Acute radiation-induced skin reactions (RISR) are an inevitable consequence of radiotherapy treatment for many cancer patients, occurring in up to 95% of cancer patients receiving radiotherapy treatment.

Acute skin reactions can include erythema, pruritus, and inflammation through to dry desquamation and moist desquamation. These reactions can occur at any site treated with radiation. However, the face, neck, trunk, and extremities are particularly susceptible. Patients receiving higher doses of radiation are also more likely to suffer from RISR.

RISR are a source of significant pain, discomfort and psychological distress. In particular, moist desquamation increases the risk of infection, resulting in potential treatment breaks which can compromise patient outcomes.

While there are currently no definitive guidelines for the management of RISR, the following general skin care advice should be followed:

  • Gently cleanse the skin with warm water and a mild, unscented soap;
  • Avoid tight clothing and synthetic fibres;
  • Protect the treated area from sunlight and wind exposure;
  • Avoid using cosmetics, powders, and perfumes in the treated area, particularly products containing alcohol, alpha hydroxyl acids, or fragrances;
  • Do not apply sunscreen to the treated area;
  • Avoid using cold or hot packs or use electric blankets in the treated area;
  • Avoid applying deodorant to broken or irritated skin; and
  • Avoid wearing jewellery in the treated area.

These measures may assist patients to prevent or minimise RISR. Regular assessment of the radiation-treated area should also occur so that treatment can be initiated in a timely manner. There are a number of scoring systems available to guide therapy. The Common Toxicity Criteria for Adverse Events (CTCAE) scoring system is shown below.

Grade Criteria
0 No change
1 Faint erythema, dry desquamation
2 Moderate erythema or oedema, patchy moist desquamation, confined to skin folds and creases
3 Moist desquamation in areas other than skin folds, bleeding induced by minor trauma
4 Life-threatening consequences, full thickness skin necrosis/ulceration, spontaneous bleeding, skin graft indicated

Dry desquamation, commonly associated with surface flaking of the skin, can be managed conservatively. The skin should be moisturised to maintain integrity and relieve discomfort. However, this condition may progress to moist desquamation characterised by blistering, ulceration, and moist exudates. Moist desquamation requires close monitoring and more intensive management as the condition can rapidly worsen. Patients should be observed for signs of infection and provided with analgesics if necessary.

Standard care of RISR management includes the use of sorbolene to moisturise the affected area. Newer products such as StrataXRT® have been compared to standard care with favourable results.

StrataXRT® is a bacteriostatic and inert silicone-based gel which is used for the prevention and treatment of radiation dermatitis. StrataXRT® has shown solid evidence in reducing the onset, duration and severity of radiation dermatitis. It reduces trans-epidermal water loss thus promoting a moist wound healing environment, leading to faster re-epithelialisation of the skin post-treatment. In one Australian retrospective case study, RTOG (Radiotherapy Oncology Group) grade 3 reactions were prevented in the StrataXRT® treatment group and minimal radiation dermatitis was observed compared to what is seen in usual standard care.

StrataXRT® is applied as a thin layer to the affected area twice a day following the first dose of radiation therapy and should be continued for a minimum of 60 to 90 days post radiation therapy. The gel should dry in five to six minutes after application and may then be covered by cosmetics or other skincare.

In reducing the incidence of skin reactions and improving the healing of moist desquamation, StrataXRT® reduces the frequency and duration of treatment interruptions. This minimises extra nursing time, therapy costs, and the utilisation of other hospital specialities that would otherwise be required for severe skin reactions.

References:

  1. Ford C. Is StrataXRT gel more effective in the prevention and management of radiation induced skin reactions (RISR) than standard care? Eveleigh: Cancer Institute NSW; 2017.
  2. Smee R, Bissell N, Malcolm N.Does the use of StrataXRT prevent moist desquamation in NMSC patients treated with superficial radiation therapy in the head & neck area? – A retrospective case study. World Congress on Larynx Cancer, 2015.
  3. Stratpharma. Clinical efficacy in preventing and treating radiation dermatitis (n.d.). Retrieved May 1, 2018.
  4. Stratpharma. StrataXRT for the prevention and treatment of radiation dermatitis (n.d.). Besel: Stratpharma. Retrieved May 1, 2018.

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