Radiation induced skin reactions occur as a result of damage by ionising radiation.
Structural tissue damage, free radicals, the inflammatory response and irreversible DNA damage may all contribute to changes to involved skin during radiation treatment.
Radiotherapy induced skin changes are common and can affect up to 95% of people who receive radiotherapy.r
Changes to the skin usually become visible within two to three weeks following the start of radiation treatment, and can last for several weeks after treatment has been completed. Long term skin changes may be visible permanently.r
There are multiple risk factors that predispose to the development and severity of radiation induced skin reactions. These risk factors can include (but are not limited to) treatment and patient related factors.r
Treatment related factors that increase the likelihood or severity of a skin reaction:
- higher total and daily dose of radiation
- increased total treatment time
- type and energy of radiation (e.g high energy electrons)
- location of treatment field (i.e skin folds, chest wall etc.)
- larger treatment field
- use of bolus materials
- concomitant chemotherapy and some immunotherapy agents
- dose inhomogeneity
- previous radiotherapy to the same area (or exit dose).
Patient related factors that increase the likelihood or severity of a skin reaction:
- co-morbidities (i.e immunosuppressed, diabetes)
- poor nutritional status
- large body habitus
- poor compliance with skin care regimen
- prior exposure to some chemotherapy agents (i.e doxorubicin "recall" reaction)
- skin folds
- suitability for protective dressings.