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Principles of care

Therapy radiographers will usually be responsible for daily assessment of the treated skin and will provide the patient with skin care information. Patients with advancing skin reactions should be referred to appropriate nursing support or specialist radiographers in line with local practice. Each patient should be treated on a case‐by‐case basis if they progress to moist desquamation as they will require specialist wound care which will vary according to the site and severity of the reaction (Bernier et al. [18]).
The principles of wound healing should be understood by those practitioners who assist the patient with managing an advanced skin reaction. The suggested management of different stages of skin reaction is summarized in Box 25.1.
Box 25.1
Recommended management for acute radiotherapy skin reactions

Erythema and dry desquamation (both managed in the same way)

  • Moisturizing creams without added SLS provide symptomatic relief (number of applications per day may be increased as treatment progresses)
  • 1% hydrocortisone: for itchy, irritated skin
    N.B. should be applied sparingly, twice a day, but not to areas of broken skin
  • Prophylactic use of Cavilon No Sting barrier spray
  • Prophylactic use of Mepitel film or Mepilex Lite; both products may reduce friction in high‐risk areas
  • Consider an antihistamine such as chlorphenamine (Piriton) for pruritus
  • Polymem can be used for dry desquamation and should be dampened for better skin contact. It can be prescribed in a roll which can be cut to fit many difficult sites. Polymem contains a cleansing agent and maintains a moist healing environment. Cutting guide available online
  • Hydrogel sheets: reduce discomfort (soothing and cooling) before skin is broken

Moist desquamation

  • Saline soaks can be soothing and help control exudate and sloughing. Apply gauze to area of desquamation and soak with sterile saline. Leave in situ for 25 minutes, re‐soaking after 10 minutes before removal and dressing
  • Amorphous hydrogels: useful in head and neck (especially behind ears), skin folds or the perineum, and can be reapplied as required
  • Cavilon No Sting barrier spray can provide a second skin to prevent infection and reduce pain
  • Mepitel and secondary dressing may be sufficient alone
  • Polymem as before

Necrosis

Debride any eschar/slough; manage according to TIME/WBP – contact tissue viability team
Adapted from Bolderston et al. ([21]), Herst ([66]), McQuestion ([93]), NHS Quality Improvement Scotland (NHSQIS [104]).
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