shown that few, or even no, skin care products are effective in preventing or reducing acute radiotherapy skin reactions.
There are lots of skin products that are used and have not been evaluated, and there is a wide variation in practice, with many treatment centers using local remedies that have not been tested.
Basic strategies, such as keeping the skin clean seem to be more helpful than particular creams. The goal here is to keep the skin clean, control pain, provide comfort, avoid friction and trauma from clothes, weather, and prevent infections.
Other measures that can help with skin care include pain management and good nutrition to support wound healing.
Smoking cessation is also, an important measure a patient can take to reduce their risk of severe skin reactions. Furthermore, be careful with sun exposure, to maintain good hygiene and to avoid skin care products just before treatment.
Do not use make-up on the irradiated area while having radiotherapy and you should definitely use electric rather than manual razors.
Other Skin Care Tips:
- Don’t rub the area too hard to avoid soreness.
- Don’t use perfume or perfumed soaps, talcs or lotions on the affected areas.
- Use a deodorant that is free of any metal.
- Don’t shave the area being treated (you can use an electric trimmer instead of shaving).
- Wear loose-fitting clothes, and use clothes made of natural fibers.
- Avoid tight collars and ties if you’ve had radiotherapy to your neck, and avoid shoulder and bra straps.
- As always, when exposed to the sun you should use a high factor sunscreen, and wear a hat.