Radiotherapy and your skin

Radiotherapy can make the skin go red or darker in the treatment area. Some people have no skin problems at all but others can have very sore skin. Whether or not you have a skin reaction depends on your own type of skin and the area being treated.

If you get a skin reaction it will be red (or darker in dark skinned people) and sore, like a sunburn. It won't happen straight away but develops gradually after several sessions. Your radiographer looks out for these reactions. But you should also let them know if you feel any soreness. If the skin gets very sore it may peel. But it should heal quickly. Skin reactions usually settle down two to four weeks after your treatment finishes.

You may also get redness or darkening on the other side of your body to the treatment area - for example, on your back if the front of the chest is being treated. This area where the radiotherapy beam leaves the body is called the radiotherapy exit site. If the exit site skin becomes red or sore tell the radiotherapy unit staff.

Some people have a severe skin reaction, where the skin breaks and leaks fluid, but this is rare. In this case the radiotherapy treatment is delayed for a while so the skin can recover.

Advice about skin care varies from one hospital to another. You may be told not to wash the treatment area at all during treatment, although there is little evidence that this helps. It is best to follow the instructions of your own treatment unit. But there is evidence that daily washing with mild, unperfumed soap and warm or cool water is helpful. You should gently pat the skin dry with a soft towel. Or you could use a hair dryer on the cold setting to air dry your skin briefly. Rubbing the skin makes it sore.

Don't use creams or dressings on the treatment area unless they are prescribed by your radiotherapist. Don't use talcum powder because this contains tiny metal particles that can make the soreness worse after radiotherapy. If the tumour is affecting your skin, your nurses may put on special dressings after your treatment.

Other skin care tips when washing and shaving include

• Don't rub the area too hard as this can make it sore
• Don't use perfumed soaps, talcs, deodorants, lotions or perfumes
• Try baby soap or liquid baby wash but check with the radiotherapy staff in your department first
• Men having radiotherapy to the head and neck should use an electric razor instead of wet shaving
• These tips apply only to the treatment area - you can treat the rest of your skin normally

Remember - it is very important that you don't remove the marks on your skin showing the treatment area. They will fade a bit, but don't try to replace them yourself. Let the radiotherapy staff know and they will draw them again for you.

During radiotherapy and for a while afterwards your skin may be sensitive. You may find it more comfortable to

• Wear loose fitting clothes
• Use clothes made of natural fibres
• Avoid tight collars and ties if you've had radiotherapy to your neck
• Avoid shoulder and bra straps - wear a crop top instead or go without a bra

Women being treated for breast cancer may be more comfortable not wearing a bra.

The treated area of skin is sensitive so try to avoid strong sun or cold winds. Women having radiotherapy to the head or neck can try wearing a dense weave silk or cotton scarf when they go outside. Men could try wearing a hat and putting up the collar on their shirts and jackets.

As always, when exposed to the sun you should

• Use a high factor sunscreen
• Wear a hat and long sleeved shirts

If you like to swim, ask your radiotherapist about this. If you swim in chlorinated water it may cause irritation in the treatment area. Some doctors say it is OK to swim but others prefer you not to swim until your treatment is finished. If you have a bad skin reaction with broken skin (this is rare) then you should not swim until it is healed.

You may find that the treatment area looks permanently tanned after your treatment has finished. This is a long term side effect but is nothing to worry about. You can use make up to camouflage it if you like.

Later, you may appear to have broken veins in the treated area. This is a long term side effect of radiotherapy and can't be helped. It is called telangiectasia. Tiny veins grow in the treatment area and may show on the surface of your skin. You can cover this with make up if you like.