Radiotherapy induced skin reactions

By : Magnus Enerbäck, January 9 2012Posted in: Radiotherapy

Skin reaction appearance

Radiation-induced skin reactions can be graded according to the Radiotherapy Oncology Group Assessment tool (RTOG).

RTOG 0: No visible skin reaction.

RTOG 1: Faint or dull erythema, heat, pain sometimes with itching and oedema. Almost all patients suffer from this kind of skin reaction

RTOG 2a: Tender or bright erythema with or without dry desquamation (shedding of the outer layers of the skin).

RTOG 2b: Patchy, moist desquamation, moderate erythema.

RTOG 3: Confluent, moist desquamation and pitting oedema. Radiation-induced skin damage can also be graded using the Radiation-Induced Skin Reaction Assessment Scale (RISRAS). This scale is preferred by some clinicians as it is more detailed and also includes the patients’ experience.


Wound management

RTOG 1, 2a:
The skin should be washed with warm tepid water and a non-perfumed soap if desired. Gently pat dry. The patient should wear loose, light cotton clothing without rubbing seams. To prevent friction and to soothe the damaged skin, a neutral moisturiser can be used to maintain soft, supple skin. Any irritation must be avoided, such as perfumed soaps, UV light, plasters, chlorine in swimming pools, or shaving with razor blades. A clinically proven way to prevent and treat skin damage is using Mepilex Lite1. The dressing can be retained by a bandage or a seamless bra without underwire.

RTOG 2b:
The integrity of the skin is now broken. Principles of moist wound healing should be implemented. Dressings used should have adhesives that do not further damage the wound or skin - like Mepilex Lite.

Maintain general skin care guidelines as previously mentioned. The wound can be irrigated with warm normal saline if required. The choice of atraumatic dressing should be made in accordance with the quantity of exudate, wound bed appearance / wound condition, wound site and size. Mepilex, having the same gentle adhesive as Mepilex Lite, can be used for higher exudate levels.

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