Chapter 25: Wound management
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Evidence‐based approaches
A baseline assessment should note the condition of the skin at commencement of treatment and highlight any specific risk factors (see Table 25.10).
The identification of patients with a higher risk of developing a severe skin reaction is important: the patient can be advised of the expected skin reaction and it may also allow prophylactic measures to be started. Consideration should be given to the educational needs of the patient and their family or carers and their ability to adhere to skin care advice (Maher [87]).
Historically, skincare advice for patients has been derived from clinical experience (Bernier et al. [18], Kedge [75], NHSQIS [104]). The Society and College of Radiologists’ (SCoR) Radiotherapy Skincare Guidelines (Harris et al. [64]) were developed following an extensive review of the evidence collected from research. Much of the advice recommended in the new guidelines has remained unchanged from that which has always been given; for example, there is consensus that patients should avoid heat or ice packs and should be gentle with skin care. However, there have been a couple of noteworthy changes to traditional opinion.
- There is insufficient evidence to advise patients to avoid deodorants, unless the skin is broken.
- It is suggested that patients can continue with their regular skin care products, soaps and moisturizers, although now it is advised that the moisturizer should not include sodium lauryl sulphate (SLS) as it can lead to skin thinning and loss of moisture (Tsang and Guy [135]).
There are, unfortunately, omissions from the guidelines and if patients ask for advice it should be given following the general principles of reduced friction and gentle care.
A specific area where there is no advice in the new guidelines is regarding the use of perming or chemical straightening of hair during radiotherapy to the head. The need for gentle care suggests that strong chemicals should not be applied in the area, either during treatment or for several weeks following its completion. Locally, patients have been told to avoid colouring, perming or chemical straightening of their hair until the skin over the head shows no residual sign of treatment. It is important to stress to the patient that recommended skin or hair care is only applicable in the area receiving radiation.
Table 25.11 summarizes skincare advice from a variety of sources including the SCoR and advice given by radiotherapy departments nationally. The advice is also consistent with that given by internet sources such as Macmillan Cancer Support and Cancer Research.
Table 25.11 Skin care advice during radiotherapy
| Do | Avoid | Rationale |
|---|---|---|
| Gently wash skin using warm water (not hot) and pat the skin dry especially in skin folds (e.g. under breast, groin) | Excessive friction or exfoliating products. No loofah or rough rubs
Do not soak treatment skin for long periods | Daily washing improves skin condition and general well‐being for patients (Roy et al. [120])
Insufficient evidence to advise against any cleansing products |
Apply a moisturizer to the treatment area
Apply cream more frequently as needed 2–3 times daily once skin becomes itchy/dry | Medicated creams, creams containing sodium lauryl sulphate (SLS), creams containing paraffin wax
Do not use on broken skin | Application of cream promotes comfort. SLS thins the epidermis.
Insufficient evidence to advise a specific moisturizer |
| Apply 1% corticosteroids for pruritus, for short‐term use only | Do not use on broken skin | Steroids can thin the skin and use should be limited or avoided if possible |
Wash hair gently with usual shampoo
Use a hairdryer on a cool setting only | Using a hot hairdryer
Hair dye or perming/chemical straightening
Brushing or combing of the scalp | Hair washing does not increase skin reaction but restricting washing causes distress (Westbury et al. [140]) |
| Wear loose natural fibre clothes and use a scarf around the neck to stop collars rubbing | Tight clothes and synthetic fibres
Any rubbing in the treatment area | Natural fibres are softer on the skin and rub less. Synthetic fibres increase production of sweat |
| Protect from sunlight, wind or extremes of temperature | Heat pads, ice, sunbeds | Consensus opinion/experience |
| Use your usual deodorant unless your skin is broken | Products containing alcohol such as aftershave, make‐up, perfume | Insufficient evidence to advise against deodorant use |
| Use Netelast, Tubigrip or similar to hold dressings in place | Do not use adhesive tapes in the treatment field | As skin becomes fragile removal of tape will cause additional damage |
| Hair removal, i.e. shaving, waxing, depilatory creams or laser | Consensus opinion/experience |
