The guidelines to skincare during radiotherapy

One of the things cancer patients and their loved ones often ask us is how to look after skin during cancer treatment. Doctors are sympathetic, but more medication isn't always the perfect solution and guidelines frequently change on how to soothe the unavoidable skin side effects of cancer treatment. 

With that in mind, we have reviewed the latest advice in this article, to help you understand how best to support your skin during and after radiotherapy. 


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The side effects of radiotherapy on the skin

The skin side effects of radiotherapy present like sunburn, including: Redness, itching, burning and soreness. Unlike sunburn, skin usually reacts to radiation gradually, often starting during the second or third week of treatment, and possibly only in patches. As treatment goes on, the irritation may increase, and sometimes start to cause peeling or blistering. If the skin breaks, infection is a risk.

Other skin side effects can include redness or darkening on the other side of your body to the treatment area and it's highly sensitive to sunlight. Longer lasting effects may be darkened skin, sensitivity and dilated or broken blood vessels. 

Skin reactions are most likely to start around week two to three and can be worse in the last week of treatment or seven to 10 days after treatment has finished, lasting up to four weeks post radiotherapy.


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Skincare guidelines before radiation treatment starts

Historically, cancer patients were told not to wash the affected area with soap and water, or to use deodorant. Updated research suggests this is unnecessary and can impact our social wellbeing. Sheffield Hallam University [2] published a paper in 2020 citing multiple studies and showing that even the specific soap type does not need to be restricted.

In the past, the concern was that deodorants with metallic components may cause a secondary radiation effect, but studies have shown this to be unfounded and outdated. However, there is a general recommendation not to apply deodorant specifically to the affected area of skin if it's damaged. 

The university noted that a rule of thumb is to monitor skin conditions and respond to product use accordingly. They recommend:

• Highlighting any preexisting skin conditions with your oncologist before treatment starts

• Discussing your skincare routine with your doctor including any existing medical skincare products that you use 

• Be mindful of things that can make skin reactions worse, such as smoking, diabetes, cardiovascular disease, hyper mobile Ehlers-Danlos syndrome, and skin folds in the treatment area 

• Ask your doctor about the likelihood of developing skin reactions from radiation

• Take precautions - for example, reduce sun exposure to the treatment area and use a sunscreen with SPF50


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Guidelines for skin care during radiotherapy

The Radiotherapy Department, Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust [1], put together the following guidelines, which is in line with the latest information from other resources and research papers. The main goal is to focus on comfort and wellbeing through treatment.

Practitioner guidelines

These are the current guidelines recommended to doctors and medical practitioners when it comes to supporting patients and their skincare through radiotherapy.

Radiation dosage: RTOG 0 
No visible changes to the skin 

• Apply moisturiser one or two times a day

• Promote oral fluids and a balanced diet throughout treatment

• Continue regular personal hygiene 

• Avoid direct sunlight 

Radiation dosage: RTOG 1
Faint or dull erythema

• Apply moisturiser two or three times a day

• Increase fluid intake

Radiation dosage: RTOG 2a
Brisk erythema and/or dry desquamation. Skin may be sore, itchy and tight.

• Apply a Hydrogel to dry desquamation and moisturiser to surrounding area two or three times a day

• May use Actiform cool pads for itching or take antihistamine and analgesia if needed

Radiation dosage: RTOG 2b 
Patchy moist desquamation and pain

• Apply Hydrogel to dry desquamation area two to three times a day

• Continue with moisturiser to surrounding area

• May use dressings  

• Take analgesia as required

Radiation dosage: RTOG 3
Confluent moist desquamation, bleeding may be evident, pain

• Apply Hydrogel to dry desquamation area two to three times a day

• Continue with moisturiser to surrounding area

• Use dressings

• Take analgesia as required

Radiation dosage: RTOG 4
Ulcerated, necrosis (very rare)

• Refer to clinical oncologist 

Cancer patient guidelines

At home, the recommendations for looking after your skin during radiotherapy treatment include advice from your doctors and nurses as well as the following.

• Use warm water and mild washing products to wash the area that is being treated

• Do not soak too long in the bath

• Dry the area with a soft towel and not rub, but pat dry

• Wear loose cotton clothing next to the skin 

• Avoid wet shaving the area or using wax for hair removal

• Sun exposure to the area should be avoided

• Perfumed soaps, talcum powder and perfumes can cause irritation

• Use moisturisers that are free of sodium lauryl sulphate (SLS), gently applied to the area

• Appropriate dressings and products should be used on broken skin to reduce further trauma or infection.

• Use products that are non-adhesive or silicone low adhesive


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Guidelines after radiation treatment has finished

After treatment ends, the recommendation from the Sheffield Hallam University's paper continues to hinge on observation and reacting to your personal needs. They note, along with other established and accepted information that skin reactions can worsen after treatment and peak around 10 to 14 days after it has finished. Some skin side effects may be permanent, such as skin sensitivity and hyperpigmentation. Skin reactions that can occur months or even years after treatment may include fibrosis, lymphoedema, cellulitis or dilated or broken blood vessels. 

Skin product recommendations during and after radiotherapy 

Our Defiant Beauty skincare collection has been created with the help of cancer patients and oncology nurses. It’s fragrance free, 100% natural, and is specifically for anyone undergoing cancer treatment. They have been formulated to help relieve the particular side effects of cancer treatment on the skin.


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