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CARE OF RADIATION SKIN REACTIONS
Definition
Radiation skin reactions are a common side effect of radical ionizing radiation treatment. The pathophysiology of a radiation
skin reaction is a combination of radiation injury and the subsequent inflammatory response and can occur at both the
entrance and exit site of the irradiation. Ionizing radiation damages the mitotic ability of stem cells within the basal layer
preventing the process of repopulation and weakening the integrity of the skin. Reactions are evident one to four weeks after
beginning treatment and can persist for several weeks post treatment.
Factors Contributing to the Severity of Radiation Skin Reactions
Type of Radiation and
Energy
•
•
•
Treatment Technique
•
Location of the
Treatment Field
Volume of Treated
Tissue
Dose, Time and
Fractionation
Parameters
•
Chemotherapeutic
Agents
Co-existing Chronic
Illnesses
Tobacco Use
•
Age
•
Nutritional Status
•
•
•
•
•
•
A source of radiation used in cancer treatment is a linear accelerator. This high voltage
machine generates ionizing radiation from electricity to deliver external beam radiation
therapy in the form of photons or electrons
Radiation treatments delivered by external beam vary in depth depending on the energy of
the beam produced
Photons penetrate more deeply with increasing energy and also partially spare the skin
from the effect of radiation; while electrons have shallow depth and high skin dose
There is evidence to suggest that specific treatment techniques such as Intensity Modulated
Radiation Therapy (IMRT) are associated with a decreased severity of acute radiation skin
reactions
The radiation skin reaction may be more severe depending on the location of the treatment
field i.e. sites where two skin surfaces are in contact such as the breast or buttocks
The total volume of the area treated is considered when the dose is prescribed because
larger areas of body surface will be irradiated which may result in increased skin toxicity
Radiation treatments are prescribed in units of measurement known as Gy (Gray) or cGy
(centiGray) with 1 Gy equaling 100 cGy
In order to manage the toxicities associated with radiation therapy, the total dose is divided
into multiple daily doses called fractions
The effects of ionizing radiation therapy are enhanced by specific radiosensitizers such as
doxorubicin, 5-fluorouracil and bleomycin
Coexisting chronic illnesses such as anemia, diabetes mellitus and suppression of the
immune system may contribute to the severity of the radiation skin reaction
Smoking limits the oxygen carrying capacity of hemoglobin. Elevated carboxyhemoglobin
levels have been associated with changes to the epithelium and increased platelet
stickiness. Nicotine affects macrophage activity and reduces epithelialization
Vasculoconnective damage caused by ionizing radiation, when combined with the
degenerative changes to the epidermis and dermis, leads to an exacerbation of radiation
skin reactions as age increases
Malignancy alone can compromise nutritional status. Patients who are poorly nourished
may be at risk for poor wound healing
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 1 of 17
Consequences
Radiation skin reactions commonly progress from erythema to dry desquamation to moist desquamation and rarely to
ulceration. Additionally, with current technology and treatment delivery, necrosis is now also a rare occurrence. Patients may
complain of tenderness, discomfort, pain or burning in the treated skin. Some patients note a change in activities of daily
living as a consequence of the skin reaction.
General Skin Care Recommendations
Washing: Patients should be encouraged to wash the irradiated skin daily using warm water and non perfumed soap. The
use of wash cloths may cause friction and are therefore discouraged. The use of a soft towel to pat dry is recommended.
Use of Deodorants: Patients may continue to use deodorants during radiation therapy.
Other Skin Products: Patients are discouraged from using any perfumed products which may possess chemical irritants
and induce discomfort. Products such as gels or creams should be applied at room temperature. Patients should be
encouraged to use products advocated by the radiation department.
Hair Removal: The use of an electric shaver is recommended and wax or other depilatory creams are discouraged. Patients
are asked not to shave the axilla if it is within the treatment field.
Swimming: Patients may continue to swim in chlorinated pools but should rinse afterwards and apply a moisturizing lotion.
Patients experiencing a radiation skin reaction which has progressed beyond dry desquamation should avoid swimming.
Heat and Cold: Patients are encouraged to avoid direct application of heat or cold to the irradiated area i.e. ice or electric
heating pads.
Band-Aids, Tape and Clothing: Rubbing, scratching and massaging the skin within the treatment area causes friction and
should be discouraged. The use of Band-Aids or tape on the skin should also be avoided. Wearing loose fitting cotton
clothing may avoid traumatic shearing and friction injuries. The use of a mild detergent to wash clothing is also
recommended.
Sun Exposure: Patients should be instructed to avoid direct sun exposure and cover the irradiated skin. The use of
sunscreen products with at least SPF 30 are recommended for at least one year following treatment.
Care of Malignant Wounds During Radiation Therapy
Malignant wounds are the result of cancerous cells infiltrating the skin and its supporting blood and lymph vessels causing
loss in vascularity leading to tissue death. The lesion may be a result of a primary cancer or a metastasis to the skin from a
local tumour or from a tumour in a distant site. It may take the form of a cavity, an open area on the surface of the skin, skin
nodules, or a nodular growth extending from the surface of the skin. A malignant wound may present with odour, exudate,
bleeding, pruritis and pain and interfere with the patient’s quality of life.
Treating the underlying cause of a malignant wound may involve surgery, radiation therapy, chemotherapy or hormone
therapy. Managing symptoms such as bleeding, exudate and pain, reducing tumor size and promoting wound healing
whenever possible can be additional aims of treatment. A reduction in the impact of symptoms may contribute to the overall
comfort of the patient.
The goal of radiation therapy is to reduce tumour size. As the tumour becomes smaller, a radiation skin reaction may develop
on surrounding tissue and the patient may experience erythema, dry desquamation and moist desquamation.
Skin care practices During Radiation Therapy: If the malignant lesion is encapsulated, skin care practices are the same
as for patients with intact skin. However, if the lesion erupts (as a result of the inflammatory response associated with
radiation therapy) skin care practices for open wounds should be initiated. The principles of moist wound healing should be
applied from the beginning of treatment to promote patient comfort and create an optimal wound environment in the open
lesion and in any radiation skin reaction in surrounding tissues. Applying products which absorb drainage is essential to avoid
infection and promote comfort. Protecting the surrounding intact skin is a priority therefore observing the general skin care
recommendations is required.
http://www.bccancer.bc.ca/NR/rdonlyres/0A61B812-801E-4F1E-8375A89A8BD58377/51006/M30CareofMalignantWounds.pdf
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 2 of 17
Principle of Moist Healing
Cell growth needs moisture and the principle aim of moist wound therapy is to create and maintain optimal moist conditions.
Cells can grow, divide and migrate at an increased rate to optimize the formation of new tissue. During this phase of wound
healing an aqueous medium with several nutrients and vitamins is essential for cell metabolism and growth.
The wound exudate serves as a transport medium for a variety of bioactive molecules such as enzymes, growth factors and
hormones. The different cells in the wound area communicate with each other via these mediators, making sure that the
healing processes proceed in a coordinated manner.
Wound exudate also provides the different cells of the immune system with ideal conditions to destroy invading pathogens
such as bacteria, foreign bodies and necrotic tissues, diminishing the rate of infection. Moist wound treatment is known to
prevent formation of a scab, allowing epithelial cells to spread horizontally outwards through the thin layer of wound exudate
to rapidly close the wound.
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 3 of 17
Focused Health Assessment
GENERAL ASSESSMENT
SYMPTOM ASSESSMENT
Contact Information
Normal
•
•
•
•
•
Physician name oncologist, general
practitioner (GP)
Pharmacy (if applicable) name and contact
information
Home health care (if
applicable) – name and
contact information
Consider
Causative/Contributing
Factors
•
•
•
•
•
•
Cancer diagnosis (site)
Cancer treatment: date of
last treatment/s,
concurrent treatments,
volume of tissue treated,
technique, type of
radiation and energy,
location of treatment field,
volume of tissue treated,
dose, time and
fractionation
Co-morbidities
Nutritional status
Tobacco use
Recent lab or diagnostic
reports
What is the condition of your skin normally?
What are your normal hygiene practices?
Onset
•
When did the changes in your skin begin?
Provoking / Palliating
• What makes it feel better or worse?
Quality (in the last 24 hours)
•
•
Do you have any pain, redness, dry or scaling skin,
blisters or drainage?
Do you have any swelling?
Severity / Other Symptoms
•
•
Since your last visit, how would you rate the
discomfort associated with the skin reaction? between
0-10? What is it now? At worst? At best? On
average?
Have you been experiencing any other symptoms:
fever, discharge, bleeding
PHYSICAL ASSESSMENT
Vital Signs
•
Include temperature,
pulse, respiratory rate and
blood pressure
Frequency – as clinically
indicated
Physical Assessment
Assess skin condition
• Location
• Colour
• Size
• Wound base (if present)
• Discomfort
• Drainage (if present)
• Signs of infection
Treatment
•
•
•
When was your last cancer treatment (radiation or
chemotherapy)?
How have you been managing the radiation skin
reaction? (cream, ointments, dressings)
Are you currently using any medications? How
effective are they? Any side effects?
Understanding / Impact on You
• Is your skin reaction and treatment impacting your
•
•
activities of daily living (ADL)?
Do you require any support to (family, home care
nursing) complete your skin care routine?
Are you having any difficulty sleeping, eating,
drinking?
Value
• What is your comfort goal or acceptable level for this
symptom?
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 4 of 17
DERMATITIS GRADING SCALE
Adapted NCI CTCAE (Version 3.0)
GRADE 0
(Normal)
Normal
GRADE 1
(Mild)
Faint erythema or dry
desquamation
GRADE 2
(Moderate)
GRADE 3
(Severe)
GRADE 4
Moderate to brisk
erythema; patchy
moist desquamation,
mostly confined to skin
folds and creases;
moderate edema
Moist desquamation
other than skin folds
and creases; bleeding
induced by minor
trauma or abrasion
Skin necrosis or
ulceration of full
thickness dermis;
spontaneous bleeding
from involved site
GRADE 0 – GRADE 1
NON – URGENT
Support, teaching, & follow-up as clinically indicated
Clinical Presentation
Erythema
• Pink to dusky colouration
• May be accompanied by mild edema
• Burning, itching and mild discomfort
Dry desquamation
• Partial loss of the epidermal basal cells
• Dryness, itching, scaling, flaking and peeling
• Hyperpigmentation
Brisk Erythema
Reaction
Assessment
Promote Cleanliness
Promote Comfort
Reduce Inflammation
Dry Desquamation
Assessment to include:
• Location
• Size of area
• Colour
• Discomfort (burning, itching, pulling, tenderness) – erythema
• Discomfort (dryness, itching, scaling, flaking, peeling) – dry desquamation
• Use non-perfumed soap. Bathe using warm water and palm of hand to gently wash affected
skin. Rinse well and pat dry with a soft towel
• Wash hair using warm water and mild, non-medicated shampoo such as baby shampoo
• Patients receiving RT for perineal/rectal cancer, should use a sitz bath daily beginning at the
start of treatment
• Apply hydrophilic (water based) body lotions or creams on affected area. Gently apply with
clean hand twice a day. Do not rub skin
• Avoid petroleum jelly based products
• Avoid irritant products containing alcohol, perfumes, or additives and products containing
Alpha Hydroxy Acids (AHA)
• Normal saline compresses up to 4 times daily
• Alleviate pruritus and inflammation. Corticosteroid creams may be used sparingly as ordered
by the physician
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 5 of 17
GRADE 0 – GRADE 1 – Continued…
NON – URGENT
Support, teaching, & follow-up as clinically indicated
Prevent Trauma
to the Treatment
Area
•
•
•
•
•
•
Follow-Up
Possible
Referrals and
Resources
•
•
•
•
•
For facial and underarm shaving, use an electric razor
Recommend loose, non-binding, breathable clothing such as cotton
Protect skin from direct sunlight and wind exposure by wearing a wide brimmed hat and
protective clothing
Remove wet swimwear, shower and apply moisturizer after swimming in pools and lakes
Avoid extremes of heat and cold, including hot tubs, heating pads and ice packs
Avoid adhesive tape. Extend dressing out of treatment area and adhere to intact skin with paper
tape. Secure dressing with cling gauze, net tubing or under clothing
Patients to be assessed at each visit. If symptoms are not resolved, provide further information
regarding recommended strategies
- Instruct patient/family to call back if radiation skin reaction worsens
- Arrange for nurse initiated telephone follow–up
Document assessment, intervention and patient care plan
Communicate with health care team as appropriate
Registered Nurse
Physician
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 6 of 17
GRADE 2 – GRADE 3
URGENT:
Requires medical attention within 24 hours
Clinical
Presentation
Moist Desquamation
• Sloughing of the epidermis and exposure of the dermal layer
• Blister or vesicle formation
• Serous drainage
• Pain
Moist Desquamation
Reaction
Assessment
Assessment to include:
• Location
- Moist areas
- Dry areas
• Size of area
• Wound base: granular tissue, eschar or necrotic tissue
• Exudate
- Type
- Amount
- Odour
• Discomfort (burning, itching, pulling, tenderness)
• Signs of clinical infection
- fever
- foul odour
- purulent drainage
- pain and swelling extending outside of radiation area
Promote
Cleanliness
•
•
●
Maintain
Principles of
Moist Healing
•
•
•
•
●
•
Manage Pain
Prevention of
Infection
•
•
•
•
•
Cleanse with warm or room temperature normal saline
Apply normal saline compresses up to 4 times daily
Patients receiving RT for perineal/rectal cancer, should use a sitz bath daily beginning at the start
of treatment
Can use a moisture retentive protective barrier ointment after each saline soak
Consider the use of hydrogels
Use a non-adherent dressing
Use absorbent dressings over non-adherent dressings. Change as drainage warrants
Control drainage. Consider using hydrocolloid dressings
Cover open areas to protect nerve endings. To significantly decrease burning and tenderness use
non-adherent or low adherent dressings
Assess pain at each appointment (Link to Pain SMG)
Administer analgesics as ordered by the physician
Regularly assess for signs of infection
Culture wound if infection suspected
Apply antibacterial/antifungal products as ordered by the physician
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 7 of 17
GRADE 2 – GRADE 3 – Continued…
URGENT:
Requires medical attention within 24 hours
Prevent Trauma
to the Treatment
Area
•
•
•
•
•
•
Follow-Up
•
Possible
Referrals and
Resources
•
•
•
•
For facial and underarm shaving, use an electric razor
Recommend loose, non-binding clothing
Protect skin from direct sunlight and wind exposure
Discontinue swimming in pools and lakes
Avoid extremes of heat and cold, including hot tubs
Avoid adhesive tape. Extend dressing out of treatment area and adhere to intact skin with paper
tape. Other products include cling gauze and net tubing under clothing
Patients to be assessed at each visit. If symptoms are not resolved, provide further information
regarding recommended strategies
- Instruct patient/family to call back if radiation skin reaction worsens
- Arrange for nurse initiated telephone follow–up
Document assessment, intervention and patient care plan
Communicate with health care team as appropriate
Registered Nurse
Physician
GRADE 4
EMERGENT:
Requires IMMEDIATE medical attention
Clinical Presentation
Reaction
Assessment
Promote Cleanliness
• Rarely occurs
• Skin necrosis or ulceration of full thickness dermis
• May have spontaneous bleeding from the site
• Pain
Assessment to include:
• Location
- Moist areas
- Dry areas
• Size of area
• Wound base: granular tissue, eschar or necrotic tissue
• Exudate
- Type
- Amount
- Odour
• Discomfort (burning, itching, pulling, tenderness)
• Signs of clinical infection
- fever
- foul odour
- purulent drainage
- pain and swelling extending outside of radiation area
•
Cleanse with warm or room temperature normal saline
•
Apply normal saline compresses up to 4 times daily (or as required)
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 8 of 17
GRADE 4 – Continued…
EMERGENT:
Requires IMMEDIATE medical attention
Maintain Principles
of Moist Healing
Prevent Trauma
Manage Pain
Prevention of
Infection
Follow-Up
Possible Referrals
and Resources
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Maintain a moist environment for healing
Use a non-adherent dressing
Layer dressings as appropriate. If dressings overlap, apply the dressing with the longest
wear time first. Label dressings with date
May require debridement
Use a non-adherent dressing
Secure products with appropriate secondary dressing
Avoid adhesive tape. Extend dressing out of treatment area and adhere to intact skin with
paper tape. Other products include cling gauze and net tubing under clothing
Cover open areas to protect nerve endings
Use non-adherent or low adherent dressings
Assess pain at each appointment (Link to Pain SMG)
Administer analgesics as ordered by the physician
Regularly assess for signs of infection
Culture wound if infection suspected
Apply antibacterial/antifungal products as ordered by the physician
Patients to be re-assessed at each visit
Instruct patient/family to contact the Health Care Professional if the skin reaction worsens
Document assessment, intervention, and patient care plan
Communicate with health care team as appropriate
Registered Nurse
Physician
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 9 of 17
Potential Post-Radiation Skin Reaction
Late Reactions
Definition
Clinical Presentation
Reaction
Assessment
Maintain Skin
Flexibility
Prevent Injury
•
•
Skin reactions occurring six or more months after completion of radiation therapy
The clinical presentation and the degree of late reaction vary. Patient care will be
individualized and based on the degree of severity.
• Pigmentation changes
• Permanent hair loss
• Telangectasia
• Fibrous changes
• Atrophy
• Ulceration
Assessment to include:
• Location
- Moist areas
- Dry areas
• Size of area
• Wound base: granular tissue, eschar or necrotic tissue
• Exudate
- Type
- Amount
- Odour
• Discomfort (burning, itching, pulling, tenderness)
• Signs of clinical infection
- fever
- foul odour
- purulent drainage
- pain and swelling extending outside of radiation area
• Apply hydrophilic (water based) body lotions or creams on affected area. Gently apply with
clean hand twice a day. Do not rub skin
•
Follow-Up
•
•
•
•
•
•
Possible Referrals
and Resources
•
•
•
•
Manage Pain
Prevention of
Infection
Avoid excessive sun exposure. Wear protective clothing. Sunblocking creams or lotions with
minimum SPF 30 recommended at all times
Assess pain at each appointment (Link to Pain SMG)
Administer analgesics as ordered by the physician
Regularly assess for signs of infection
Culture wound if infection suspected
Apply antibacterial/antifungal products as ordered by the physician
Patients to be assessed at each visit. If symptoms are not resolved, provide further
information regarding recommended strategies
- Instruct patient/family to call back if radiation skin reaction worsens
- Arrange for nurse initiated telephone follow–up
Document assessment, intervention and patient care plan
Communicate with health care team as appropriate
Registered Nurse
Physician
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 10 of 17
Potential Post-Radiation Skin Reaction
Recall Phenomenon
Definition
Clinical Presentation
Reaction
Assessment
Promote Cleanliness
Maintain Principles
of Moist Healing
Manage Pain
Prevention of
Infection
Follow-Up
Possible Referrals
and Resources
•
Recall phenomenon occurs when skin reactions manifest very rapidly within a previously
treated radiation field, following the administration of chemotherapy drugs
• Symptoms of moist desquamation
• Rapid onset and progression
Assessment to include:
• Location
- Moist areas
- Dry areas
• Size of area
• Wound base: granular tissue, eschar or necrotic tissue
• Exudate
- Type
- Amount
- Odour
• Discomfort (burning, itching, pulling, tenderness)
• Signs of clinical infection
- fever
- foul odour
- purulent drainage
- pain and swelling extending outside of radiation area
• Cleanse with warm or room temperature normal saline
• Apply normal saline compresses up to 4 times daily
• Patients receiving RT for perineal/rectal cancer, should use a sitz bath daily beginning at the
start of treatment
• Can use a moisture retentive protective barrier ointment after each saline soak
• Consider the use of hydrogels
• Use an non-adherent dressing
• Use absorbent dressings over low-adherent dressings. Change as drainage warrants
• Control drainage. Consider using hydrocolloid dressings
• Cover open areas to protect nerve endings
• Use non-adherent or low adherent dressings
• Assess pain at each appointment (Link to Pain SMG)
• Administer analgesics as ordered by the physician
• Regularly assess for signs of infection
• Culture wound if infection suspected
• Apply antibacterial/antifungal products as ordered by the physician
• Patients to be assessed at each visit. If symptoms are not resolved, provide further
information regarding recommended strategies
- Instruct patient/family to call back if radiation skin reaction worsens
- Arrange for nurse initiated telephone follow–up
• Document assessment, intervention and patient care plan
• Communicate with health care team as appropriate
• Registered Nurse
• Physician
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 11 of 17
Treatment Procedures
Application of Topical Products
Moisturizing
Products
Corticosteroid
Creams
•
Instruct the patient to gently apply a thin layer of water soluble moisturizing ointment or
cream using their clean hand 2 to 4 times daily to the skin in the treatment area
•
•
•
A prescription for hydrocortisone cream is required
Do not use hydrocortisone if a skin infection is suspected as it may mask signs of infection
and increasing severity of the radiation skin reaction
Do not use hydrocortisone on a long-term basis as it may cause problems resulting from
reduced blood flow to the skin
Instruct patient to gently apply a very thin layer of hydrocortisone cream using their clean
hand as prescribed by the physician
Instruct patient to apply to skin in the treatment area until discomfort decreases and to wash
hands after application
Discontinue use of hydrocortisone if there is any exudate from the affected area
•
•
Instruct patient to apply a thin layer of (water soluble) barrier cream to the treatment area
Non-adhesive dressings may be applied, depending on the location of the skin reaction
•
•
•
Barrier Creams
Normal Saline Compresses
Indications
Contraindication
Procedure
Note
•
•
•
•
•
•
•
•
•
•
•
•
To reduce discomfort due to inflammation or skin irritation
To cleanse open areas
To loosen dressings
Increased discomfort during procedure
Moisten gauze with warm or room temperature saline solution
Wring out excess moisture (ensure that gauze will not dry out and adhere to open area)
Apply moist gauze to open areas for 10-15 minutes. Cover compress with abdominal pad or
disposable under-pad to retain warmth and moisture
Remove gauze and gently irrigate wound with normal saline if required to remove any debris
Gently dry surrounding skin
Apply dressing/other treatments as indicated
Repeat up to 4 times daily or as required
Continuous moist saline compresses may be indicated for short term use (24-48hrs.) for a
necrotic or heavily exudative wound. It is critical that the compress is replaced frequently
enough that it does not dry out and adhere to the area. Moist gauze is applied only to the
wound area to avoid maceration of intact skin
Sitz Baths
Purpose
•
Indications
•
•
•
•
•
•
•
•
•
•
•
•
Contraindication
Procedure
Perineal hygiene is the primary reason for using a sitz bath during/post RT when the area is
tender and inflamed
Use at onset of treatment for comfort and cleanliness
Use at any time for any skin reaction in the perineal/peri-rectal area
Discomfort with defecation
Continuous discomfort due to perineal inflammation, hemorrhoids, radiation-induced diarrhea
Discomfort during procedure
Water should be warm (40-43°C)
Hot water can cause increased drying of skin
Warm water will increase vasoconstriction and may decrease the itching
Do not add bath oils or other products to water
A hand held shower with a gentle spray or bathtub may be appropriate alternatives
Maximum 10-15 minutes, repeat up to 4 times daily and/or after each bowel movement
Gently pat area dry with a soft towel or expose area to room air
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 12 of 17
Silver Sulfadiazine Cream (antibacterial)
Purpose
Indications
Contraindications
Procedure
•
•
•
•
•
•
•
•
•
•
•
•
•
To reduce risk of infection
To reduce discomfort
To maintain moist healing environment
To reduce adherence of dressings
The treatment and prophylaxis of infection in open wounds (moist desquamation)
Allergy to sulfa
Should not be used for patients with history of severe renal or hepatic disease or during
pregnancy
Gently cleanse wound area with normal saline if area is small and dressing is easily removed
Cleanse with tap water (sink, bathtub, shower or sitz bath) if area is large, difficult to cleanse
or adherence of dressing is a problem
It is important to gently remove all residual cream from previous applications (saline
compresses may be required)
Apply a thin layer of cream to area of affected skin only
Apply appropriate secondary dressing
Change dressing at least once daily
Hydrogels
Hydrogel is a sterile wound gel for helping create or maintain a moist environment. Some hydrogels provide absorption,
desloughing and debriding capacities to necrotic and fibrotic tissue. Hydrogel sheets are cross-linked polymer gels in sheet
form
Purpose
Indications
Contraindication
Procedure
•
•
•
•
•
•
•
•
•
•
•
•
•
To increase comfort (cooling effect on skin)
To increase moisture content
To absorb small amounts of exudate
Moist desquamation with minimal exudate
Not advised for infected wounds
Moderate to heavily exudating wounds
Areas that need to be kept dry
Cleanse area with normal saline soaks or sitz baths
Pat dry surrounding skin
Either apply a thin layer of hydrogel directly onto the area of moist desquamation or apply with
a tongue depressor
Cover with non-adhesive dressing (may be secured by clothing if patient is ambulatory)
May be used in combination with transparent films, foams, hydrocolloids or other nonadherents
Reapply at least daily and always following normal saline soaks/sitz baths
Hydrocolloid Dressings
Hydrocolloids are occlusive and adhesive water dressing which combine absorbent colloidal material with adhesive
elastomeres to manage light to moderate amount of wound exudate. Most hydrocolloids react with wound exudate to form a
gel-like covering which protect the wound bed and maintain a moist wound environment
Purpose
Indications
Contraindication
Procedure
•
•
•
•
Maintain moist wound bed
To increase comfort
Support autolytic debridement by keeping wound exudate in contact with necrotic tissue
Moist desquamation with moderate exudate
•
•
•
•
•
•
•
Not advised for infected wounds
Heavily exudating wounds
Cleanse area with normal saline soaks or sitz baths
Pat dry surrounding skin
Choose a dressing that extends beyond the wound
Remove backing and apply to wound
Change dressing as required depending on causative factors, contributing factors and amount
of exudate
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 13 of 17
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determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
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determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
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Date of Print: Revised July 18, 2012
Contributing Authors:
Anne Hughes, Regional Professional Practice Leader, Nursing
Alison Mitchell, Radiation Therapy Educator VIC
June Bianchini, Assessment Module Leader CSI
Frankie Goodwin, Assessment Module Leader
Normita Guidote RN
Rachelle Gunderson RN
Ann Hulstyn RN
Susan Kishore RT
Krista Kuncewicz RT
Sheri Lomas RT
Gillian Long, Radiation Educator AC
Heather Montgomery RN
Dawn Robertson RN
Jenny Soo, Radiation Educator VC
Stacey Tanaka RN
Victoria van le Leest RT
Wendy Vanhoerden RN
Tara Volpatti RT
Dr. Frances Wong, Radiation Oncologist FVC
Karen Yendley RT
Reviewed By:
British Columbia Cancer Agency Radiation Therapy Skin Care Committee
Dr. Hosam Kader, Radiation Oncologist VIC
Dr. Jonn Wu, Radiation Oncologist FVC
BCCA Nursing Practice Committee
The information contained in these documents is a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to
treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to
determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use, available at
www.bccancer.bc.ca/legal.htm.
Page 17 of 17