What are the aims of this leaflet?

This leaflet has been produced by The Society and College of Radiographers for patients who may develop skin reactions during or after radiotherapy. It is also provides advice on how you can look after your skin.

A skin reaction will only occur in the area being treated. Ask your radiographer and clinical nurse specialist where this is if you are not sure. If you have any questions that are not answered by this document, please talk to your radiographers and clinical nurse specialist.

How might my skin react to treatment?

A radiotherapy skin reaction is likely for most patients. It will not happen straight away, but tends to develop gradually throughout treatment and usually starts to settle 2-4 weeks after treatment finishes.

During the course of your radiotherapy, you may develop a skin reaction and notice your skin:

  • Gradually becomes pinker or darker (depending on your skin colour).
  • Feel dry or tight, and sore.
  • Develop a rash and feel itchy (this may feel worse when you get warm or hot).
  • Blister or peel. If this happens seek further advice as you may need dressings or gel.

You may develop an exit rash. This is where the radiotherapy beam causes a reaction in the area opposite to where it goes in.

This will depend on how and where you are being treated. Tell your radiographer and clinical nurse specialist if you see or feel anything on your skin that concerns you.

What can make my skin reaction worse?

If you develop a skin reaction during the course of your radiotherapy, a number of factors that may affect the reaction include:

  • If you are prescribed a higher dose of radiation for your type of cancer.
  • If you receive treatment to area where your skin folds. This includes the groin, breast, buttocks or armpit; these areas can be warm, moist and rub together, making the skin more sensitive.
  • If you receive treatment to the head and neck area. This is due to the sensitive nature of the skin and the tendency for this area to be exposed to the sun. If you are receiving treatment on your neck, you can help by covering this area with a cotton or silk scarf when you go outside.
  • If you smoke (this can affect the oxygen levels in your skin) Please ask for advice if you need help to stop or to cut down on smoking).
  • If you have other conditions such as diabetes or heart disease. Please tell you radiographers and clinical nurse specialist if you have any other health conditions so that it can be noted in your records.

Skincare Advice

Reaction to your skin cannot be prevented. However, there are things you can do to help yourself feel more comfortable.

  • Tell your radiographers and clinical nurse specialist about your usual daily routine. They will let you know if any changes are advised.
  • Keep notes of any differences to your skin so you can share with your radiographers and clinical nurse specialist. Please tell them if your skin reaction is painful, so they can recommend pain relief. Talk to them about any worries you have.

It will help your overall health if you take note of the following advice:

  • Keep up an intake of 6-8 glasses of water a day.
  • Eat a nutritionally well-balanced diet.

A diet that includes fruit, vegetables, whole grains and lean protein. You can ask your radiographers and clinical nurse specialist to provide examples and to explain the importance of staying hydrated and eating a healthy diet in more detail. If you’re receiving treatment to your abdominal area they may recommend a different diet.

  • You may go swimming if your skin is NOT peeling or blistering. It is best to shower immediately afterwards to wash off the chlorine and then apply moisturiser. Please stop swimming if it irritates your skin.
  • You may find it more comfortable to wear loose fitting clothing made of natural fibres such as cotton or silk.
  • Please avoid sun exposure and protect the area from direct sunlight. You can wear a brimmed hat and/or cover up with clothing. Continue to protect the treated area from the sun for at least one year after you have finished treatment. Because your skin will be more sensitive, use sunscreen with SPF 50 (sun protection factor 50).

  • Please continue to use the moisturiser you prefer and like to use. No specific moisturiser can be recommended for use during and after treatment as there is not sufficient evidence to support the use of one over the other.
  • Use moisturiser frequently; gently smooth it onto your skin until it is absorbed. The aim is to help keep your skin supple.
  • If you do not currently use a moisturiser, speak with your radiographer and clinical nurse specialist and they will be able to suggest a few for you.
  • You do not need to wipe your moisturiser off before receiving treatment, but please do not apply moisturiser immediately before your treatment.
  • Please stop using moisturiser if it irritates your skin and talk your radiographer and clinical nurse specialist.
  • If your skin blisters or peels, stop using moisturiser in that particular area and ask your radiographer or clinical nurse specialist for more advice.

Make sure the water is not too hot; wash the skin gently with products you would normally use and gently pat the area dry.

Please continue to use the deodorant you normally use, unless it irritates your skin; stop if your skin blisters or peels.

'DON'Ts' for the treatment area

Please avoid:

  • Rubbing the area.
  • Using sticky tape on the area, such as Elastoplast or Micropore.
  • Shaving – reduce shaving if possible, unless advised differently by your radiographer and clinical nurse specialist.
  • Using wax, cream or lasers for the hair removal on or close to the treatment area.
  • Using make up, hair dye, perfume and aftershave on or close to the treated area.

After your treatment has finished

  • Your skin reaction may worsen for the next 10-14 days before starting to improve.
  • Most patients find that their skin has improved around 4 weeks after treatment.
  • If the skin has blistered or peeled it may take longer to heal.

The treatment area will continue to be more sensitive than the rest of your skin, even once you have completed your radiotherapy, especially to heat and sunlight.

If you have any questions

Please talk to your radiographers and clinical nurse specialist. They are here to help you during and after your treatment.