Skin reactions occur because external beam radiation travels through the skin to reach the area being targeted for treatment. Radiation to any area of the body can cause skin reactions. The equipment used to deliver radiation therapy does not usually cause major damage to the skin. Some people do not experience any skin reactions with radiation therapy.
Radiation treatment may cause some general skin reactions, including:
- dryness or flaking
- tenderness or soreness
Most skin reactions occur within the first 2 weeks of receiving external beam radiation therapy. They usually go away 2–4 weeks after treatment is finished.
Sometimes skin changes occur after radiation is finished and become long-term (chronic) problems. The skin over the treated area can become thinner. It may also appear:
- darker or tanned (because the cells that produce skin pigment are affected)
- smooth, tight and shiny
- red or flushed (because small blood vessels are widened)
Radiation recall is a skin reaction that can occur when certain chemotherapy drugs, such as doxorubicin (Adriamycin), are given after radiation therapy treatment. It usually appears in the area of skin where the radiation was given. The skin becomes red and tender, and it may peel or blister like a sunburn. Radiation recall can happen shortly after, a few months after or a year or more after radiation treatments. Radiation recall is treated like other skin reactions.
Prevention and management
Keeping skin clean, dry and moisturized during treatment can help reduce potential problems. Some areas of the body are more sensitive to the effects of radiation. For example, skin folds may be more sensitive because of increased warmth and moisture where skin surfaces rub together.
Skin care during radiation therapy
It is important to follow skin care instructions that the radiation oncologist or radiation therapy team give you. The following are general guidelines about skin care:
- Follow the bathing instructions suggested by the radiation therapy team.
- Wash the area gently with warm water.
- Rinse the area well after washing and pat it dry. Do not rub the area roughly with a washcloth or towel.
- Use a mild shampoo, like a baby shampoo.
- Allow the hair to air dry. Do not use a hair dryer.
- Ask the radiation therapy team to recommend products that will not irritate the skin or interfere with treatment. Do not use any powders, creams, perfumes, deodorants, body oils, ointments or lotions in the treatment area unless approved by someone on the team. These products can irritate skin that is more sensitive because of radiation treatment or may affect the dose of radiation treatment.
- Do not use aftershave or hair removal products on skin in the treatment area.
- Use an electric shaver rather than a razor to prevent cutting the skin in the treatment area.
- Protect treatment areas from rubbing, pressure or irritation by wearing loose, soft clothing next to the skin. Cotton and silk are less irritating on radiated skin than harsh fabrics like wool and denim.
- Don’t wear a bra when having radiation therapy to the breast area. If this is too uncomfortable, talk to the radiation therapy team about possible options. They may suggest wearing a soft, comfortable bra without underwire.
- Do not put anything hot or cold (such as heating pads or ice packs) on the treatment area.
- Do not squeeze or scratch pimples.
- Do not wash or scrub off any markings used to target radiation therapy until after the last treatment. Marks made by a pen will gradually fade away. If the marks need to be removed quickly after treatment, lotion can be applied to them. Marks made by permanent tattoo will not fade over time and can’t be removed by lotion.
- Rinse well after swimming in a swimming pool because chlorine can be drying to the skin.
- Skin in the treatment area will be sensitive to sunlight and may burn easily. Cover treated skin with a hat or clothing before going outside. Ask the radiation therapy team about using a sunscreen and when it is okay to start using it. Protect the skin from the sun for at least 1 year after radiation therapy.
- Talk to the radiation therapy team if skin in the treatment area gets cut or scraped. They will suggest ways to take care of cuts and scrapes. They can also tell you how to bandage cuts if needed, such as using tape made for sensitive skin and applying tape outside the treatment area.
It is important to report skin reactions to the healthcare team. Mild skin reactions do not usually need treatment. Severe reactions may require medical treatment or radiation therapy may be delayed to help the skin recover.
Skin irritation can continue for several weeks after treatment ends, so special care may be needed for a short time after radiation therapy.
Some people choose to use makeup or cosmetics to help hide or camouflage discoloured skin after completing radiation therapy. Check with the radiation therapy team about when it is okay to try this and what products you can use.