Radiotherapy-related skin reactions

Specialist radiation oncologist, Dr Maríza Tunmer, educates us on radiotherapy-related skin reactions and how to prevent and manage them.

Radiation dermatitis

Radiation dermatitis is the medical term for skin reactions related to radiotherapy and is a common side effect experienced by patients receiving radiotherapy as part of their cancer treatment.

It’s the result of inflammatory effects in both the superficial layer of the skin (epidermis) as well as the layers just beneath this (dermis). These effects may impact a patient’s quality of life and may cause discomfort and pain. It may even result in interruptions in treatment and this may negatively affect control of the cancer being treated. 

Patients particularly at risk for the development of skin reactions, include those receiving treatment for breast-, head and neck-, and skin cancers, sarcomas and cancers in the pelvic area. However, any patient receiving radiotherapy may develop a skin reaction.

Acute or chronic side effects

Like other radiotherapy-related side effects, radiation dermatitis is divided into acute (early) and chronic (late) side effects. 

Acute side effects occur while a patient is on radiotherapy or, by definition, within 90 days/three months of starting treatment.

Chronic or late side effects may occur any time after that. Sometimes late side effects are related to the severity of acute side effects.

The severity of side effects depends on many factors, including the area being treated; duration of treatment; total dose of radiotherapy received; use of chemotherapy at the same time as radiotherapy; and then also patient-related factors:

• Area of the body being treated:  
  • The most sensitive areas are the face, neck, chest, extremities, and  abdomen. 
• Other factors which may increase the risk:
  • Smoking
  • Obesity
  • Older age
  • Sex (female)
  • Certain skin/soft tissue conditions
  • Certain genetic mutations

Acute side effects

These are mostly related to inflammation. They include: redness (erythema); itchiness (pruritus); swelling (oedema); hair loss or inflammation of the hair follicles (folliculitis); pigment changes (darkening or lightening of the skin); peeling which may be dry or wet (dry- or moist desquamation) and, in severe cases, this may progress to skin ulceration. 

Following completion of the radiotherapy course, the skin cells start to heal. The time period is variable and may depend on several factors, including the severity of the skin reaction.  

Late side effects

These may occur any time after three months following the start of radiotherapy. Sometimes even years after treatment. These include effects, such as hardening or stiffening of the skin (fibrosis); pigmentation (darkening or lightening of the skin, as described above); and the development of thin, red blood vessels visible under the skin (telangiectasia). 

Prevention and management of skin reactions

Certain practices may help prevent or reduce the severity of the skin reaction:

• Skin hygiene – keep the area being treated clean and dry.
• Washing with water (lukewarm) and fragrance-free soap.
• Use of fragrance-free, water-based moisturisers, such as aqueous cream. But, not to be applied shortly before the daily treatment as this may increase the radiotherapy dose to the skin.

Avoiding the use of perfumes and baby powder.

• Protection from sun exposure.
• Avoiding friction by wearing loose-fitting, soft clothing.
• Use of specialised creams, ointments or protective films, as discussed with your doctor.

The development and severity of a treatment-related skin reaction varies from patient to patient. Should you be undergoing radiotherapy treatment, discuss the expected side effects and management with your radiation oncologist.

References

1. Bray FN, Simmons BJ, Wolfson AH, Nouri K. Acute and Chronic Cutaneous Reactions to Ionizing Radiation Therapy. Dermatol Ther (Heidelb). 2016;6(2):185–206

2. Brown KR, Rzucidlo E . et al.  Acute and chronic radiation injury. J Vasc Surg. 2011 Jan;53(1 Suppl):15S-21S. Epub 2010 Sep 16

3. Wong, R.K.S., Bensadoun, RJ., Boers-Doets, C.B. et al. Support Care Cancer (2013) 21: 2933

MEET OUR EXPERT – Dr Maríza Tunmer

Dr Maríza Tunmer is a specialist radiation oncologist working in private practice at WITS University Donald Gordon Medical Centre in Gauteng. She also works as a sessional consultant at Charlotte Maxeke Johannesburg Academic Hospital.