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Published on May 04, 2021

How to care for your skin during radiation treatment

Radiation Skin

Radiation therapy can be an important part of the treatment for many types of cancer, but it’s a remedy that can cause side effects on the skin, including itchiness, redness, blistering and peeling. Working with their team of medical caregivers, patients can take steps to relieve the discomfort of those side effects.

“Radiation dermatitis is different from burns,” said Christine Davenport, a registered nurse who works in the Radiation Oncology Department at Davenport-Mugar Cancer Center at Cape Cod Hospital. “Radiation destroys cancer cells, but it also injures nearby healthy cells like the fast-growing basal layer of your skin.”

The damage happens in the deep layers of your skin, approximately 10 to 14 days after the first radiation treatment, she said.

“That corresponds to the time it takes for the damaged skin cells to migrate up to the surface of your skin. If the new cells are produced faster than the old cells are shed, your skin becomes dry and flaky. That's called ‘dry desquamation,’ and that's a pretty common thing that we see. And then, as it continues, your skin might not produce enough new cells to replace the old ones. The outer layer of your skin can become broken and oozing, and that's called ‘moist desquamation.’”

The effects on the skin are cumulative, so the severity of a patient’s reaction may increase for one to two weeks after their radiation therapy is completed, as the new skin cells replace those that were damaged, she said.

“Radiation is a local treatment, so where the radiation is aimed is where patients get their side effect in terms of skin issues, as opposed to chemotherapy, which is body-wide because it goes through your whole system,” she said. “The main systemic effect for radiation is usually fatigue.”

There’s not much patients can do to prepare their skin in advance of treatment, except avoid sunburns.

When treatment starts, patients should treat their skin gently, using warm instead of hot water while bathing or showering and using a mild, moisturizing soap.

“We usually give guidance on using moisturizers up to three times a day, which will help to keep the skin intact,” she said. “The only caveat to that is we don't want anything on the skin for four hours before treatment. This is the art of medicine and the team a patient works with may have their own recommendations.”

“There have been many studies looking at skin care products to lessen skin reactions for patients undergoing radiation therapy. No product has been universally adopted for this purpose.”

“While such products can be a bit more expensive than other moisturizers, the benefit may outweigh the cost, and there is ongoing research on innovative ways to manage what can become such be a distressing part of a cancer patient’s journey.”

Self-care during treatment

Some more tips from Davenport:

  • Radiation dermatitis “kind of sneaks up on you,” she said, taking a couple of weeks to develop. “Then we troubleshoot it as we go along.”
  • If patients have progressive redness, irritation or itching, the caregivers will recommend an over-the-counter ointment or anti-itch product.
  • Wearing loose cotton clothing over the treatment area or leaving it open to the air is recommended, she said.
  • Deodorants can be used.
  • Electric shavers are better than razors, which can pull the skin and cause further injury.
  • Avoid sun exposure to the treated area. If you must go outside, use a sunscreen or keep the area covered. After the treatment is over, areas that have been radiated will sunburn more quickly.

“The worst reaction that happens is moist, blistering skin, and a lot of our patients don't get to that point,” she said. “The radiation techniques are designed to spare the skin as much as possible unless the skin is the radiation target.”