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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.
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.
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
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
SYMPTOM ASSESSMENT
Contact Information
Normal
Consider
Causative/Contributing
Factors
Onset
Provoking / Palliating
What makes it feel better or worse?
Quality (in the last 24 hours)
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
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
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
NON URGENT
Support, teaching, & follow-up as clinically indicated
Prevent Trauma
to the Treatment
Area
Follow-Up
Possible
Referrals and
Resources
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
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
URGENT:
Requires medical attention within 24 hours
Prevent Trauma
to the Treatment
Area
Follow-Up
Possible
Referrals and
Resources
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
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
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
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 followup
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
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 followup
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
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
Contraindication
Procedure
Note
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 (40-43C)
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
Indications
Contraindications
Procedure
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
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
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
Bibliography
Aistars, J., (2006). The Validity of Skin Care Protocols Followed by Women With Breast Cancer Receiving External
Radiation. Clinical Journal of Oncology Nursing. 10 (4), pp. 487-492.
Archambeau, J., Pezner, R., & Wasserman, T., (1995). Pathophysiology of irradiated skin and breast. International Journal of
Radiation Oncology, Biology, & Physics. 31, pp.1171-1185.
Atiyeh, B., Ioannovich, J., Al-Amm & El-Musa, K., (2002). Management of Acute and Chronic Open Wounds: The Importance
of Moist Environment in Optimal Wound Healing. Current Pharmaceutical Biotechnology. 3, pp.179-195.
Atiyeh, B., Costagliola, M., Hayek, S., & Dibo, S., (2007). Effect of silver on burn wound infection control and healing: review
of the literature. Burns. 33 (2), pp. 139-148.
Babin, E., Sigston, E., Hitier, M., Dehesdin, D., Marie, J., & Choussy, O., (2008). Quality of life in head and neck cancer
patients: predictive factors, functional and psychosocial outcome. European Archives of Otorhinolaryngology. 265, pp.265270.
Bentzen, S.M., & Overgaard, J., (1994). Patient to patient variability in the expression of radiation induced normal tissue
injury. Seminars in Radiation Oncology. 4, pp.69-80.
Bolderston, A., (2003). Skin Care Recommendations during Radiotherapy: A Survey of Canadian Practice. The Canadian
Journal of Medical Radiation Therapy. 34 (1), pp.3-11.
Bolderston, A., Lloyd, N., Wong, L., & Robb-Blenderman, L., (2006). The prevention and management of acute skin reactions
related to radiation therapy: a systematic review and practice guideline. Supportive Care in Cancer. 14, pp.802-817.
Bostrom, A., Lindman, H., Swartling, C., Berne, B., & Bergh, J., (2001). Potent corticosteroid cream (mometasone furoate)
significantly reduces acute radiation dermatitis: Results from a double blind, randomized study. Radiotherapy and Oncology.
59, pp.257-265.
Burch, S., Oarjer, S., Vann, A., & Arazie, J., (1997). Measurements of 6MV X-Ray surface dose when topical agents are
applied to external beam irradiation. International Journal of Radiation Oncology, Biology and Physics. 38 (2), pp. 447-451.
Butcher, K., & Williamson, K., (2011). Management of erythema and skin preservation; advice for patients receiving radical
radiotherapy to the breast: a systematic literature review. Journal of Radiotherapy in Practice. pp. 1-11.
Journals.cambridge.org/action/displayJournal?jid=JRP. Visited on April 18, 2011.
Campbell, J., & Lane, C., (1996). Developing a skin-care protocol in radiotherapy. Professional Nurse. 12 (2), pp.105-108.
Cancer Care Ontario, (2005). The Prevention and Management of Acute Skin Reactions Related to Radiation Therapy: A
Clinical Practice Guideline. http://www.cancercare.on/cms/one.aspx. (date visited August 17, 2009.).
Delaney, G., Fisher, R., Hook, C., & Barton, M., (1996). Sucralfate cream in the management of moist desquamation during
radiotherapy. Australasian Radiation. 41, pp.270-275.
Denham, J.W., Hamilton, C., Simpson, S., Ostwald, P., OBrien, M., Kron, T., Joseph, D., & Dear, K., (1995). Factors
influencing the degree of erythematous skin reactions in humans. Radiation and Oncology. 36, pp.107-120.
DHaese, S., Bate, T., Claes, S., Boone, A., Vanvoorden, V., & Efficace, F., (2005). Management of skin reactions during
radiotherapy: a study of nursing practice. European Journal of Cancer Care. 14, pp. 28-42.
Dorr, W., (2006). Skin and Other Reactions to Radiotherapy-Clinical Presentation and Radiobiology of Skin Reactions. In:
Controversies in the Treatment of Skin Neoplasias. Frontiers of Radiation Therapy Oncology. 39, pp. 96-101.
Elliott, E., Wright, R., Swann, S., Nguyen-Tan, F., Takita, M., Bucci, M., Garden, A., Kim, H., Hug, E., Ryu, J., Greenberg, M.,
Saxton, J., Ang, K., & Berk, L., (2006). Phase III Trial of an Emulsion Containing Trolamine for the Prevention of Radiation
Dermatitis in Patients with Advanced Squamous Cell Carcinoma of the Head and Neck. Journal of Clinical Oncology. 24 (13),
pp. 2092-2097.
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 14 of 17
Fenig, E., Brenner, B., Katz, A., Sulkes, J., Lapidot, M., Schachter, J., Malik, H., Sulkes, A., & Gutman, H., (2001). Topical
Biafine and Lipiderm for the prevention of radiation dermatitis: A randomized prospective trial. Oncology Reports. 8 (2),
pp.305-309.
Fisher, J., Scott, C., Scarantino, C., Leveque, F., White, R., Rotman, M., Hodson, D., Meredith, R., Foote, R., Bachman, D., &
Lee, N., (2000). Randomized Phase III Study comparing Best Supportive Care to Biafine as a Prophylactic Agent for
Radiation Induced Skin Toxicity for Women Undergoing Breast Irradiation. Internationl Journal Radiation Oncology, Biology,
& Physics. 48 (5), pp. 1307-1310.
Freedman, G., Anderson, P., Li, J., Eisenberg, M., Hanlon, A., Wang, L., & Nicolaou, N., (2006). Intensity Modulated
Radiation Therapy (IMRT) Decreases Acute Skin Toxicity for Women Receiving Radiation for Breast Cancer. American
Journal of Clinical Oncology. 29 (1), pp. 66-70.
Halperin, E., George, S., Darr, D., Pinnell, S., & Gaspar, L., (1993). A double-blind, randomized, prospective trail to evaluate
topical vitamin C solution for the prevention of radiation dermatitis. International Journal of Radiation Oncology, Biology and
Physics. 26 (3), pp.413-416.
th
Halperin, E., Perez, C., & Brady, L., ed., (2008). Principles and Practice of Radiation Oncology. 5 Edition. Philadelphia,
Pennsylvania, USA: Lippincott Williams & Wilkins.
Hannuksela, M., & Ellahham, S., (2001). Benfits and risks of sauna bathing. American Journal of Medicine. 110 (2), pp. 118126.
Harper, J., Franklin, L., Jenrette, J., & Aguero, E., (2004). Skin Toxicity During Breast Irradiation: Pathophysiology and
Management. Southern Medical Journal. 97 (10), pp.989-993.
Hassey, K., & Rose, C., (1982). Altered Skin Integrity In Patients Receiving Radiation Therapy. Oncology Nursing Forum. 9
(4), pp.44-50.
Heggie, S., Bryant, G., Tripcony, L., Keller, J., Rose, P., Glendenning, M., & Heath, J., (2002). A Phase III study on the
efficacy of topical aloe vera gel on irradiation breast tissue. Cancer Nursing. 25 (6), pp.442-451.
Hollinworth, H., & Mann, L., (2010). Managing acute skin reactions to radiotherapy treatment. Nursing Standard. 24 (24), pp.
53-64.
Kedge, E, M., (2009). A systematic review to investigate the effectiveness and acceptability of interventions for moist
desquamation in radiotherapy patients. Radiography. 15. pp. 247-257.
Kelsall, H., & Sim, M., (2001). Skin irritation in users of brominated pools. International Journal of Environmental Health
Research. 11 (1), pp. 29-40.
rd
Khan, F.M., (2003). Physics of Radiation Therapy. 3 Edition. Philadelphia, USA: Lippincott, Williams & Wilkins.
Korinko, A., & Yurick, A., (1997). Maintaining Skin Integrity During Radiation Therapy. American Journal of Nursing. 97 (2),
pp.40-44.
Lavery, B.A., (1995). Skin Care During Radiotherapy: A Survey of UK Practice. Clinical Oncology. 7, pp.184-187.
Liguori, V., Guillemin,C., Pesce, G., Mirimanoff, R., & Bernier, J., (1997). Double-blind, randomized clinical study comparing
hyaluronic acid cream to placebo in patients treated with radiotherapy. Radiotherapy and Oncology. 42 pp.155-161.
Lin, L., Que, J., Lin, L & Lin, F., (2006). Zinc Supplementation to Improve Mucositis and Dermatitis in Patients After
Radiotherapy for Head and Neck Cancers: A Double Blind Randomized Study. Radiation Oncology. 65 (3), pp.745-750.
MacMillan, M., Wells, M., MacBride, M., Raab, G., Munro, A., & MacDougall, H., (2007). Randomized Comparison of Dry
Dressings Versus Hydrogel in Management of Radiation Induced Moist Desquamation. Radiation Oncology. 68 (3), pp.864872.
Maddocks-Jennings, W., Wilkinson, J., & Shillington, D., (2005). Novel approaches to radiotherapy-induced skin reactions: A
literature review. Complementary Therapies in Clinical Practice. 11, pp.224-231.
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 15 of 17
Maiche, A., Grohn, P., & Maki-Hokkonen, H., (1994). Effect of chamomile cream and almond ointment on acute radiation skin
reaction. Acta Oncologica. 30. pp.395-396.
McNees, P., (2006). Skin and Wound Assessment and Care in Oncology. Seminars in Oncology Nursing. 22 (3), pp. 130143.
McQuestion, M., (2006). Evidence-Based Skin Care Management in Radiation Therapy. Seminars in Oncology Nursing. 22
(3), pp. 163-173.
National Health Service, (2004). Skincare of Patients Receiving Radiotherapy: Best Practice
Statement. http://www.nhshealthquality.org/nhsqis/files/20373%20NHS. (date visited September 12, 2008).
Naylor, W., & Mallett, J., (2001). Management of acute radiotherapy induced skin reactions: a literature review. European
Journal Of Oncology Nursing. 5 (4), pp.221-233.
Noble-Adams, R., (1999). Radiation-induced reaction 1: an examination of the phenomenon. British Journal of Nursing. 8
(17), pp.1134-1140.
Noronha, C., & Almelida, A., (1999). Local Burn Treatment-Topical Antimicrobial
Agents. Annals of Burns and Fire Disasters. Vol X111, (4) pp.216-220.
st
Nouri, K., (2008). Skin Cancer. 1 Edition. USA: The McGraw Hill Companies Inc.
Olsen, D.L., Raub, W., Bradley, C., Johnson, M., Macias, J., Love, V., & Markoe, A., (2001). The effect of aloe vera gel/mild
soap versus mild soap alone in preventing skin reactions in patients undergoing radiation therapy. Oncology Nursing Forum.
28 (3), pp.543-547.
Otto, S., ed., (2001). Oncology Nursing. 4th Edition. St. Louis, Missouri: Mosby Inc.
Pignon, J.P., (2008). A Multicenter Randomized Trial of Breast Intensity-Modulated Radiation Therapy to Reduce Acute
Radiation Dermatitis. Journal of Clinical Oncology. 26 (13), pp.2085-2092,
Porock, D., Kristjanson, L., Nicoletti, S., Cameron, F., & Pedler, P., (1998). Predicting the Severity of Radiation Skin
Reactions in Women With Breast Cancer. Oncology Nursing Forum. 25 (6), pp.1019-1029.
Porock, D., Nikoletti, S., & Cameron, F., (2004). The Relationship Between Factors That Impair Wound Healing and the
Severity of Acute Radiation Skin and Mucosal Toxicities in Head and Neck Cancer. Cancer Nursing. 27 (1), pp.71- 78.
Primavera, G., Carrera, M., Berardesca, D., Pinnaro, P., Messina, M., & Arcangeli, G., (2006). A Double-Blind, VehicleControlled Clinical Study to Evaluate the Efficacy of MASO65D (XClair), a Hyaluronic Acid-Based Formulation, in the
Management of Radiation-Induced Dermatits. Cutaneous and Ocular Toxicology. 25 (3), pp.165-171.
Roy, I., Fortin, A., & Larochelle, M., (2001). The impact of skin washing with water and soap during breast irradiation: a
randomized study. Radiotherapy and Oncology. 58, pp. 333-339.
Schmuth, M., Wimmer, M., Hofer, S., Sztankay, A., Weinlich, G., Linder, D., Elias, P., Fritsch, O., & Fritsch E., (2002). Topical
corticosteroid therapy for acute radiation dermatitis: a prospective, randomized, double-blind study. British Journal of
Dermatology. 146, pp.983-991.
Seki, T., Morimatsu, S., & Nagahori, H., (2003). Free residual chlorine in bathing water reduces the water-holding capacity of
the stratum corneum in atopic skin. Journal of Dermatology. 30 (3), pp. 196-202.
Sitton, E., (1992). Early and Late Radiation-Induced Skin Alterations Part 1: Mechanisms of Skin Changes. Oncology Nursing
Forum. 19 (5), pp.801-807.
Su, C., Mehta, V., Ravikumar, L., Shah, R., Pinto, H., Halperin, J., Koong, A., Goffinet, D., & Le, Q., (2004). Phase II Double
Blind Randomized Study Comparing Oral Aloe Vera Versus Placebo to Prevent Radiation Related Mucositis in Patients with
Head and Neck Neoplasms. International Journal Radiation Oncology, Biology, & Physics. 60 (1), pp.171-177.
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.
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Szumacher, E., Wighton, A., Franssen, E., Chow, E., Tsao, M., Ackerman, I., Kim, J., Wojcicka, A., Yee, U., Sixel, K., &
Hayter, C., (2001). Phase II study assessing the effectiveness of biafine cream as a prophylactic agent for radiation-induced
acute skin toxicity to the breast in women undergoing radiotherapy and concomitant CMF chemotherapy. International
Journal of Radiation Oncology, Biology & Physics. 51(1), pp.81-86.
Theberge, V., Harel, F., & Dagnault, A., (2008). Use of Axillary Deodorant and Effect on Acute Skin Toxicity During
Radiotherapy for Breast Cancer: A Prospective Randomized Noninferiority Trial. International Journal of Radiation Oncology,
Biology & Physics. 75
(4), pp. 1048-1052.
Watson, L., Gies, D., Thompson, E., & Thomas, B., (2012). Randomized Control Trial: Evaluating Aluminum-Based
Antiperspirant Use, Axilla Skin Toxicity, and Reported Quality of Life in Women Receiving External Beam Radiotherapy for
Treatment of Stage 0, 1, and II Breast Cancer. International Journal of Radiation Oncology, Biology and Physics. 83 (1), pp.
29-34.
Wells, M., Macmillan, M., Raab, G., MacBride, S., Bell, N., MacKinnon, K., MacDougall, H., Samuel, L., & Munro, A., (2004).
Does aqueous or sucralfate cream affect the severity of erythematous radiation skin reactions? A randomized controlled trial.
Radiotherapy and Oncology. 73, pp.153-162.
Wickline, M., (2004). Prevention and Treatment of Acute Radiation Dermatitis: A Literature Review. Oncology Nursing Forum.
31 (2), pp.237-244.
Williams, M., Burk, M., Loprinzi, C., Hill, M., Schomberg, P., Nearhood, K., OFallon, J., Laurie, J., Shanahan, T., Moore, R.,
Uria, R., Kuske, R., Engel, R., & Eggleston, W., (1996). Phase III Double Blind Evaluation of an Aloe Vera Gel as a
Prophylactic Agent for Radiation Induced Skin Toxicity. International Journal Radiation Oncology, Biology, & Physics. 36 (2),
pp.345-349.
Vuong, T., Franco, E., Lehnert, S., Lambert, C., Portelance, L., Nasr, E., Faria, S., Hay, J., Larsson, S., Shenouda, G.,
Souhami, L., Wong, F., & Freeman C., (2004). Silver Leaf Nylon Dressing To Prevent Radiation Dermatitis In Patients
Undergoing Chemotherapy And External Beam Radiotherapy To The Perineum. International Journal of Radiation Oncology,
Biology, & Physics. 59 (3), pp.809-814.
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.
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