William calls your office complaining of painful redness and blisters on his chest. He admits that during the recent warm weather, he hadn’t been wearing a shirt while working in the yard. He initially thought it was a sunburn, but the symptoms continued to worsen and were unrelieved by typical sunburn remedies. Upon reviewing William’s chart, you see that he recently received radiation and chemotherapy therapy for Hodgkin disease. 

What Would You Do?

Radiation dermatitis is a common complication of radiation therapy, occurring in up to 95% of patients. Approximately 10% of epidermal cells divide each day, with the entire epidermal layer being replaced every month. Radiation damages these dividing cells and also stimulates the release of histamine and serotonin while damaging underlying blood vessels. 

There are many unanswered questions regarding optimal skin care for radiation dermatitis, and research continues. Evidence suggests that since sun exposure can increase dermal damage, patients should be encouraged to apply sunscreen when outdoors. Non-drying soap should be used for regular skin hygiene. Baby powder should be avoided as it can increase the risk of fungal infections. Aloe has not been proven effective for symptom management. However, topical calendula, a marigold plant extract, has shown benefit in preventing and treating radiation dermatitis for patients with breast cancer. Hyaluronic acid has also shown benefit for symptom management, although one recent study showed no benefit when used prophylactically.

The nurse reviewed these recommendations with William and scheduled him for a follow-up visit.