Radiation Dermatitis

Aka: Radiation Dermatitis, Radiation Recall, Skin Reactions to Radiation Therapy, Radiation Therapy Induced Skin Changes

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II. Epidemiology

  1. Incidence: 95% of photon radiation treatment patients

III. Risk Factors

  1. Comorbidities
    1. Connective Tissue Disorders
    2. Skin disorders
    3. Body Mass Index >25 kg/m2
    4. Smoking
  2. Factors affecting severity
    1. Total radiation dose
    2. Dose fractionation schedule
    3. Tissue volume treated
    4. Moist Desquamation occurs more rapidly in previously irradiated regions
    5. Concurrent Chemotherapy (Radiation Recall on re-initiation of Radiation Therapy)
      1. Doxorubicin
      2. Fluorouracil
      3. Hydroxyurea
      4. Methotrexate
      5. Paclitaxel

IV. Signs: Early Changes following Radiation Therapy

  1. Onset within hours to weeks of Radiation Therapy
  2. Erythema
    1. Pink, mildly swollen skin with Sensation of Pruritus or burning
  3. Dry Desquamation
    1. Epidermal basal cells partially sloughed
    2. Skin dryness, pealing or Scaling
    3. Hyperpigmentation
  4. Moist Desquamation
    1. Epidermal basal cells completely sloughed
    2. Blisters
    3. Serous discharge
    4. Neuropathic pain

V. Signs: Late Changes following Radiation Therapy

  1. Skin pigmentation change
  2. Permanent Hair Loss
  3. Telangiectasia
  4. Skin atrophy
  5. Skin Ulceration

VI. Management

  1. Gentle skin washing with Mild Soap and water
  2. Mepilex Dressing
  3. Topical Corticosteroids (see below)
  4. Avoid ineffective therapies
    1. Aloe vera
    2. Chamomile
    3. Ascorbic Acid
    4. Pantothenic Acid
    5. Trolamine
    6. Sucralfate

VII. Prevention

  1. Gentle skin washing with Mild Soap and water
  2. Skin Lubricant use regularly
  3. Avoid exacerbating factors (e.g. hot baths, mechanical irritation)
  4. Topical Corticosteroid (moderate to high potency, e.g. Betamethasone valerate, Mometasone furoate)
    1. Indications (high risk for dermatitis)
      1. Breast Cancer
      2. Head and neck cancers
      3. Gynecologic cancers
      4. Anal or rectal cancer
      5. Large areas of Radiation Therapy
      6. High total doses of Radiation Therapy
    2. Protocol
      1. Apply a thin layer of Topical Corticosteroid over intact skin twice daily
      2. Start at time of Radiation Therapy onset and continue for 2-3 weeks after treatment completed
  5. Hydrofilm or Mepitel film
    1. Indicated in Breast Cancer related Radiation Therapy
  6. Photobiomodulation therapy
    1. Indicated for Breast Cancer or head and neck cancer related Radiation Therapy

VIII. References

  1. Berkey (2010) Am Fam Physician 82(4):381-8 [PubMed]
  2. Eary (2026) Am Fam Physician 114(4): 393-411 [PubMed]

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