Managing Skin Reactions

Erythema

Where cases of erythema occur, patients can be advised to apply an aqueous cream to the treatment area two to three times daily, to alleviate the discomfort of dry skin and defer the onset of damage to the epithelial cells. Evidence in current literature suggests the use of emollient creams to manage erythema significantly reduces the onset of more severe skin reactions [1].

Moist Desquamation

In the occurrence of cases of moist desquamation it is important to ensure that infection is avoided through good skin management. In these instances nursing care would be required, following moist wound care management principles and the resultant use of hydrocolloid gels and flexible dressings [1].

Often, during the course of treatment, the lesion can dry up, forming a scab over the healing wound which it is advisable to leave, allowing the scab to fall off naturally. However, in some instances, the formation of this scab could be so thick that it compromises the radiotherapy treatment, due to the photon beam being absorbed by the dead skin layers. In such cases, it may be necessary to remove the scab, to ensure correct treatment, using a hydrogel dressing which is placed on the scab overnight, allowing it to soften, for easy removal the following day.

In certain cases, if the lesion has been left unattended for a long period of time, it can thicken to form a ‘horn’ that cannot easily be removed using hydrogel. In order to expose the source of the growth, it is advisable to treat the lesion using enzyme intervention with a product containing streptokinase which, once injected into the lesion, will cause the growth to breakdown.

Complex Lesion Management

In certain instances, some lesions can present as moist and malodorous and these will therefore require daily attention. Current practice suggests absorptive dressings should be applied, with the use of hydrogel (covered with a non adhesive dressing) to facilitate moist wound care [4]. Where possible, dressing tape should be avoided as the use of such can increase the potential for further skin damage. It is also advisable to only clean the lesion if there is evidence of debris or infection. Malodorous lesions can cause great discomfort to the patient and removal of the offensive odour is therefore vital. Historically, charcoal based dressings were used, however these have now be replaced by topical antibiotic creams, allowing the surface bacteria to be killed and thereby providing positive results.

For bleeding lesions it is advisable to treat using an alginate dressing as this has haemostatic qualities which help to reduce minor bleeding.

Wound care is the primary concern when managing complex lesions although not the only; patients must be advised that general behaviour such as smoking, malnourishment, dehydration, diabetes, circulatory and respiratory problems can all compromise rapid healing.

Post Treatment Care

Post treatment patients are advised that there skin reaction will peak approximately seven days following the end of treatment, due to the accumulative nature of radiotherapy and therefore it is important that they continue with their recommended treatment area regime for this time.

Care needs to be given when exposing the area to the sun due to heightened sensitivity which, if not protected, could cause the area to react severely in cases of sunburn. If the area cannot be covered by a sunhat or other garment then the patient is advised to use a high factor SPF (sun protection factor) cream at all times.


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