Changes to the Skin

If cancer patients notice changes to their skin during or after radiation therapy, they are not alone. One common side effect of radiation therapy is skin irritation, such as redness or sensitivity, in the treated area. Their skin may also become dry, itchy or moist. These and other changes can be uncomfortable and upsetting.

Why Does Radiation Therapy Cause Skin Reactions?

Radiation therapy is the use of high-energy radiation or radioactive substances to shrink or kill cancerous cells. Radiation therapy may come from a machine outside the body via radiation beams or x-rays (external radiation) or from radioactive material placed directly into or near a tumor inside the body (internal radiation).

When radiation passes through the skin, the skin cells in the treatment area become damaged. If a cancer patient receives frequent radiation, his or her skin cells often don’t have enough time to repair and regenerate in between treatments. Radiation therapy may cause the exposed skin to peel off faster than it can grow back, causing sores or ulcers to develop.

What Type of Skin Reactions May Occur?

Radiation-induced skin reactions may progress from erythema (redness), to desquamation (shedding of outer skin layers), and sometimes to ulceration. During the first week or two of radiation treatment, the patient may notice a faint redness and the skin may become itchy or tender. After three to four weeks, the skin may become dry and peel, or the patient may notice moist areas. Later effects of radiation may include darkening or thinning of the skin.

The following are some common reactions that can occur on radiated skin:

• Rash, redness, sunburned-like appearance
• Itching (pruritus), flaking, scaling
• Tenderness, discomfort, pain, burning
• Dryness, peeling
• Blisters, sores, ulcers
• Moist (weeping) areas, oozing
• Swollen, puffiness
• Infection
• Increased sensitivity to sunlight

Who Experiences Skin Reactions?

Radiation-induced skin reactions vary, depending on the treatment type and length, radiation dosage, the area being treated, skin type, and other factors.

For instance, skin irritation is more likely to occur in areas where the skin is thin and smooth (e.g., face, neck) or where the patient has body folds (e.g., breast, buttocks, abdomen, armpit, groin). In addition, skin reactions tend to occur more often if the patient has received a high dose of radiation, a single radiation beam, or chemotherapy shortly before or during radiation therapy.

The following are some additional risk factors for radiation-induced skin reactions:

• Skin cancer, breast cancer, or head and neck cancer
• Compromised skin integrity (e.g., surgery, scars, lesions)
• Certain medical conditions (e.g., diabetes, renal failure)
• Compromised nutritional status
• Compromised lymph drainage (e.g., breast)
• A history of chronic sun exposure
• A history of tobacco use

How Long Do Skin Reactions Last?

Skin changes may become more noticeable as the course of radiation therapy progresses. Acute radiation side effects occur one to four weeks after beginning treatment and may persist for several weeks following treatment. Late radiation side effects occur six or more months after treatment is complete.

Fortunately, most skin reactions are temporary and will usually go away a few weeks of completing radiation therapy. In some cases, though, the irradiated skin will be slightly darker, thinner, or dryer than it was before. Also, the skin may burn more easily from sun exposure, and may be prone to infection and breakdown.

How Are Skin Reactions Treated?

There are several innovative radiation techniques being offered today that may help to reduce damage to skin tissue. There are also many comfort measures and medications available to relieve skin irritation caused by radiation therapy.

A patient’s doctor may prescribe topical drugs in the form of therapeutic creams or ointments. The person may also receive antibiotics to fight infection or pain medications to relieve discomfort. For severe skin reactions, such as a redness that evolves into blistering, moist weeping, or infection, the doctor may discontinue treatment for a period of time to allow the skin to heal.

In addition to the help the doctor provides, encourage the cancer patient and family to become knowledgeable about how to take care of skin during radiation therapy, so they’ll be better able to relieve discomfort, lessen further irritation, and speed healing.

Note: This information isn’t intended nor implied to be a substitute for professional medical advice. Encourage the cancer patient to always report any radiation-induced skin reactions to the physician immediately.

Tips for Taking Care of Skin During Radiation Therapy

When you minister to a cancer patient, you can share the following tips for skin care:

• Know what skin changes to expect. To help prepare yourself, ask your doctor ahead of time what skin changes you can expect during radiation therapy. Plan how you will deal with skin reactions. Also, remember that many skin changes are temporary and will go away after you complete treatment.
• Keep your skin clean and dry. When washing irradiated skin, use lukewarm water and mild, non-perfumed soap. Don’t rub or scrub your skin. Instead, let the water run over the treated area. Rinse the area thoroughly and gently pat dry with a soft towel. Be careful not to wash off any ink markings needed for treatment.
• Use skin products wisely. While you are undergoing radiation therapy, consult with your doctor first before using any skin care products. Your doctor may prescribe cleansing, protective, moisturizing, drying, anti-itch, or anti-inflammatory agents. Your doctor may also advise you to avoid skin care products for at least four hours before treatment.
• Avoid irritants. Avoid perfumes, deodorants, body oils, bubble bath, scented lotions, cosmetics, or products containing alcohol. If you are being treated under one or both arms, do not use an antiperspirant or deodorant. Your doctor may recommend non-allergenic products.
• Be gentle on your skin. If you must shave in the treatment area, use an electric razor to avoid cuts. Do not use a pre-shave lotion, aftershave, or hair removal products. If a rash appears, avoid shaving again until the skin has completely healed. If you need to bandage the area, use paper rather than adhesive tape and try to apply the tape outside of the treatment area.
• Take care of your hair and nails. If you had treatment to your head, be gentle when combing or brushing your hair. Use a mild shampoo (e.g., baby shampoo) and avoid using curling irons. Also, your fingernails may become weak, break or lift off, or develop ridges during treatment. Keep your hands moisturized and your nails cut short (avoid cutting cuticles).
• Avoid extreme temperatures. Protect your skin from extreme heat or cold. Take showers or short, cool baths instead of long, hot baths. Avoid using heating pads, hot water bottles, or ice packs. Also, dress properly as extreme weather conditions can worsen and/or cause dry skin reactions. Your skin will likely feel better in cool, humid places.
• Wear loose-fitting clothing. Avoid clothes that are tight-fitting, such as collars, bras, girdles, and pantyhose. Avoid irritating or scratchy fabrics, such as wool, that may rub your skin. Instead, try soft cotton clothes and bed sheets. Wash your clothes in mild, gentle detergents.
• Eat well and stay hydrated. A healthy, well-balanced diet is important for healthy skin, and can also help the body tolerate cancer treatments, fight infection and rebuild tissue. A registered dietitian can help develop an appropriate meal plan for you. In addition, try to drink plenty of fluids each day to keep your body hydrated. Avoid alcohol and caffeinated beverages.
• Stay out of the sun. The sun can burn you even on overcast days. You will need to protect previously radiated skin from the sun even after radiation therapy is over. If you must be in the sun, use sunscreen with SPF 30 or higher, and wear a hat and protective clothing. Do not use tanning beds.
• Check your skin daily. It’s important to check your skin daily to look for any changes which can lead to infection. Let your health care team know if your skin looks or feels different, or if you notice any cuts or open areas. Your doctor may prescribe antibiotics to treat infection, antihistamines to reduce swelling or itching, and/or analgesics (pain medications) to alleviate discomfort.
• Seek supportive therapies. Various complementary medicine therapies may help you cope better with radiation-induced skin reactions. For instance, mind-body medicine can help you relax with techniques like distraction and guided imagery. Image enhancement can help you look and feel better about yourself. Talk with your doctor about these and other available resources.

Note: This information isn’t intended nor implied to be a substitute for professional medical advice. Encourage the patient to always seek the advice of his or her physician or other qualified healthcare provider regarding changes to the skin during and after radiation therapy.