Late reactions are induced by inflammation followed by fibrosis or even necrosis.
Chronic radiodermatitis is responsible for reduced quality of life.
Chronic radiodermatitis is a highly polymorphic clinical condition. We may observe:
- telangiectasias,
- skin atrophy,
- dyschromia,
- fibrosis,
- and potentially slow-healing necrosis.
During the constitution phase, there may be no symptoms. Sometimes the area that has been irradiated develops chronic local inflammation with oedema, pruritus, or erythema.
This is followed by the organised sequelae phase, characterised by a non-inflammatory state with dry, itchy, hairless skin.
Finally, poikiloderma may develop with atrophy of the sclerotic subcutaneous tissues.
Telangiectasias may appear many years after the end of treatment. These telangiectasias are more frequent in cases of sun exposure.
The patient should be advised to avoid exposure to the sun for one year following treatment and to apply a high protection factor sunscreen.
Popular beliefs:
Some misconceptions continue to circulate, wrongly, among the general public, such as:
- The need to shave the irradiated area: It is important not to traumatise an irradiated area by shaving. In any case, shaving should be avoided (even in the absence of radiodermatitis) and depilation or hair removal should be used instead to reduce microtrauma to the skin.
- No bathing or washing with water: Rigorous hygiene of the irradiated area is essential. As such, bathing and good hygiene are recommended.
Advice for patients undergoing radiotherapy treatment:
- Daily local hygiene using gentle, non-detergent, pH-neutral soap and water is essential, while avoiding hot baths and instead taking short, warm showers.
- Drying should be carried out by dabbing or using a cool dryer.
- Never take oral medication without the approval of your doctor.
- Even minimal trauma and rubbing of the treated area should be avoided:
- If hair removal or shaving is considered absolutely necessary, use an electric razor.
- Do not wear tight-fitting synthetic clothing and instead wear loose-fitting cotton garments with, for women, undergarments without underwiring to avoid irritation caused by perspiration and maceration.
- Avoid saunas, steam baths, scrubs, etc., throughout the duration of radiotherapy and in the following year.
- Avoid using any topical irritants (perfume, deodorant, etc.).
- Do not apply a thick layer of any product to the skin within the 2 hours before the session (risk of a “bolus effect”).
What advice can you give before the start of radiotherapy?
Before treatment begins, the patient must be informed in advance, in appropriate terms, of the risks to which they will be exposed in the irradiated area of skin.
Explain the various possible clinical aspects of radiodermatitis and remind the patient that the onset may be delayed.
Explain that it is necessary to seek medical advice as soon as the first signs appear on the skin and that nothing should be applied without prior advice from a doctor. Many grade 1 or 2 radiodermatitis cases are aggravated by irritating topicals or corrosive substances used by patients trying to practise self-care.
Provide advice to limit the risk of radiodermatitis:
- Strict photoprotection.
- Stopping or reducing tobacco use.
- Stopping or substituting photo-sensitising medicines.
- Review of prescriptions to check for radiosensitising chemotherapy.
- Don’t put anything on your skin on the day of radiation treatment.
What dermatological advice can you give after all radiotherapy sessions have been completed?
- Wash the irradiated area daily with a gentle skin cleanser (superfatted soap or syndets).
- Give preference to photoprotection by clothing over sunscreens.
- Limit trauma to irradiated areas.
- Avoid applying caustic products: alcohol, menthol, perfumes.
- Monitor the skin for abnormalities.
The irradiated area should be monitored to detect late-onset complications such as chronic radiodermatitis lesions, preepitheliomatous keratoses and skin carcinomas.
Skin monitoring must be continuous and lifelong.
