Radiation Dermatitis & Skin Care Management

This page is for people having radiation therapy who want to know what happens to the skin in the treated area. It covers what changes to expect, in what order, and which changes your team wants to hear about.

MedlinePlus explains that radiation also damages or kills healthy cells. During treatment, skin cells do not have enough time to grow back between radiation sessions. That causes the skin side effects. Your team may call it radiation dermatitis (skin inflammation from radiation).

The federal sources agree on a low threshold for reporting. NCI says: "Let your health care team know if you notice any skin changes so they can be treated promptly." MedlinePlus says: "Tell your provider if you have skin changes and any break or openings in your skin." ACS says: "Tell your cancer care team about any skin changes. They can help you manage pain and irritation and prevent infection."

MedlinePlus's discharge instructions for pelvic radiation say: "Contact your provider if you have pain that doesn't go away, a fever, severe vomiting or diarrhea, or blistering of the skin."

Ask your radiation team, before your skin starts reacting, which changes they want to see at your next daily treatment and which ones justify a phone call in between.

MedlinePlus puts the start at "two weeks or so after radiation treatment starts." Around then you may notice:

• Red or sunburned-looking skin, or darkening
• Itching, bumps or rash
• Peeling
• Hair loss in the treated area
• Skin that feels thinner or thicker
• Soreness, swelling, sensitivity or numbness
• Skin sores

ACS says these problems "usually go away slowly after treatment ends." NCI says healthy cells damaged during radiation usually recover within a few months after treatment is over.

Some changes stay. ACS notes that "sometimes, the treated skin remains darker or more sensitive than it was before." MedlinePlus adds that your skin may remain darker, drier, and more sensitive to the sun. When hair grows back in the treated area, it may be different than before, and some areas of hair loss may be permanent.

This is the change people are least prepared for. NCI says radiation can cause sores that "become painful, wet, and infected." NCI calls this a moist reaction. It happens most often "in areas where the skin folds, such as around your ears, breast, or bottom."

NCI says to keep the area clean and dry so it does not become infected. Your nurse will talk with you about how to clean it. Your nurse may prescribe special dressings or antibiotics.

• Wash gently with mild soap and lukewarm water. Do not scrub. Pat dry.
• Do not use lotions, ointments, makeup or perfumed products unless your provider says which ones are okay.
• Do not use heating pads or cold packs on the skin.
• Do not use bandages or adhesive tape on the area.
• Wear loose, soft clothes. Keep the area out of direct sun.

NCI describes radiation recall. If you had radiation in the past, the skin where you were treated may become red, blister, peel or hurt. If old treated skin flares up, tell your care team.

• Call 911 or go to an emergency department if you have trouble breathing, you bleed heavily, or you are suddenly confused or very hard to wake.
• If chemotherapy is being given with the radiation, or you have low white cells, call your care team right away, day or night, if your temperature is 100.4°F (38°C) or higher. During chemotherapy, CDC says, call your doctor immediately. Fever may be the only sign of an infection, and it can be life-threatening. Also call right away for chills, a sore throat, mouth sores, burning when you urinate, redness at a catheter site, or any sign of infection in the skin, even without a fever. A normal temperature is not permission to wait.
• Call your care team the same day if treated skin has opened, is weeping or is blistering. MedlinePlus lists blistering of the skin and fever among the reasons to contact your provider. NCI says a moist reaction can become infected. If you are also having chemotherapy, a fever means call your care team right away, day or night.
• Call your care team the same day if you have a fever and you are getting radiation alone. Call the same day for pain that will not settle, or severe vomiting or diarrhea with the skin changes.
• Tell your care team at your next visit, or call if unsure, about any other skin change or break in the skin.

• National Cancer Institute, Skin and Nail Changes and Cancer Treatment: https://www.cancer.gov/about-cancer/treatment/side-effects/skin-nail-changes.
• National Cancer Institute, Radiation Therapy Side Effects: https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/side-effects.
• MedlinePlus (U.S. National Library of Medicine), Pelvic radiation - discharge: https://medlineplus.gov/ency/patientinstructions/000059.htm.
• MedlinePlus (U.S. National Library of Medicine), Radiation therapy - skin care: https://medlineplus.gov/ency/patientinstructions/000735.htm.
• American Cancer Society, Radiation Therapy Effects on Different Parts of the Body: https://www.cancer.org/cancer/managing-cancer/treatment-types/radiation/effects-on-different-parts-of-body.html.
• CDC, Fever During Cancer Treatment: https://www.cdc.gov/cancer-preventing-infections/patients/fever.html.