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Radiation Dermatitis

Every year, about 650,000 people in the United States receive radiation therapy. You might be one of them.

Radiation therapy, often abbreviated RT or XRT, uses targeted ionizing radiation to shrink or destroy cells, or disrupt nerves. It’s typically used to treat conditions where the body’s cells are dysfunctional or over-growing, like cancers, trigeminal neuralgia, or Graves’ ophthalmopathy.

While it’s often an effective treatment, people often experience side effects or complications from RT. One of the most common side effects is a skin injury called “radiation dermatitis.”

Radiation dermatitis can be painful and distressing. Fortunately, it can also be treated effectively.

If you’re worried about the effects of radiation on your skin, Medical Monks is here to help.

In this guide, we draw on vetted literature reviews, clinical comparison studies, and oncology best practices’ resources to offer an up-to-date understanding of these conditions, and how you might best treat them.

What Is Radiation Dermatitis? (Radiation Burn)

“Radiation dermatitis is a skin condition that is a common side effect of radiation therapy. The affected skin becomes painful, red, itchy, and blistered.”

—National Cancer Institute

“Radiation dermatitis” is a medical term for a radiation burn. Most radiation burns are mild, while about 1 out of 5 are more severe.

Radiation burns are similar to sunburns or second degree burns. Skin becomes dry, itchy, blotchy, tender, and may swell at the radiation site. Often, skin peels and blisters form.

Weeping Radiation Burn

A weeping radiation burn is a type of radiation dermatitis that develops open sores. The sores may leak serous fluid: a clear or yellow liquid that’s part of your blood’s plasma.

The most severe radiation burns may begin to bleed.

Acute Vs. Chronic

Acute radiation dermatitis is the most common type of radiation burn. It happens within 3 weeks of radiation therapy.

In contrast, chronic radiation dermatitis onsets 90 days or longer after RT.

It happens when radiation damages or alters your skin’s endothelium tissue. RT can make the skin produce too much collagen. It can also create dysfunction among immune cells, throwing different types of cells out of balance.

As these malfunctions go on, your skin can start to atrophy. It may become thinner or more fragile. It can also begin to scale or develop scar tissue buildup.

Both acute radiation burns and chronic radiation dermatitis should be treated with care. Either can increase the risk of infection. Preventing infection and promoting skin healing is the goal of treatment.

How To Diagnose & Assess Radiation Dermatitis

When a person has symptoms of radiation burns or chronic radiation dermatitis, the first step is to examine the area. This lets the doctor assess the nature and severity of the skin condition.

The most widely-used assessment looks for 9 signs of radiation dermatitis on the skin. It compares the individual’s skin’s condition to a standard scale.

Treatment differs depending on the specific type of dermatitis the person is dealing with. For most people, the goals of treating radiation dermatitis include:

Manage or relieve pain
Heal wounds
Heal skin tissue
Reduce fibrosis (scar tissue)
Reduce or prevent skin necrosis

While the conditions overlap, there are different approaches when treating acute radiation burns and chronic radiation dermatitis.

Acute Radiation Burn Treatment Options

Acute radiation dermatitis is skin inflammation, burning, or blistering while radiation is ongoing, or within three weeks of treatment. To address these painful symptoms, most treatment has one (or more) of four goals:

heal wounds
prevent or treat infection
reduce inflammation
relieve skin dryness / itchiness

Treatments are typically dressings or creams.

Mild Radiation Burn Wound Dressings (Low Exudate, Dry)

Most acute radiation dermatitis wounds will be dry, with low amounts of exudate. They’ll need more hydration and cooling than similar wounds with different causes. Look for cooling gels like KerraLite Cool Border Hydrogel Dressing to soothe the irradiated skin while protecting it from infection.

Because post-radiation dermatitis leaves skin tender and fragile, it’s important to make sure bandage adhesion doesn’t pose any risk of additional damage. Medical gauzes like CUTICERIN Low-Adherent Surgical Dressing attach without irritating adhesives.

Topical protective barriers like SECURA Dimethicone Protectant are also useful, sealing cracked, chapped, or blistered skin in a moisture-rich layer.

Moderate-Severe Radiation Burn Wound Dressings

If acute radiation burn wounds are weeping, leaking moderate-severe levels of exudate, or are currently / at risk of being infected, advanced wound care dressings are warranted.

Post-radiation ulcers with moderate-severe exudate benefit from absorbent, protective foam dressings—like the Mepilex Border Flex Five-Layer Foam Dressing, a bandage with a layer of superabsorbent retention cloth.

An ulcer with signs of infection often benefit from prescription-strength antibiotic dressing, like BlastX Antimicrobial Wound Gel (Rx Required). In that case, your doctor will likely also prescribe you oral or topical antibiotics.

Radiation Burn Cream: Moisturising, Pain-Relieving, Anti-Itch

Certain topical creams for radiation burns are only available with a prescription, while others are available over-the-counter. The most helpful creams fall into four categories.

Anti-Inflammatory Creams

Anti-inflammatory creams reduce redness, swelling, and itching. Effective options include topical corticosteroids, like Dynarex Hydrocortisone Cream, and inflammatory mediators like aloe vera—the key ingredient in Regenecare Wound Care Gel.

Moisture Barriers

Moisturizing creams, including barrier pastes like Calmoseptine® Ointment and rehydrating creams like Resta Cream Moisturizer For Dry Irritated Skin. These relieve skin dryness, cracking, and irritation, while also preventing any fluid from blisters from further damaging your skin.

Pain Relievers

Topical analgesics like benzocaine and lidocaine, which reduce or relieve pain and itching. Popular options include Americaine Benzocaine Itch Relief 20% Strength Spray, and the sting-free fluid Bactine Max Pain Relieving Cleansing Spray 5oz.

Antibiotics

Antimicrobial creams, which limit or prevent bacterial infection.

These include topical antibiotics like WeCare Triple Antibiotic Ointment from Dynarex, and antimicrobial compound creams like Selan Silver Protective Barrier Cream. If you use a cream with metallic components, be sure to clean it off before the next radiation treatment.

Combination Products

Some of the best topical treatments for radiation burns serve multiple purposes at once.

For example, Regenecare HA Wound Care Gel with 2% Lidocaine incorporates hyaluronic acid, a moisturizer and healing agent rated among the most effective radiation dermatitis treatment ingredients. It also includes lidocaine, an analgesic, and aloe vera, an inflammation mediator.

Chronic Radiation Dermatitis Treatment Options

Chronic radiation dermatitis is a bit more complex to treat. When it manifests as minor skin irritation, itching, blisters, and wounds, can be treated with the same products as acute radiation dermatitis.

However, it can often be more serious. Different presentations benefit from different treatment options.

Telangiectasia Treatment

Telangiectasia are visible veins and capillaries near the skin’s surface. They can be painful, but are usually only a problem due to their appearance.

Fortunately, radiation-induced telangiectasia can be treated with pulse dye laser therapy.

Chronic Ulceration

Chronic ulcers are a type of chronic radiation dermatitis that manifests as recurring open sores and wounds. Wound dressings are first line treatments, while laser therapies are the next step.

Dressing Radiation-Induced Ulcers

The best way to treat these wounds is to dress them appropriately. Fortunately, the same types of dressings and creams can be used to protect and heal chronic radiation-induced wounds, and the wounds caused by acute radiation burns.

Laser Therapy Options

Low-intensity laser therapy (LLLT) or photobiomodulation therapy (PBMT) are effective treatments for some people.They’re particularly beneficial for people experiencing chronic, post-irradiation ulceration.

This outpatient treatment uses low intensity lasers to stimulate growth of healthy cells and dermal blood vessels while reducing inflammation. For some, LLLT and PBMT can effectively adress treatment-resistant chronic, radiation-induced ulcers.

Radiation-Induced Fibrosis & Tissue Necrosis

More severe radiation dermatitis ulcers may accumulate fibrosis (scar tissue) that can be stiff, painful, and prevent ulcers and wounds from fully healing. It can also result in skin tissue necrosis.

To treat these conditions, wound care requires debriding the scar tissue and necrotic tissue. Debridement removes the dead or damaged tissue, to promote healing.

Autolytic Debridement, Biodressings

Dressings like Medihoney Gel Wound and Burn Dressing are often used to treat moderate-to-severe radiation-induced wounds. It supports autolytic debridement of fibrosis in wounds and speeds the healing of ulcers.

Recent studies of biodressings like Woun’Dres Collagen Hydrogel emphasize their incredible potential for chronic radiation burn treatment. These gels seem to both speed healing and reduce or prevent subsequent ulceration.

Surgical Treatment Options

Fibrosis and tissue necrosis often requires surgical management. Scar tissue or necrotic tissue is surgically removed. Then, the wound heals, sometimes with the aid of artificial, temporary skin like SkinTemp® II.

Post-surgical wound healing may be facilitated with hydrogels like DuoDERM Hydroactive Gel, which help maintain the wound environment for optimal healing.