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Radiation therapy works by damaging the DNA in the cancer cell, thereby disabling the cancer cells from reproducing, and growing. The cancer cells then die, and the cancer shrinks. The objective of radiation therapy is to kill enough cancer cells to maximize the probability of cure and minimize the side effects. Radiation therapy can also damage healthy tissues resulting in unwanted side effects.

One of the most common side effects from radiation therapy is reddened or irritated skin. It is important for patients to be gentle with their skin during radiation therapy. The following tips will help decrease skin irritation and breakdown. Most skin reactions will go away a few weeks after treatment is finished.

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Radiation Dermatitis

There are a number of things patients can do to help make your skin less sensitive during radiation treatment and help your skin heal faster after radiation treatment is completed.

Moisturize: At the beginning your radiation treatment, before you have any side effects, moisturize the skin after your daily treatment with an ointment such as A&D, Eucerin, Aquaphor, Miaderm, Biafene, or Radiacare. You also can put it on at night — wear an old T-shirt so the ointment doesn't get on your bed clothes. If your skin becomes dry and flakey during the course of your treatment, moisturize frequently and cleanse skin gently.

Dress comfortably: Wear loose-fitting shirts, preferably made from cotton. Avoid wearing underwire bras or any bra that digs into your skin. Don’t wear a bra if there are raw areas.

Take care when showering or bathing: Use warm rather than hot water. Try to not let the spray from the showerhead directly hit the area receiving radiation. Let the water hit your shoulder and run down over the affected area.

Avoid strong soaps and soaps with fragrance. Use fragrance-free soaps with moisturizers (such as Dove, or soaps made specifically for sensitive skin).

Avoid scrubbing with wash clothes or loofahs.

Avoid skin-on-skin contact: To help prevent redness and skin irritation, avoid skin-on-skin contact that can cause friction, moisture, pressure, and heat. The areas where this most often happens are: 

  • the armpit: where your arm presses against your armpit and the outer portion of your breast 
  • under the breast: along the bottom crease of your breast, where your breast might droop a bit and lie up against your upper belly wall 
  • between the breasts: along your cleavage where the breasts touch each other 

To avoid skin-on-skin contact: Try to keep your arm away from your body whenever possible.

Shaving: You may use an electric razor for shaving hair in the treated area. Men should not use after-shave if receiving radiation to head and neck area.

What About Pain Relief?

To relieve discomfort from blistering or peeling, take an over-the-counter pain reliever, or ask your doctor for a prescription. If problems become especially troublesome, your doctor or nurse might suggest taking a short break in treatment to allow your skin to recover.

  • Corticosteroid creams - Topical steroid cream is may be used for radiation dermatitis, although clinical evidence is mixed concerning this treatment option.
  • Antibiotics - Oral and topical antibiotics may be necessary in treating the burns associated with radiotherapy.
  • Silver leaf nylon dressing - Burns on the skin are typically treated with gauze. When it comes to radiation silver leaf nylon dressing is is a good option. It combines antimicrobial and anti-infective properties that are released into the skin to relieve discomfort and improve recovery.
  • Zinc - can be used topically to treat burns cuts and ulcers.

Avoid direct sun exposure to the treated area

If you must go outside, wear loose fitting clothing, and use a sunscreen with an SPF of 30 or higher. Sunscreen must be used on treated skin for the rest of your life. Skin that has received any radiation will be more sensitive and burn easily.

Tips for Women Undergoing Radiation to the Breast

Women undergoing breast radiation face some additional challenges and the following recommendations may by helpful

  • Wear a supportive bra without an underwire to keep your breasts separated and lifted.
  • When you're not wearing a bra, consider placing a soft washcloth or soft cotton under your breast to reduce irritation.
  • Regularly dust the breast area with cornstarch and skin folds with cornstarch to absorb moisture, reduce friction, and keep you smelling fresh.
  • Treat yeast infections before radiation begins: Yeast infections are common in the skin fold under each breast and manifest as redness, itchiness, and sometimes a faint white substance on the skin. An anti-fungal cream or powder (such as athlete's foot medicine) usually works well
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Sunscreen During Radiation Therapy

Patients undergoing radiation therapy should be especially cautious about protecting their skin from direct sunlight. Areas of the skin that receive radiation therapy can burn more easily and should be protected. Avoid direct sunlight and always wear a hat and sunscreen when outdoors or exposed to sunlight.

Some chemotherapy drugs can also increase the damage from the sun’s rays. During chemotherapy, it is best to avoid direct exposure to the sun as much as you can to avoid burning of the skin.2 The effects of chemotherapy drugs can last for one to two months after chemotherapy has been completed so make sure you understand your risks from sun exposure.

Like most over-the-counter products, not all sunscreens are created equal. Ultimately, the best type of sunscreen is the one you will use again and again. Just be sure to choose one that offers broad-spectrum protection, has a sun protection factor (SPF) of 30 or greater, and is water resistant.

Q: Are high-SPF sunscreens better?

A: Dermatologists recommend using a sunscreen with an SPF of at least 30, which blocks 97 percent of the sun’s rays. SPFs higher than 30 block slightly more of the sun’s rays, but no sunscreen can block 100 percent. It is important to note that even if you are wearing a high-SPF sunscreen, it should be reapplied approximately every two hours when outdoors and after swimming or sweating.

Q: Are sunscreens safe?

A: Scientific evidence supports the benefits of using sunscreen to minimize short- and long-term damage to the skin from sun exposure. Dermatologists agree that preventing skin cancer and sunburn far outweighs any unproven concerns about toxicity or human health hazard from sunscreen ingredients. Sunscreen alone cannot fully protect people from the sun, however. The American Academy of Dermatology (AAD) recommends that, in addition to applying sunscreen, everyone seek shade, wear protective clothing and sunglasses, and stay out of tanning beds—all important behaviors to reduce the risk of skin cancer.

Q: What type of sunscreen should I use? Are spray sunscreens safe?

A: The kind of sunscreen you choose is a matter of personal choice and may vary depending on the area of the body to be protected. Available sunscreen options include lotions, creams, gels, ointments, wax sticks, and sprays.

  • Creams are best for dry skin and the face.
  • Gels are good for hairy areas, such as the scalp and the male chest.
  • Sticks are good to use around the eyes.
  • Sprays are sometimes preferred by parents because they are easy to apply to children. Men may find spray convenient to apply to a balding scalp.

What if I have "sensitive skin"?

If you have sensitive skin, however, you may find that some UV-blocking lotions irritate your skin. You may also be allergic to some common ingredients in sunscreens.

While it may be temping to avoid the redness, stinging, and irritation and skip sunscreen altogether, leaving your skin unprotected puts you at risk for more serious skin damage. Fortunately, there are ways to shield your skin without the irritation.

If you’ve had a bad reaction to sunscreen, the following tips can help you find an effective product that you won’t be tempted to avoid.

They’re Not Created Equal The most common sunscreens are chemical-based formulations, containing ingredients that absorb the sun’s rays. Sunscreen may also be mineral-based containing zinc oxide and titanium dioxide. These deflect ultraviolet rays away from the skin. Mineral sunscreens are less likely to sting your eyes; they are gentler to skin; and they block both UVA and UVB rays. “Mineral sunscreens are the most trustworthy. They are the most stable [i.e., don’t degrade as quickly on your skin or in the bottle] and provide the broadest protection,” says California dermatologist Cynthia Bailey, MD, whose blog (drbaileyskincare.com) covers sun protection. In addition to the messy white goo that we all love to hate, you can find sunscreens in sprays, wipe-on sheets, powders, roll-ons, and waxy sticks. And many sunscreens do double-duty as beauty products. “Moisturizing, anti-aging, medicated, tinted, acne preventative, makeup priming, and other all-in-one SPF-30+ sunscreens are evolving, so one beauty product treats a variety of needs,” says esthetician Naomi Fenlin, owner of About Face Skin Care in Philadelphia. Some sunscreens also contain antioxidants such as Vitamin C and green tea, or plant-based ingredients such as aloe vera or avocado butter, for a protective boost.

Sunscreen tips from the American Association of Dermatology

  • Use a sunscreen product with at least SPF 30.
  • Check the expiration date on the lotion.
  • Reapply often at least every two hours, or more often if you are swimming or sweating.
  • Use about an ounce, or a full palm full, of sunscreen to cover the exposed parts of an adult.
  • Make sure to apply the sunscreen a half hour before sun exposure.
  • Wear clothing with a UVP (ultraviolet protection) on the label. Some manufacturers create clothing that has been designed or chemically treated to offer higher
  • Wear UV resistant sunglasses. The eyes are also susceptible to damage from the sun, including melanoma.
  • Wear a visor or hat with a wide brim.
  • Apply sunscreen before makeup or bug repellent.
  • Don’t forget your ears, face, feet, hands, and the back of your neck when applying.
  • Apply a lip balm with SPF.
  • Try to avoid the sun at times of the day when the rays are strongest, usually between 11 a.m. and 4 p.m.
General PMF Newsletter 490

Clothing Tips from the National Cancer Institute

  • Wear loose-fitting clothing with breathable fabric. If you can see light through the fabric, the rays of the sun can penetrate it.
  • Long pants, skirts, and sleeves if you are out when the sun is at its brightest
  • Hats with a wide brim (2-3 inches) or a sports hat with fabric that covers the back of the neck are good choices.
  • Sunglasses with UV protection.
  • Clothing with SPF fabric.

What About Zinc?

Sunscreens made with zinc oxide or titanium dioxide aren’t absorbed into the skin. Instead, these sunscreens sit on the skin and act as a protective shield. This may be less irritating to the skin, making it an ideal choice for those with sensitive skin and/or young infants.

Tanning Beds are a “no-no”

Sunlamps can cause the same damage to skin that the sun can, so they are not a good option. Spray tans and sunless tanning technology is a better alternative.

References

  1. https://pubmed.ncbi.nlm.nih.gov/15183484/
  2. Skin Cancer. American Academy of Dermatology website.
  3. Sunscreen FAQs. American Academy of Dermatology website.
  4. Sunscreens Explained. Skin Cancer Foundation website.