Prevention and treatment of acute and chronic radiodermatitis

Figures & data

Figure 1 Time to onset of radiodermatitis from radiotherapy start.

Abbreviations: S, significant; NS, non significant.

Table 1 General recommendations

General advice
• Skin cleansing
◦ Liquid soap or dermatological soap bar with a pH close to 5, without perfume, plant or fruit extracts
◦ Dry skin delicately but meticulously
• Skin hydration
◦ Apply a non-comedogenic emollient cream without perfume, lanoline, 1 or 2 times per day, preferably after the radiotherapy session
◦ Avoid applying topical creams to the radiation zone at least 1 hour before the radiotherapy session. This will avoid a bolus effect (increased radiation dose delivered to the epidermis)
• Photoprotection
◦ Protect the irradiated skin zone from sun exposure
◦ Apply a sunscreen SPF 50+ with UVA/UVB protection.
• Clothing
◦ Wear ample, soft cotton clothing
◦ Avoid wearing synthetic clothes
• Additional advice
◦ Use an electric razor and do not shave too close to the skin.
◦ Avoid applying products that contain alcohol (perfume, eau de toilette, ether, talcum powder)
◦ Avoid applying sticky plaster
◦ Avoid rubbing or scratching
Acute radiodermatitis
Grade 1 Mild to moderate erythema Desquamation dry and moderately sensitive		• Follow local hygiene routine If needed: • Emollient cream • Topical corticotherapy • Protective hydrogel, hydrobalance hydrocellular dressing • Avoid “Tulle gras” dressing • Low-energy laser (currently under evaluation)
Grade 2 Intense sensitive and mildly painful erythema Moist lesions confined to skin folds Edema		• Continue local hygiene routine If needed: • Emollient cream • Healing cream, acid hyaluronic cream • Topical corticosteroid • Drying lotion • Absorbent, nonadhesive, protective dressing (hydrogel, hydrocellular, hydrobalance) • Expose to fresh air as much as possible • Avoid antibacterial application • Low-energy laser (currently under evaluation)
Grade 3 Intense, painful erythema Extensive weeping moist zones larger than skin fold areas Bleeding wounds		If needed: Clean the wound with physiological serum • Tulle gras dressing 1 or 2 times a day • Nonadhesive, absorbent dressings, hydroabsorbant, hydrocellular • Alginate dressing if bleeding • Hydrofiber dressing if abundant exudate
After radiotherapy
• Continue using nonirritant local skin care, emollient, and sunscreen • Avoid wearing constricting clothing, synthetic fabric for several weeks • Watch daily for life

Notes: Data from these studies.^16,42,43

Figure 2 Example of results obtained after two sessions of vascular laser and two sessions of fractional non-ablative laser.

Note: (A) Before treatment; (B) after treatment.

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