regions are within the treatment field.6,7,21,34,35 For example, breast cancer patients are advised to avoid shaving the axilla with straight-edge razors; however, they may continue to use aluminum-based antiperspirants or deodorants during RT.6,7,34,35
Clinical studies on skincare have analyzed potential benefits for the prevention and treatment of ARD.35-44,53-63 Reviews35,36,38,39-45 of topical agents for treating ARD reported benefits or potential benefits when using formulations containing hyaluronic acid,39,40,63 epidermal growth factor (EGF),41,58,61 topical corticosteroids (TCS),45-52 or statins.53 A systematic review35 found no benefits for formulations containing aloe vera,38 chamomile,35 ascorbic acid, pantothenic acid, and trolamine.59 Topical agents that contain soothing ingredients such as niacinamide, panthenol, squalene, glycerin,62 and allantoin have demonstrated benefits for reducing ARD symptoms.28,37
A thermal water-containing skincare regimen comprising 2 types of cleanser, a moisturizer, a healing balm, and an SPF50+ sunscreen has shown benefits for ARD prevention and reduction of symptoms.37 In this study of 253 women with mostly early-stage breast cancer undergoing postoperative RT, the self-reported frequent users who once-daily used the total skincare regimen showed significantly (P less than/equal to 0.0001) less incidence of severe RD (grade 3 CTCAE v. 532 and higher) than those who self-reported using parts of the skincare regimen infrequently.37
The application of moisturizers in moderation just prior to daily administration of RT has not been shown to interfere with or increase the radiation dose to the skin.54 Encouraging patients to apply skincare daily and liberally without restrictions will likely improve adherence to the skincare regimen and QoL.6,7
Day 1 of Radiation Therapy
At day 1 of RT, patients are recommended to continue with skin-preserving therapy and apply mid-potency topical corticosteroid (TCS) cream (such as mometasone furoate 0.1% or triamcinolone 0.1%) for up to 2 weeks after completion of RT.
TCS has anti-inflammatory properties, which may prevent and prolong the ARD development time when combined with other skincare products.6,7,45-52 The recommendation is supported with high-level evidence, including a meta-analysis demonstrating that mild to potent TCS significantly prevented the incidence of any RD and moist desquamation.42 TCS use during RT has been shown to prolong the time to development of grade 3 RD.45-52 High potency TCS should not be used on the face, neck, or genitalia, and can lead to skin atrophy and permanent striae.48,52,55 Prolonged TCS use may lead to rare cAEs, such as atrophy, purpura, tearing of the skin, telangiectasias, hypertrichosis, and localized infections.48,52,55
Using zinc-containing healing balm at the RT-treated site may be resumed post-treatment the next day. However, if RT continues with several rounds over a week, then the use of zinc-containing products should be held off until the course of RT is over.
Topical Treatment of Acute Radiation Dermatitis
Pain can be managed by non-prescription non-steroidal anti-inflammatory drugs (NSAIDs). For CTCAE grade 1-2 RD with erythema and no desquamation, patients may continue their prescribed course of RT. On an ongoing basis, the patients' understanding of pre-RT education and compliance with the skincare regimen and TCS should be checked and reinforced (Table 2).6,7
For patients with CTCAE grade 2 with moist desquamation or grade 3 ARD, daily cleansing of the wound and peri-wound skin with a gentle cleanser or saline soaks was recommended.6,7 Culturing the desquamated region, especially if purulent, should be considered.6,7
Skincare with moisturizers is continued in the skin areas around the moist desquamation.6,7 Discontinuing TCS should be considered,
