Skin Care Recommendations during Radiotherapy: A Survey of Canadian Practice.

The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline

“…In the trial by Kaul [22], significant differences in favor of enzyme therapy were also reported in terms of pre-and postradiation therapy biopsy scores, although the cut-off scores (reported as + and − ranks) were not clearly reported. Analysis was based on 33 versus 32 wounds for moist hydrocolloid and topical gentian violet, respectively All patients in both groups also applied non-blinded emollient cream (Diprobase) over radiation area once daily 3 Breast cancer patients only 4 All groups recommended to apply baby powder three times daily to treated skin surface 5 If clinically necessary, patients in control group received topical treatment 6 Physicians treated established dermatitis of grade 2 or higher and/or allergy 7 Any use of anti-inflammatories, topical anaesthetics, or mucoprotectants for radiation toxicity and concomitant medication was recorded 8 Primary or metastatic 9 Patients in all groups advised to use only mild baby soap on the skin 10 No other prophylactic topical agents were to be applied during the study period; however, patients with pruritus and/or marked erythema were to use a 1% hydrocortisone cream 2-3 times daily and patients with moist desquamation were to use Domeboro's soak 3-4 times daily; patients in all groups advised not to apply soap directly to the skin 11 Cream group; instructed to clean skin with water and pH-neutral wash syndents daily; powder group: instructed to wash with water twice weekly 12 Cream washed off prior to radiation treatment 13 Moderate skin reactions cleansed by gentle washing with normal saline soaked gauze and soap; severe reactions added treatment with 1/4 solution hydrogen peroxide and saline (only in hydrous lanolin group), both followed by saline rinse prior to application 14 Patients were stratified and divided into two subsets: i) those that received chemotherapy and radiation therapy and ii) radiation therapy alone 15 Cleansed by gentle washing with 0.9% normal saline before application …”

“…A Canadian survey [3] found considerable differences between institutions in the prevention and management of acute radiation skin reactions. Inconsistencies between practitioners can lead to patients receiving conflicting or even erroneous, information.…”

Randomized Intra-patient Controlled Trial of Mepilex Lite Dressings versus Aqueous Cream in Managing Radiation-Induced Skin Reactions Postmastectomy

“…In a recent survey, Kumar, et al [2] found that 50% of responding departments in Australia and New Zealand based their skin care policy on anecdotal evidence. This situation is not limited to Australasia; skin care practices vary both between and within institutions worldwide [3][4][5]. A good example of this is the widespread use of aqueous cream in many radiation therapy departments around the world, even though a large randomized controlled clinical trial (RCT) (n=357) showed that aqueous cream does not prevent nor decrease the severity of skin reactions [6].…”

Use of Axillary Deodorant and Effect on Acute Skin Toxicity During Radiotherapy for Breast Cancer: A Prospective Randomized Noninferiority Trial

“…The current practice is to allow the use of only water and mild soap during RT (2)(3)(4). Some investigators believe that deodorant could have a bolus effect on the skin and thus potentiate skin toxicity (5,6).…”

“…More often than not, its use is prohibited. A Canadian study showed that 92% of surveyed radiation oncologists did not recommend the use of a deodorant during RT (3). This tended to be the accepted norm for each participating center.…”