Being proactive can reduce the impact of the side effects on your skin.

"Basically, most things we do now don’t impact the skin at all. And if the skin is affected, there are simple ways to take care of it.” EM. Horwitz, MD, Fox Chase Cancer Center

That’s the good news. But skin changes are common and expected during radiation therapy and it may take a few weeks or longer after treatment starts before you experience them. Each person reacts to treatment in a different way. The type of skin reaction that you may get depends on the part of your body that’s being treated, the type and dose of radiation that you get, if you have chronic health conditions including high blood pressure, diabetes, any collagen vascular diseases, such as rheumatoid arthritis or a history of skin cancer in the area to be radiated. Your history of smoking is another factor that has to be considered when it comes to healing from radiation. These conditions may delay healing or affect the severity of your skin’s reaction to radiation and therefore it is important to inform your cancer care team.

During each radiation treatment, radiation is aimed at an area of your body called the “treatment field.” Radiation passes through the skin of the treatment field and kills or slows the growth of cancer cells, but it can also affect nearby healthy cells. Damage to healthy cells can cause side effects. During multiple cycles of radiation that usually happen at a regular close cadence ( daily for multiple weeks), your skin cells often do not have enough time to repair and regenerate in between treatments.

Skin changes may become more noticeable as the course of radiation therapy progresses.

Acute radiation side effects occur 1 to 4 weeks after beginning treatment and may persist for several weeks following treatment. Late side effects occur 6 or more months after your cancer care treatment is complete.

In most cases, radiation therapy treatment does not cause long-term side effects andmost skin reactions are temporary and will usually go away after a few weeks of completing radiation therapy. The most common effect on the skin is a rash some patients develop during radiation treatment called radiation dermatitis. It usually appears on the skin in the area where you received radiation and may take a while to develop. The severity depends on where you received the radiation, the size of the area, how much radiation you got and for how long. In some cases, though, the irradiated skin will be slightly darker, thinner, or dryer than it was before. The radiated skin may burn more easily from sun exposure, and may be prone to infection and breakdown.

Radiation therapy may cause the exposed skin to peel off faster than it may grow back, causing sores and, in rare occasions, ulcers to develop. In most cases, after treatment ends, the skin will form a protective scab and the new, healthy skin will develop underneath it. This healing may take several months. You will also likely lose your hair in the area treated. Your hair may grow back, but it might not have the same texture, color or thickness.

Proper skin care during and after radiation therapy can help manage these skin side effects so that you can go through treatment with some level of comfort and prevent symptoms from worsening. To help prepare yourself, ask your cancer care team ahead of time what skin changes you may expect during radiation therapy. Plan how you will deal with skin reactions. Remember that in most cases, these skin changes are temporary and may go away when treatment ends.

Here are some practical tips that can help with healing:

When you bathe:

• Use warm rather than hot water. Take showers or short, cool baths instead of long, hot baths.
• Try to not let the spray from the showerhead directly hit the area where you are getting radiation.
• Avoid strongly scented or fragrant soaps. Use fragrance-free soaps with moisturizers or soaps made specifically for sensitive skin.
• Avoid scrubbing with washcloths or loofahs. Use a soft cloth and gentle, low-pH products.
• Be gentle with your skin both indoors and outdoors.
• Avoid shaving. If you must shave in the treatment area, use an electric razor to avoid cuts. Do not use a pre-shave lotion, aftershave, or hair removal products. If a rash appears, avoid shaving again until the skin has completely healed. If you need to bandage the area, use paper rather than adhesive tape and try to apply the tape outside of the treatment area.
• Apply a cancer care team recommended moisturizer daily as directed. Avoid moisturizer on open wounds.

When getting dressed:

• Be careful of any radiation-related wounds and sores while changing clothes.
• Don’t put anything sticky, such as surgical tape or adhesive bandages, on your skin.
• Use fragrance-free products. Avoid perfumes, body oils, scented lotions, cosmetics, or products containing alcohol.
• Skip antiperspirant and talcum powder. A non-antiperspirant deodorant as long as it doesn’t irritate your skin should be fine but check with your cancer care team for brands they recommend. Very finely milled corn starch (instead of talcum powder) helps to absorb moisture, reduce friction and keep you smelling fresh.
• Wear loose-fitting clothing to avoid irritating the treated area.
• To help prevent redness and skin irritation, avoid skin-on-skin contact. In breast cancer patients, this typically happens at the point where your arm presses against your armpit and the outer portion of your breast. Along the bottom crease of your breast, where it touches your upper belly wall as well as along your cleavage.
• Use gentle detergents, such as those for newborns or infants to wash your clothes while on treatment and avoid starching the clothes you wear over the treatment area.

Things to remember:

• Cover the treated area with sun-protective clothing.
• Use the sunscreen that your care team recommends.
• Stay in the shade when outdoors. The sun may burn you even on overcast days. You must protect previously radiated skin from the sun even after radiation therapy is over. If you are in the sun, use sunscreen with SPF 30 or higher, and wear a hat and protective clothing.
• Don’t use hot tubs or tanning beds.
• Wear appropriate clothing when you have to go outside extreme cold or hot weather and try to limit your time outdoors. Dress properly as extreme weather conditions may worsen and/or cause dry skin reactions. Cool, humid weather helps with radiated skin.
• Do not smoke. Smoking has been found to worsen radiation related skin reactions. Talk to your cancer care team before swimming, including chlorinated pools, hot tubs and non-chlorinated water (such as lakes, rivers).

At home:

• Don’t put anything hot or cold, such as heating pads, hot water bottles, or ice packs directly on your treated skin. Use a soft cover or cloth as a barrier.
• Protect radiated skin when you do chores. For example, if your hands were treated, wear rubber gloves to wash dishes.
• A healthy, well-balanced diet is important for healthy skin, and may also help the body tolerate radiation treatments, fight infection and rebuild tissue. An oncology dietitian who works with cancer patients can optimize your diet during radiation to minimize side effects.
• Try to drink plenty of fluids each day to keep your body hydrated. Avoid alcohol and caffeinated beverages.
• After you’ve finished radiation therapy, continue to protect the treated area and watch your treated skin for changes, such as redness or a rash, and report these symptoms to your cancer care team. Patients who receive chemotherapy immediately following or during radiation.

Therapy may rarely develop a more serious skin-related side effect called radiation recall.

This is a sunburn-like rash that develops on radiated areas after the patient has had chemotherapy. Radiation recall can occur weeks, months, or even years after radiation therapy has ended. Radiation recall may cause redness, swelling, pain, blisters and wet sores and peeling skin. There may remain discoloration even after the skin heals. In some cases, the rash may be severe enough that patients have to stop chemotherapy until it heals. To treat this skin condition, your cancer care team may prescribe medication such as corticosteroids, in the form of a pill or a cream, to reduce the inflammation so that you can resume your chemotherapy regimen.

The same tips that were mentioned previously in this blog can help in radiation recall to ease the pain and soothe the skin area as it heals. You should be closely monitored by your cancer care team and as always be your own best advocate keeping a close eye on your skin where you have received radiation till it heals completely.