Radiation dermatitis, frequently termed a “radiation burn,” is a common side effect of radiation therapy, affecting up to 95% of patients. This skin reaction occurs when ionizing radiation damages the basal cells within the treatment field, disrupting the skin’s ability to renew its protective outer layer. Severity varies widely, starting as mild redness (erythema) and progressing through dry desquamation (peeling skin). More significant reactions lead to moist desquamation, characterized by open, raw, or weeping areas. Management focuses on maintaining comfort, reducing inflammation, promoting skin healing, and preventing secondary infections.
Recommended Topical Treatments
Emollients and barrier creams are the first line of defense against dryness and irritation caused by radiation. These products must be lanolin-free and contain no fragrances or perfumes. They work by creating a protective layer on the skin to reduce water loss and maintain hydration, helping to soothe the treated area and reduce reaction severity.
When the skin is intact but inflamed, prescription-strength topical corticosteroids are used to reduce redness and manage symptoms. Prophylactic use of medium- to high-potency corticosteroids, such as mometasone furoate or betamethasone, can significantly lower the incidence of severe moist desquamation. These products must be applied under a doctor’s supervision to intact skin and used exactly as prescribed to avoid potential side effects like skin thinning.
For areas that progress to moist desquamation, specialized wound care products are necessary when the skin is open or weeping. Hydrogel dressings are preferred for these open areas because they provide a moist healing environment and reduce pain. These dressings keep the wound bed clean and promote the migration of skin cells necessary for repair.
Barrier films and silicone-based gels provide a protective, film-forming coating, especially in areas prone to friction. These products can be applied preventatively before skin damage occurs. For frequently moist areas, such as skin folds, drying pastes or specialized powders may be recommended to manage exudate and prevent further breakdown. Note that evidence supporting the general use of plain aloe vera for radiation dermatitis remains limited, though it is often included in specialized soothing creams for hydration.
Daily Skin Care Practices
Managing skin reactions requires a gentle and consistent cleansing routine. The treated area should be washed daily using lukewarm water and a mild, pH-neutral, unscented cleanser, applied with the hands rather than abrasive washcloths or sponges. After washing, the skin must be patted gently with a soft towel instead of being rubbed, which causes further irritation.
Moisturizing treatments should be applied in a thin layer with a gentle touch. Patients are advised to avoid applying any product in the hours immediately before a radiation session. The standard instruction is to ensure the skin is clean and dry before treatment, and the oncology team will provide specific guidance on the timing of product application.
Protecting the skin from friction is an important daily practice. This includes wearing loose-fitting clothing made from soft, natural fibers such as cotton, and avoiding tight garments like underwire bras or restrictive waistbands. Patients must also avoid applying anything to the area that involves extreme temperatures, such as heating pads, hot tubs, or ice packs, as this exacerbates the inflammatory response.
Treatments to Avoid and Signs of Complication
Several common skin care products must be avoided on the treated area because they intensify the skin reaction. Products containing alcohol, perfumes, or fragrances are particularly irritating and drying to the compromised skin barrier. Patients should also avoid products containing harsh chemicals, talcum powder, or heavy metals, such as certain zinc oxide or silver-based creams, unless specifically directed by their care team.
Adhesive materials, including medical tapes or stick-on bandages, should not be applied directly to the irradiated skin, as removal can cause trauma and strip the delicate outer layers. Sun exposure must be avoided completely, since UV radiation worsens the skin reaction and causes long-term damage. If sun exposure is unavoidable, the treated area should be covered with protective clothing or a high SPF mineral-based sunblock, after consulting with the care team.
All topical products, including those available over-the-counter, must be reviewed with the oncology team before use. Patients must monitor the treated area for specific warning signs that signal a complication or infection. These signs include increased pain, pronounced swelling, fever, or the presence of pus or foul odor. Blistering or the rapid development of large, open areas of moist desquamation also require immediate medical consultation, as these reactions may necessitate a pause in treatment and specialized wound care.