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Patient Education - Radiation-induced cutaneous damage - Acute Effects

Patient Education - Radiation-induced cutaneous damage - Acute Effects

Patient Education - Radiation-induced cutaneous damage - Acute Effects

SUMMARY

Radiation-induced cutaneous damage (RICD) is a common side effect of radiation therapy. Most patients who receive radiation therapy will experience some form of RICD.[1] RICD occurs when the radiation directed at your cancer cells also damages the skin surrounding your tumor. Initial skin changes caused by radiation (acute effects) are usually seen within 90 days from the day you received radiotherapy.

  • Redness (erythema)
  • Swelling (edema)
  • Itching
  • Color changes
  • Hair loss
  • Skin peeling (desquamation) with or without fluid drainage
  • Skin breakdown (ulceration)

    Factors that increase possibility of having acute RICD:

    • Higher radiation dose [2]
    • Radiation to areas of skin folds - armpits, neck, groin, underneath breasts [3]
    • Diabetes, existing skin disorders, obesity, compromised immune system [1][4][5]
    • Smoking [6]
    • Female gender [7]
    • Advanced age [7]
    • Darker skin tone [8]

      Treatment

      Treatment depends on the severity of your skin damage. The goals of treatment are to provide pain relief and a moist healing environment. Severe wounds may require cessation of radiation therapy and other medical interventions.

      Prevention

      • Wear loose clothing [4][9]
      • Avoid very hot and very cold temperatures [10]
      • Wash your treatment area gently with or without mild soap or shampoo. Dry the area gently [9][11][12]
      • Use non-scented, lanolin-free, emollient cream daily [13][14]
      • Do not apply lotion to your treatment area an hour before your appointment [15]
      • Limit your time in the sun. Always use sunscreen with UVA and UVB coverage [1][4][9]
      • For shaving, use an electric razor instead of a razor blade. Do not use shaving cream [4]
      • Avoid irritation of the skin

      When to contact your healthcare provider?

      Contact your doctor if you begin experiencing any signs of acute RICD, especially if you develop fever, increasing pain, redness or swelling, skin changes, breaks, or drainage

      l>


      WHAT is radiation-induced cutaneous damage?

        • Radiation-induced cutaneous damage (RICD) is a common side effect of radiation therapy. It is also known as radiation dermatitis, radiodermatitis, cutaneous radiation injury, and radiation-induced skin injury.
          • As much as 95 percent of all patients receiving radiation therapy will experience some form of RICD [1]. The so called “acute damage” usually resolves after radiotherapy is completed, but “chronic damage” can develop months or years later. Up to 15% of patients receiving radiation therapy will develop chronic RICD [16].
          • Your radiation therapy may be spread out over several days or weeks. During radiotherapy, radiation is directed at your tumor and targets cancer cells. However, the radiation will also damage healthy skin cells surrounding the tumor [14]. Normally, skin cells will grow back to replenish the area with healthy cells. Acute RICD occurs when healthy skin cells do not have enough time to grow back in the treatment area between your treatment days [17].

          WHAT are the symptoms of acute RICD?

            • Your skin may undergo many changes during radiation therapy. Keep in mind that these skin changes may not show until days or weeks after you begin therapy.
              • By definition, acute RICD presents with symptoms within 90 days of the day when radiation therapy started [1] The area of your body that is irradiated may experience [13]:

                  • Redness (erythema)
                  • Swelling (edema)
                  • Itching
                  • Color changes
                  • Hair loss
                  • Skin peeling (desquamation) with or without fluid drainage
                  • Breakdown of the tissue (ulceration)

                AM I at risk for developing RICD? 

                  • Your risk for developing acute RICD depends on many factors, including:

                      • Higher total radiation dose [2].
                      • Location of radiation therapy. Areas of skin folds such as the groin, neck, armpit, and underneath the breasts have a higher chance of developing RICD [3].
                      • Current medical conditions. Diabetes, existing skin disorders, obesity, or immunosuppression increase the risk for RICD.[1][4][5]
                      • Lifestyle. Smoking and spending more time in the sun will put you at increased risk for RICD. [6]

                    WHAT can I expect after radiotherapy?

                      The effects you will experience after radiotherapy depend on the total amount of radiation you receive. Keep in mind that skin damage usually improves after finishing radiation treatment.

                        • Review the table 1 below to know what to expect after your radiation treatment. Radiation dosage is measured in units called Gray (Gy). Ask your treatment team what your total radiation dose will be.

                        Table 1. Skin changes you may experience after radiation therapy, depending on total dosage in Gray (Gy) [1][2][4][13][17][18][19]

                        If your total radiation dose in Gray (Gy) is...then in the irradiated area you may experience......after treatment
                        2Redness, swellinghours
                        6-10More redness, hair loss7-10 days
                        10-25Painful redness, darkening of skin, peeling, scaly skin3-4 weeks
                        30-40Peeling of skin with drainage> 4 weeks
                        >40Skin wounds, bleeding, drainage> 4 weeks

                        HOW can acute RICD be treated? 

                          • The goals of RICD treatment are to cover and track progression of the wounds, and to provide pain relief. Treatment depends on the severity of your wounds.

                            • Your healthcare team may apply topical steroids to your wound for pain relief and prevention [20].
                            • For more severe RICD, your treatment team may stop your radiation therapy. A dressing will be applied to your wound to maintain a moist healing environment [19]. If your wound is infected, you will receive an antibiotic.
                            • Finally, for the rare, most serious cases of RICD that involve bone and other structures underneath your skin, surgery will be necessary.

                            WHAT happens if RICD is left untreated?

                              If left untreated, RICD may become painful, infected, and can delay your cancer treatment [21]. Ulceration may progress to damage deeper structures such as muscle, blood vessels, and nerves. In the most severe cases, these wounds can become life-threatening.

                              WHEN should I call my healthcare provider? 

                                • If possible, keep track of your skin changes by noting their size and appearance
                                • Contact your doctor if you begin experiencing any signs of acute RICD
                                • Call your healthcare provider if you have a fever, increasing pain, redness, or swelling, skin changes, breaks, or drainage, and any new symptoms.

                                HOW can I prevent acute RICD?

                                  Take these steps to reduce your risk of RICD and to prevent your RICD from worsening.

                                    • Clothing
                                      • Wear loose clothing to prevent further skin irritation [4] [9]
                                    • Temperature
                                      • Avoid very hot and very cold temperatures. Do not place hot packs or cold packs on your treatment area [10].
                                    • Skin cleaning
                                      • Gently wash your treatment area with or without a mild soap or shampoo. Dry the treatment area gently and completely [9] [11] [12].
                                      • Consult with your doctor before using any skin product.
                                    • Skin hydration
                                      • Use non-scented, lanolin-free, emollient cream daily. Ask your radiation team for recommendations [13][14].
                                      • Do not apply lotion to your treatment area an hour before your appointment. This can enhance radiation injury to your skin.[15].
                                    • Sun exposure
                                      • Limit your time in the sun. Always protect your skin with sunscreen that has UVA and UVB coverage [1][4][9]
                                    • Hair care
                                      • Clip your hair rather than shave it.
                                      • If you must shave the area, use an electric razor instead of a razor blade. Do not use shaving cream [4].
                                    • Avoid irritation of the skin

                                    FAQs

                                      Q: What skincare products or brands can I use during radiation therapy?

                                        A: Ask your doctor for recommendations.


                                        Q: What do I do if my skin tears?

                                        A: Do not apply moisturizing cream to broken skin. Do not peel the skin. Contact your doctor.


                                        Q: Can I use deodorant on the treated skin?

                                        A: Yes. Preferably, use an unscented deodorant.


                                        Q: Can I apply aloe vera gel on my treatment area?

                                        A: No. This will further irritate your skin.

                                        For more information

                                          For more information about RICD, contact your healthcare team or cancer treatment center.

                                            Online resources include:

                                              • Medline Plus (https://medlineplus.gov/ency/patientinstructions/000735.htm)
                                              • National Cancer Institute (https://www.cancer.gov/publications/patient-education/radiationttherapy.pdf)
                                              • ASTRO (https://www.astro.org/Patient-Care/Patient-Education/Patient-Education/)
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                                              NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

                                              REFERENCES

                                              1. Bray FN, Simmons BJ, Wolfson AH, Nouri K et al. Acute and Chronic Cutaneous Reactions to Ionizing Radiation Therapy. Dermatology and therapy. 2016;volume 6(2):185-206.
                                              2. Ryan JL. Ionizing radiation: the good, the bad, and the ugly. The Journal of investigative dermatology. 2012;volume 132(3 Pt 2):985-93.
                                              3. Vuong T, Franco E, Lehnert S, Lambert C, Portelance L, Nasr E, Faria S, Hay J, Larsson S, Shenouda G, Souhami L, Wong F, Freeman C et al. Silver leaf nylon dressing to prevent radiation dermatitis in patients undergoing chemotherapy and external beam radiotherapy to the perineum. International journal of radiation oncology, biology, physics. 2004;volume 59(3):809-14.
                                              4. Hegedus F, Mathew LM, Schwartz RA et al. Radiation dermatitis: an overview. International journal of dermatology. 2017;volume 56(9):909-914.
                                              5. Brown KR, Rzucidlo E et al. Acute and chronic radiation injury. Journal of vascular surgery. 2011;volume 53(1 Suppl):15S-21S.
                                              6. De Langhe S, Mulliez T, Veldeman L, Remouchamps V, van Greveling A, Gilsoul M, De Schepper E, De Ruyck K, De Neve W, Thierens H et al. Factors modifying the risk for developing acute skin toxicity after whole-breast intensity modulated radiotherapy. BMC cancer. 2014;volume 14():711.
                                              7. Spałek M. Chronic radiation-induced dermatitis: challenges and solutions. Clinical, cosmetic and investigational dermatology. 2016;volume 9():473-482.
                                              8. Ryan JL, Bole C, Hickok JT, Figueroa-Moseley C, Colman L, Khanna RC, Pentland AP, Morrow GR et al. Post-treatment skin reactions reported by cancer patients differ by race, not by treatment or expectations. British journal of cancer. 2007;volume 97(1):14-21.
                                              9. Chan RJ, Webster J, Chung B, Marquart L, Ahmed M, Garantziotis S et al. Prevention and treatment of acute radiation-induced skin reactions: a systematic review and meta-analysis of randomized controlled trials. BMC cancer. 2014;volume 14():53.
                                              10. Hymes SR, Strom EA, Fife C et al. Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006. Journal of the American Academy of Dermatology. 2006;volume 54(1):28-46.
                                              11. Roy I, Fortin A, Larochelle M et al. The impact of skin washing with water and soap during breast irradiation: a randomized study. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncol.... 2001;volume 58(3):333-9.
                                              12. Wong RK, Bensadoun RJ, Boers-Doets CB, Bryce J, Chan A, Epstein JB, Eaby-Sandy B, Lacouture ME et al. Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group. Supportive care in cancer : official journal of the Multinational Association of Supportive Car.... 2013;volume 21(10):2933-48.
                                              13. Seité S, Bensadoun RJ, Mazer JM et al. Prevention and treatment of acute and chronic radiodermatitis. Breast cancer (Dove Medical Press). 2017;volume 9():551-557.
                                              14. Kole AJ, Kole L, Moran MS et al. Acute radiation dermatitis in breast cancer patients: challenges and solutions. Breast cancer (Dove Medical Press). 2017;volume 9():313-323.
                                              15. Radvansky LJ, Pace MB, Siddiqui A et al. Prevention and management of radiation-induced dermatitis, mucositis, and xerostomia. American journal of health-system pharmacy : AJHP : official journal of the American Society of.... 2013;volume 70(12):1025-32.
                                              16. Borab Z, Mirmanesh MD, Gantz M, Cusano A, Pu LL et al. Systematic review of hyperbaric oxygen therapy for the treatment of radiation-induced skin necrosis. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 2017;volume 70(4):529-538.
                                              17. Singh M, Alavi A, Wong R, Akita S et al. Radiodermatitis: A Review of Our Current Understanding. American journal of clinical dermatology. 2016;volume 17(3):277-92.
                                              18. The Princess Royal Radiotherapy Review Team. St James’s Institute of Oncology. Managing Radiotherapy Induced Skin Reactions . 2011;.
                                              19. Bolderston A, Lloyd NS, Wong RK, Holden L, Robb-Blenderman L, Supportive Care Guidelines Group of Cancer Care Ontario Program in Evidence-Based Care. et al. The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline. Supportive care in cancer : official journal of the Multinational Association of Supportive Car.... 2006;volume 14(8):802-17.
                                              20. Chung JH, Agrawal AK, Swift PS et al. Management of acute radiation side effects. In: Feusner JH, Hastings CA, Agrawal AK, editors. Supportive care in pediatric oncology. Berlin, Heidelberg: Springer Berlin Heidelberg . 2015;.
                                              21. McQuestion M. Evidence-based skin care management in radiation therapy: clinical update. Seminars in oncology nursing. 2011;volume 27(2):e1-17.
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