Dermatologic Side Effects of Radiation Therapy for Breast Cancer: Patient Perspective
Gentle washing and drying of the skin within the radiation portal is the most effective approach to reduce acute radiotherapy-associated skin reactions in breast cancer patients and is routinely recommended for all patients receiving radiotherapy. 1
Common Dermatologic Side Effects
Radiation therapy for breast cancer commonly causes skin changes that range from mild to severe:
Acute Effects (During Treatment and Shortly After)
- Radiation Dermatitis: Occurs in the majority of patients receiving breast radiation
- Mild erythema (redness) appears within the first few weeks
- Dry desquamation (dry, flaky, peeling skin) may develop
- Moist desquamation (wet, weeping areas where skin sloughs off) occurs in less than 10% of patients 2
- Symptoms include itching, burning, and pain
Late Effects (Months to Years After Treatment)
- Radiation-induced Fibrosis: Thickening and hardening of skin and underlying tissue
- Hyperpigmentation: Darkening of the treated skin area
- Telangiectasia: Visible small blood vessels on the skin surface
- Radiation-induced Morphea: Localized hardening and discoloration of the skin 3
- Secondary Malignancies: Rare but possible, including angiosarcoma 4
Management of Radiation Dermatitis
Prevention and Basic Skin Care
Gentle Washing:
- Use lukewarm water and mild soap
- Pat dry gently rather than rubbing 1
Avoid During Treatment:
- Tight clothing over treatment area
- Extreme temperatures (hot or cold packs)
- Sun exposure to the treatment area
- Adhesives, perfumes, or alcohol-based products on treatment area
Treatment Based on Severity
Mild Reactions (Grade 1)
- Continue gentle washing and drying
- Moisturizers may provide comfort but have not shown definitive preventative benefit 2
Moderate Reactions (Grade 2)
- Topical agents that have shown effectiveness:
- Human epidermal growth factor cream
- Linoleic acid emulsion
- Polyurethane dressings 5
Severe Reactions (Grade 3-4)
- Topical silver sulfadiazine for moist desquamation
- Polyurethane dressings have shown effectiveness in managing all stages of skin toxicity 5
- Anti-inflammatory medications may be needed
- Oral antihistamines can help reduce pruritus (itching) 1
Advanced Radiation Techniques to Reduce Skin Toxicity
Several radiation techniques have consistently demonstrated decreased rates of radiation dermatitis:
- Intensity-modulated radiotherapy (IMRT)
- Hypofractionated radiotherapy
- Accelerated partial breast irradiation
- Prone positioning during treatment 6
Important Considerations
- Radiation dermatitis is a dynamic process, with different treatments being effective at different stages 5
- Most patients (>90%) will experience some degree of skin reaction during treatment 2
- The majority of acute skin reactions resolve within 4-6 weeks after completing radiation therapy
- Long-term skin changes may persist and require ongoing management
When to Seek Medical Attention
Patients should contact their healthcare provider if they experience: