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]

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/)