By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Radiation is used to kill cancer cells. Unfortunately, radiation does not discriminate between cancer cells and healthy cells. Skin cells are particularly vulnerable, and almost everyone who undergoes radiation will experience some skin changes.

Typical skin changes
Common skin changes include:

• Redness: The skin may appear reddened, similar to a sunburn; redness may range from mild to severe.
• Dry skin: Radiated skin will be very dry and may peel.
• Itching: The affected skin may be very itchy, leading the sufferer to scratch. Scratching may cause breaks in the skin that can become infected.
• Swelling: The affected skin may be swollen.
• Moist reaction: When the affected skin sloughs off faster than it can grow back, ulcers may form and/or skin may become wet or infected. This occurs most commonly in areas of skin folds, such as behind the ears, in the buttocks, in abdominal folds and under the breasts in women. It may also occur in areas where the skin is very thin, such as the neck and the forehead.

Skin changes usually begin within a few weeks after treatment commences. These changes may go away when treatment is completed, but the affected skin may never be the same; it may be thicker, drier, darker and more prone to sunburn than before the treatment.

Managing radiation effects
There are several key elements in caring for radiated skin:

• Be gentle: Do not rub, scratch or scrub radiated skin. Clothing should be made of soft cottons and bed linens should be made of a material that won’t irritate the skin. Avoid tight clothing made of material that doesn’t breathe, such as nylon.
• Avoid extreme heat and cold: Do not use ice packs, hot water bottles or heating pads on the affected area(s).
• Bathe in lukewarm water: Avoid hot showers or soaking in the tub for prolonged periods of time. Showering daily is permitted providing the water is not hot. If bathing is preferred, limit baths to every other day and do not soak for long periods. Avoid the use of soaps that have a lot of perfume or deodorant soaps. Pat the skin dry - do not rub the skin. Do not remove radiation markings.
• Use approved products: Lotions and skin products should be approved for use on radiated skin. This includes makeup, lotions, deodorant, perfumes, soaps, hair removal products and oils.
• Humidify: Use a humidifier to cool and humidify the air, which can aid in comfort (make sure the humidifier is cleaned as instructed by the manufacturer to avoid bacterial contamination).
• Use sunscreen: Radiated skin should be protected from the sun. Use an approved sunscreen and wear clothing that covers the skin as much as possible. Wear a hat to protect the scalp. Individuals who have had radiation are at increased risk of developing skin cancer and will need to limit sun exposure for the rest of their lives. Tanning beds should be completely avoided.
• Avoid adhesives: Do not apply adhesive tapes or sticky bandages to radiated skin. Use dressings that do not contain adhesives (i.e. use gauze rolls to hold dressings in place).
• Medications: Oral medications may decrease the itching associated with skin changes. Medicated creams and lotions may also provide relief to dry and itchy skin. Antibiotics may be required if radiated skin is infected.

As can be seen, care of radiated skin is important, and patients undergoing radiation must be counseled regarding the best way to manage side effects of radiation. Nurses are often tasked with providing the necessary teaching to this patient population.

Source:
Bennett, N & Tuaine, J. (2011). Care of radiation-induced skin reactions: Departmental Guidelines. Southern District Health Board. http://www.southerncancernetwork.org.nz/file/fileid/37304

About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.