Series No 1 - General skincare advice for patients having radiotherapy

A skin reaction may appear at any time during treatment, but usually begins about 10 days after starting treatment. You may notice:

• Your skin gradually becoming pinker or darker, depending on your skin colour. The skin may feel warm to the touch. This is called erythema.
• Your skin may feel dry or tight rather like a “sun reaction”.
• A rash may also appear and feel itchy and sore. This is called dry desquamation.
• Very rarely, the skin may peel and can be very sore. This is called moist desquamation and can be very uncomfortable and distressing. This can happen where there are skin folds, or where the skin receives a high dose of radiotherapy. If this happens you will be given further help and advice by the radiotherapy review team.

During your course of treatment your skin will be checked daily by the radiographers. You will be seen in clinic usually once a week by the radiotherapy review team or your specialist nurse who will check your skin as part of the review.

If you are having a short course of radiotherapy (one to ten treatments) you may notice your skin reaction developing several weeks after your treatment has finished. The radiographers will give you advice on your last treatment on how to look after your skin.

• Having treatment to areas where there are skin folds can make your skin reaction worse. This includes the groin, breast, buttocks, or armpit because they can be warm, moist and rub together causing friction.
• Treatment to the head and neck area may mean a worse skin reaction.
• Having chemotherapy alongside radiotherapy can make your skin reaction worse.
• Smoking can make your skin reaction worse – if you need help to stop, please ask for advice.
• A skin reaction is more likely if you are overweight due to more skin folds.
• The amount of radiotherapy dose to the skin.
• Those with very fair sensitive skin, also black and Asian skin may be more at risk.

Your treatment team and the radiotherapy review team will talk to you about your usual daily skin care routine. They will let you know if any changes are advised. Please talk to them about any worries you have.

Radiotherapy skin reactions cannot be prevented, but by following this advice you may keep your skin in good condition and feel more comfortable. This only applies to the skin in the area being treated.

• Wash the skin gently with warm water and the soap products you usually use.
• Gently pat the skin dry with a soft towel or let the skin dry naturally. Be careful to pay extra attention to skin folds such as those under the arm, breast, groin, or buttocks.
• You may continue to use your normal deodorant unless it is found to irritate your skin.
• Do not soak the area in a hot bath or under a long hot shower.
• Do not use talcum powder, bubble baths, bath salts or body lotions in the treated area as they tend to dry or irritate the skin.
• Wear loose fitting, natural fibre clothing next to the skin. For example, a cotton T-shirt.
• Avoid rubbing or scratching the skin in the treatment area.
• Avoid extremes of temperature such as heating and cooling pads.
• Avoid sun exposure and protect the area from direct sunlight. You can wear a brimmed hat and/or cover up with clothing.
• Avoid wet shaving with a razor and shave cream. You may use an electric shaver for removing hair in the treatment area during your radiotherapy unless it is found to irritate the skin. Care should be taken not to ‘drag’ the skin too much as this could make the skin sore.
• Do not apply any cosmetics, perfumes or aftershaves to the skin in the treated area.
• Avoid wax and creams for hair removal.
• Avoid sticky tape on the area (such as ElastoplastTM or MicroporeTM).
• Do not use a sun bed, as this could worsen the skin reaction.
• Do not smoke, or at least try to cut down. Smoking may reduce the effectiveness of treatment and can often make the side effects much worse. If you need help to stop smoking, please ask as we offer a stopping smoking service here.
• If the treatment area includes your head, you may wash your hair gently with a non-medicated shampoo. Dry your hair naturally if possible or use a hair dryer on a cool setting. Brush your hair very gently.
• To improve your overall health, try to drink 6-8 glasses of water a day and eat a nutritionally well-balanced diet.

Use a moisturiser of your choice. Use the moisturiser frequently and gently smooth it on to your skin until it is absorbed. You do not need to wipe the moisturiser off before treatment, but please do not apply moisturiser immediately before treatment.

If you do not use a moisturiser, speak to the radiographers and they will be able to suggest a few options, such as ‘E45’ or ‘Zerobase’. We recommend that you patch test any new moisturising product you are using on an area of your body that is not the treatment area, to ensure you do not have a reaction.

If your skin becomes irritated, peels and is sore, stop using the moisturiser. You will be referred to the radiotherapy review team for appropriate skin care.

If you are worried about your skin or any other side effects after your radiotherapy treatment, please call the radiotherapy review team for advice. If you have questions about your treatment, follow-up appointments or medications, please speak to your clinical team.

After radiotherapy, your skin will continue to be more sensitive. Your reaction may worsen for the next 10-14 days. This can be very worrying for patients. We expect the side effects to worsen, but please be assured they will gradually settle. Please continue to follow the skin care advice you have been given by the radiotherapy team until your skin returns to normal. Once your skin has fully healed, you can use normal skin care products again. Most patients find their skin has healed by about 4 weeks after treatment finishes. If the skin has peeled, healing may take longer than this.

The skin in the treated area will always be more sensitive to the sun, particularly the first year after radiotherapy. Use a sunscreen with a minimum UVB sun protection factor (SPF) of 30+ and UVA protection as your skin will be more sensitive.
 
If you are unsure about this advice or have any questions, please talk to your treatment team, or the radiotherapy review team.

Radiotherapy Review Team (via Radiotherapy Reception) Telephone: 020 3447 3700/3701

Proton Beam Therapy Review Team (via Proton Beam Therapy Reception) Telephone: 020 3456 8000/8001

Out of hours oncology advice number (available 24 hours) Mobile: 07947 959020

If you have any concerns that you would like to discuss in confidence, please contact our PALS (Patient Advice and Liaison Service) for information and advice.

Telephone: 020 3447 3042
Email: uclh.pals@nhs.net