How To Care for Your Skin During Radiation Therapy

This information describes skin reactions to look out for during your radiation therapy. It also explains how to care for your skin to help prevent and manage skin reactions.

About skin reactions from radiation therapy

Skin changes in the treatment area are common and expected during radiation therapy.

Everyone reacts to treatment in a different way. The type of skin reaction you may have depends on:

• The part of your body being treated.
• The type of radiation therapy you get.
• The dose (amount) of radiation you get.

Tell your radiation oncologist or nurse if you:

• Smoke or vape.
• Have high blood pressure.
• Have diabetes.
• Have any collagen vascular diseases, such as rheumatoid arthritis or dermatomyositis (DER-muh-toh-MY-oh-SY-tis). Dermatomyositis is a disease that causes a skin rash and muscle weakness.
• Have had skin cancer in the treatment area.
• Have had radiation therapy in the treatment area before.

These things can affect how much your skin reacts to your radiation therapy. They can also affect how your skin heals.

Types of skin reactions during radiation therapy

You may have 1 or more of these skin reactions during your radiation therapy. Talk with your care team about what to expect.

• Your skin in the treatment area may look pink or tanned. As your treatment continues, your skin may turn bright red or very dark.
• Your skin may become swollen or puffy.
• Your skin may feel dry, feel tight, be itchy, and look flaky.
• Some people get blisters in the treatment area. These blisters may open and peel. Contact your care team if blisters appear.
• You may get a rash, especially in areas where your skin has been in the sun. Tell a member of your care team if you get a rash. They can be a sign of an infection.
• You may lose some or all of your hair in the treatment area. Hair most often grows back 3 to 6 months after you finish radiation therapy.

Your radiation therapy care team will see you every week during your radiation therapy. They will check your skin. If you’re having reactions, they’ll suggest ways to manage them.

If you have skin reactions, they will most likely peak up to 2 weeks after your last treatment. It may take several weeks for your skin to heal after you finish your radiation therapy.

With some radiation treatments, side effects don’t appear until weeks or months after treatment ends. These are called late side effects. Tell your radiation therapy care team if you have skin changes at any time after your treatment. They will help you manage them.

How to care for your skin during your radiation therapy

These guidelines are only for your skin in the treatment area. You can care for the rest of your skin as usual.

Keep your skin clean

• Bathe or shower every day.
  • You can bathe or shower before your appointment, after your appointment, or both. Avoid putting anything on your skin right before your radiation treatment.
  • Use warm water and a mild unscented bar soap or body wash.
  • Be gentle with your skin. Do not use a washcloth, scrubbing cloth, loofah, or brush.
  • Rinse your skin well.
  • Pat your skin dry with a soft, clean towel.
• If you got tattoo marks before your treatment, they are permanent. They will not wash off.
• Your radiation therapists may outline your treatment area with a purple felt-tipped marker. You can take off these markings with mineral oil when your radiation therapists say it’s OK.
• Do not use alcohol or alcohol pads on your skin.

Soaps to use during radiation therapy

Use a mild, unscented soap, such as baby soap. Avoid harsh soaps, especially antibacterial soaps. They can make your skin too dry.

Talk with your radiation nurse before using natural or herbal soaps. Some of these have ingredients that can irritate your skin.

These brands make soaps you can use:

• Neutrogena®
• Dove®
• Basis®
• Cetaphil®
• CeraVe®

Everyone’s skin is different. Your radiation nurse may recommend other soaps. Follow their instructions.

Moisturize your skin often

• Start using a moisturizer when you start radiation therapy. This can help minimize any skin reactions.
• Do not use more than 1 type of moisturizer unless your nurse tells you to.
• Apply a thin layer of the moisturizer 2 times a day. Avoid applying it right before your radiation treatment. You can apply it any other time.
• Do not put moisturizers on broken or open areas of your skin.

Moisturizers to use during radiation therapy

You can use an over-the-counter moisturizer, such as one made by Cetaphil or CeraVe.

Choose a moisturizer without fragrances or lanolin, unless your nurse gives you other instructions. Lanolin is an oil made by animals that have wool, such as sheep. It can cause an allergic reaction for some people.

Talk with your radiation nurse before using natural or herbal moisturizers. Some of these have ingredients that can irritate your skin.

Everyone’s skin is different. There are lots of different moisturizers that are good to use. Your radiation nurse may suggest one to you. You can always ask your if you have questions or want a list of suggestions.

Managing itchy skin

Your radiation care team may prescribe a medicine to treat itchy skin. They may prescribe it when you start radiation therapy or after a few treatments.

Tell your care team if you have itchy skin. Talk with them before using any over-the-counter products to help with the itching. Some of these products are too drying.

Do not put more than 1 product on your skin unless your nurse tells you to.

Avoid irritating your skin in the treatment area

• Wear loose-fitting cotton clothing over the treatment area. Avoid wearing an underwire bra over the treatment area.
• Use only the moisturizers, creams, and lotions your doctor or nurse recommends.
• Do not put makeup, perfume, cologne, powder, aftershave, or aerosol (spray) sunscreen on your skin.
• Do not use deodorant if your armpit is in the treatment area. Do not use it if your skin is broken, cracked, or irritated. Only use deodorant on intact (not broken) skin. Stop using it if your skin becomes irritated.
• Do not shave. If you must shave, use an electric razor. Stop if the skin becomes irritated.
• Do not put anything sticky (such as Band-Aids®, medical tape, and pain patches) on your skin. Talk with your care team about other places you can put a pain patch, if needed.
• Do not expose your skin to very hot or cold temperatures. This includes hot tubs, water bottles, heating pads, and ice packs. These things can damage your skin cells and make skin irritation worse.
• If your skin is itchy, do not scratch it. Ask your nurse for recommendations on how to relieve the itching. They may give you soothing gel pads, saline soaks, or special skin dressings to help.
• If you do not have any skin reactions during your radiation therapy, you can swim in a chlorinated pool. Be sure to rinse off the chlorine right after getting out of the pool. Avoid natural bodies of water (such as the ocean, lakes, and rivers), especially if your skin is broken. They have germs that may cause an infection.
• Avoid tanning or burning your skin during radiation therapy and for the rest of your life after radiation therapy.
  • If you’re going to be in the sun, use a PABA-free sunblock with an SPF of 30 or higher.
  • Wear loose-fitting clothing that protects your skin from the sun, such as long-sleeved shirts, wide-brimmed hats, and sunglasses. If you can, choose clothing that has an ultraviolet protection factor (UPF) of 30 or higher. You can find the UPF on the label of some clothes.

When to call your radiation oncologist or nurse

Call your radiation oncologist or nurse if:

• You have a fever of 100.4 °F (38 °C) or higher.
• You have chills.
• Your pain or discomfort is getting worse.
• Your skin in the treatment area:
  • Is getting more red or swollen.
  • Feels hard or hot.
  • Has a rash or blisters.
  • Is itchy.
• You see drainage (liquid) coming from your skin in the treatment area.
• You see any new open areas (wounds) or changes to your skin.
• You have any questions or concerns.

Your care team may ask you to send them photos of your skin using MyMSK, MSK’s patient portal. Read How to Take Pictures of Your Skin for Your Healthcare Provider to learn more.