Many regimens to treat leukemia, lymphoma, or myeloma require the use of external beam radiation treatments, or radiotherapy. While this treatment can be very effective, it can also cause side effects, as normal tissues within the therapy zone are damaged by the radiation. One of these side effects is skin toxicity. In many cases, external beam radiotherapy is done on an outpatient basis; therefore, it is very important that you know how to care for your skin during radiation treatment.
Factors That Influence Your Skin’s Response to Radiation
The way your skin will respond to radiation depends on a number of factors, including:
- The daily treatment dose
- Total dose and total time
- Size of the area being exposed to radiation
- Type of radiation beam
- The area of your body being exposed
- Other treatments you are taking
- Other medical problems you may have
- How close the tumor is to the skin surface
- Your nutritional status
Many people believe that if they do not experience a skin reaction, they did not receive enough radiation or that it is not working. But skin side effects are like any other -- some people get them and some people don’t.
Types of Skin Reactions
Acute skin reactions: The outer layers of your skin are in a constant state of self- renewal. That is, as skin cells die, they are continually being replaced by fresh new cells. Acute skin reactions to radiation occur when your skin is unable to keep up production of enough new cells to replace those lost by treatment.
In acute skin reactions, your skin may be:
- Warmer to the touch
- Dry, flaky, and peeling (also called “dry desquamation”)
- Moist, oozing, sloughing, and painful (also called “moist desquamation”)
- Looking tanned (called hyperpigmentation)
Acute skin reactions usually occur within 1-6 weeks of treatment. It takes time for the damage to the cells to heal, so it may take 2-4 weeks after your last radiation treatment for the reaction to resolve.
Late skin reactions: The late skin changes to produced by radiation may occur months or years after treatment, and may be permanent.
In late skin reactions, your skin may be:
- Extra pale in the treatment area
- Tanned in appearance
- Sensitive to the sun
- Thin and fragile
- Dense and hard
- Marked with purple-red, spider-like veins
How to Care for Your Skin During Radiation Treatment
While some cases of skin reaction may be inevitable, there are steps you can take to help keep your skin healthy and prevent further complication.
Here are a few tips for caring for your skin during radiation therapy:
- BE GENTLE with your skin.
- Assess your skin frequently.
- Do not remove temporary skin marks used for treatment purposes, unless otherwise instructed. Tattoos are permanent and will not be affected.
- Wash treatment area with warm, not hot, water. Ask your healthcare provider about using a mild soap, such as Dove or Ivory. Do not scrub.
- Avoid heating pads, hot water bottles, or ice packs to treatment area.
- Protect your skin from the sun, wind and cold.
- If sun exposure is absolutely necessary, wear at least SPF 15 sunscreen.
- Wear loose-fitting, breathable clothing.
- Avoid the use of deodorants, powders, heavily scented lotions, cosmetics, and perfumes in the treatment area unless approved by your healthcare provider.
- If shaving is necessary within the treated area, use an electric razor instead of a straight razor, and do not use shaving cream or hair removal products.
- Avoid tape on the treatment area.
- Ask your healthcare provider if a skin moisturizer would be helpful.
The Bottom Line
Skin changes within the area being treated with radiotherapy are very common. As with any treatment-related side effect, there are certain factors that can increase your risk of developing skin reactions. Assess your skin frequently and follow the advice of your healthcare provider before implementing a skin care regimen.
Iwamoto, R. “Radiation Therapy” in Varricchio, C. ed(1997) A Cancer Source Book for Nurses, 7th ed American Cancer Society Sudbury, MA (pp. 91- 103)
Maher, K. “Radiation Therapy: Toxicities and Management” in Yarbro, C., Frogge, M., Goodman, M., Groenwald, S. eds. (2000) Cancer Nursing: Principles and Practice 5th ed Jones and Bartlett. Sudbury, MA (pp.323-352)