Radiation Dermatitis: Skin Care Questions

The most useful habit during radiation is to check first. The American Cancer Society says to "ask your cancer care team before using any skin products on the area during treatment and for several weeks afterward," and its list is long: "powders, creams, perfumes, deodorants, body oils, ointments, lotions, hair-removal products, or home remedies." That includes things you have used for years without trouble.

The National Cancer Institute makes the same point from the other direction. Ask your nurse to recommend specific skin products, then use the creams or lotions they recommend "to prevent your skin from becoming dry." Products containing alcohol or fragrance are ones to avoid.

You do not have to keep the area untouched. Wash it, gently. ACS: "Use only lukewarm water and mild soap. Let water run over the treated area but don't rub." NCI adds: "Take short showers or baths in lukewarm, not hot, water," and "use mild soaps that are gentle on your skin." Pat dry instead of rubbing.

Protect the ink marks while you wash. ACS says to "avoid rubbing away the ink marks needed for your radiation therapy." If they fade, tell the therapists rather than redrawing them.

NCI's advice is to apply skin cream or ointment "after drying off from a shower but while your skin is still a little damp." Ask your own team whether to put anything on in the hours before a session, since some centers want the area clean and product-free at the machine.

NCI's wording is that if you are receiving radiation therapy, you should ask about skin products, "such as powder or antiperspirant, that you should avoid using before treatment." Do not assume a ban, and do not assume permission. Ask about the specific product you own, and about the hours right before a session.

For shaving, NCI's guidance is to shave less often, or stop, if the skin is tender, and to use an electric razor instead of a regular one. ACS says to check with the care team before shaving the treated area at all. Its patient booklet also says not to use "pre-shave, after-shave, or hair removal products," which covers waxing and depilatory creams.

ACS: "Avoid tight, rough-textured, or stiff clothes," and wear "loose clothing made from soft, smooth fabrics." Do not starch your clothes.

ACS: "Do not put heat or cold on the treatment area without talking to your cancer care team first. This includes heating pads, heat lamps, and ice packs." NCI says the same about heating pads, ice packs and bandages. ACS also says not to rub, scratch, or use tape on treated skin. If the area must be covered, "use paper tape or tape for sensitive skin," kept off the treatment area itself.

Treated skin is more sun-sensitive, and it stays that way. ACS: "If possible, cover the treated skin with dark-colored or UV-protective clothing before going outside." Ask whether you can use sunscreen; if the answer is yes, use "a broad-spectrum sunscreen with an SPF of at least 30" and reapply often. Its instruction about afterward is short: "Continue this extra protection even after radiation therapy ends." NCI suggests a loose long-sleeved shirt, long pants, a wide-brimmed hat, and sun-protective lip balm.

NCI's goal here is infection control: "try to keep the area clean and dry so it does not become infected." For skin that is peeling, painful and wet, your nurse may prescribe special dressings, antibiotics, or both. That is a prescription decision rather than a drugstore one, so ask in advance who to call at night.

• Which cream or ointment do you want me using, and how often?
• Should I put anything on before a session, or only afterward?
• Is my deodorant allowed, and is there one you prefer?
• Can I shave this area, and with what?
• Can I use sunscreen on the treated skin, and which product?
• If the skin opens or weeps, what do I do that evening, and what number do I call?
• How long after my last session do these rules still apply?

NCI's baseline instruction covers anything you are unsure about: "Let your health care team know if you notice any skin changes so they can be treated promptly."

For what the skin reaction itself looks like as it develops, see Radiation Dermatitis & Skin Care Management and Side Effects Overview.

• National Cancer Institute, Skin and Nail Changes during Cancer Treatment
• American Cancer Society, Radiation Therapy Effects on Different Parts of the Body
• American Cancer Society, Radiation Therapy: What It Is and What to Expect