The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline

Abstract

Skin washing, including gentle washing with water alone with or without mild soap, should be permitted in patients receiving radiation therapy to prevent acute skin reaction. There is insufficient evidence to support or refute specific topical or oral agents for the prevention or management of acute skin reaction. In the expert opinion from the SCGG, the use of a plain, non-scented, lanolin-free hydrophilic cream may be helpful in preventing radiation skin reactions. In addition, a low dose (i.e., 1%) corticosteroid cream may be beneficial in the reduction of itching and irritation.

RTOG criteria to evaluate acute skin reaction and its risk factors in patients with breast cancer submitted to radiotherapy

“…There is little consensus between involved professionals, and knowledge advancements regarding the care of wounds have little impact on patients with skin reactions caused by radiation (16)(17)(18) .…”

Radiotherapy and wound healing: Principles, management and prospects (Review)

“…Literature suggests that most advice given to patients being treated with radiation therapy is based on expert opinion rather than on reporting study results (84). the main recommendation is that gentle skin and hair washing should be unrestricted.…”

“…Bolderston et al described a lack of strong evidence regarding the management of radiation therapy-related wounds such as moist desquamation (84). steroid creams, sucralfate cream and various dressings were examined, but their comparisons were limited by use of unequal treatment parameters.…”

Prophylaxis and Management of Acute Radiation-Induced Skin Reactions: A Systematic Review of the Literature

“…Skin reactions related to radiation therapy usually manifest within 1-4 weeks of radiation start, persist for the duration of radiation therapy, and may require 2-4 weeks to heal after completion of therapy 5 . The severity of the skin reaction ranges from mild erythema (red rash) and dry desquamation (itchy, peeling skin) to more severe moist desquamation (open wound) and ulceration 6 .…”

“…Areas of the body that contain skin folds, such as the groin, are at higher risk of developing a reaction because of a phenomenon called the "bolus effect"; these areas are more likely to receive a higher dose of radiation and more prone to bacterial contamination 9 . Prescribed treatment at low doses (<2000 cGy) in conventional fractionation at depth usually does not elicit a skin reaction, and consequently, patients receiving palliative treatment are not usually at risk 6 .…”