Published: 2021-02-22

Study of the various cutaneous adverse reactions to radiotherapy

Priyatharshini Venkatakrishnan, Govardhan Jagadeesh Kumar, Bhavana Sampadarao


Background: Radiation-induced skin toxicity is a widely recorded toxicity of definitive radiation therapy with about half of patients experiencing grade 2 or higher skin reactions. Radiation-specific characteristics include total exposure, fractional dose, beam energy, field size, anatomic of radiation, and subsequent systemic therapy. Aim of the study was to identify and grade the various cutaneous adverse reactions to radiotherapy.

Methods: 25 patients underwent radiation therapy for any type malignancies were included in the study. Skin manifestations due to other systemic/ cutaneous diseases prior to radiotherapy. Detailed history was taken about disease course, cutaneous manifestations with emphasis on treatment (type of radiation, dosage and duration). General physical examination and dermatological examination were done.

Results: In this study 60% of patients were male, the minimum dose of radiation was 30Gy in 13% patients, maximum dose of radiation was 70Gy in 33% patients, 88% of patients were in RTOG grade 2. Hyperpigmentation was the commonest findings 23 (92%), followed by dry desquamation 11 (44%), the next common was epilation 10 (40%).

Conclusions: Radiation toxicity, generally occurring during or shortly after treatment can range from mild (hyperpigmentation, erythema) to severe (moist desquamation).



Radiotherapy, Cutaneous reaction, Radiation dermatitis, Adverse reaction

Full Text:



Fisher J, Scott C, Stevens R, Marconi B, Champion L, Freedman GM et al. Randomized phase III study comparing best supportive care to Biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation. Int J Radiat Oncol Biol Phys. 2000;48(5):1307-10.

Salvo N, Barnes E, Van Draanen J, Stacey E, Mitera G, Breen D et al. Prophylaxis and management of acute radiation-induced skin reactions: a systematic review of the literature. Curr Oncol. 2010;17(4):94-112.

Trueman E. Managing radiotherapy induced skin reactions in the community. J Community Nurs. 2013;27(4):16-24.

Constine LS, Milano MT, Friedman D. Late effects of cancer treatment on normal tissues. In: Halperin EC, Perez CA, Brady LW, eds. Principles and Practice of Radiation Oncology Philadelphia (PA): Lippincott Williams and Wilkins. 2007:320-55.

Hymes SR, Strom EA, Fife C. Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006. J Am Acad Dermatol. 2006;54:28-46.

Bolderston A, Lloyd NS, Wong RK, Holden L, RobbBlenderman L. Supportive Care Guidelines Group of Cancer Care Ontario Program in Evidence-Based Care. The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline. Support Care Cancer. 2006;14(8):802.

McQuestion M. Evidence-based skin care management in radiation therapy. Semin Oncol Nurs. 2006;22(3):163-73.

Hassey Dow K, Dunn Bucholtz J, Iwamoto R, Fieler VK, Hilderley LJ. Nursing care in radiation oncology, 2nd ed. W.B. Saunders: Pennsylvania. 1997.

Fisher J, Scott C, Stevens R, Marconi B, Champion l, Freedman GM et al. Randomised phase III study comparing best supportive care to biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation: radiation therapy oncology group. Int J Radiat Oncol Biol Phys. 2000;48(5):1307-10.

Sitton E. Early and late radiation-induced skin alterations, part I: mechanisms of skin changes. Oncol Nurs Forum. 1992;19(5):801-7.

Nenot JC. Medical and surgical management for localised radiation injuries. Int J Radiat Biol. 1990;57(4):783-95.

Guskova AK, Baranov AE, Barabaranova AV, Moiseev AA, Paitken EK. The diagnosis, clinical picture and treatment of acute radiation sickness in the victims of Chernobyl Atomic Electric Power Station, II, non-bone marrow syndromes of radiation lesions and their treatment. Ter Arkh. 1989;61(8):99-103.

Brown JB, Fryer MP. High energy electron injury from accelerator machines (cathode rays): radiation burns of chest wall and neck: 17-year follow up of atomic burns. Ann Surg. 1965;162(3):426-37.

Saevets NV, Povstianoi NE. Radiation burns located in the area of major blood vessels (experimental study). Klin Khir. 1980;3:24-7.

Steidley KD, Stabile RJ, Sanfilippo LJ. A case history of severe radiation burns from 50 kVC X-rays. Health Physician. 1981;40(3):399-405.

Ciko Z, Antic M, Jokic N, Brajovic D, Radovic M. Acute radiation sickness associated with radiation burns. Vojnosanit Pregl. 1986;43(4):311-3.

Gogin EE. Combine radiation exposures and their immediate and late sequelae. Ter Arkh. 1990;62(7):11-5.

Hopewell JW. The skin: its structure and response to ionising radiation. Int J Radiat Biol. 1990;57(4):751-73.

Sitton E. Early and late radiation-induced skin alterations part II: nursing care of irradiated skin. Oncol Nurs Forum. 1992;19(6):907-91.

Barkham AM. Radiotherapy skin reactions and treatments. Prof Nurse. 1993;8(11):732-6.

Campbell IR, Illingworth MH. Can patients wash during radiotherapy to the breast or chest wall? A randomised controlled trial. Clin Oncol. 1992;4:78-82.

Heenan ALJ. Emollient applications for chronic skin problems. Prof Nurse. 1996;11(11):743-8.

Margolin SG, Breneman JC, Denman DL, La Chapelle P, Weckback L, Aron BS. Management of radiation induced moist skin desquamation using hydrocolloid dressing. Cancer Nurs. 1990;13(2):71-80.

Strunk B, Maher K. Management of multifactorial moist desquamation in a patient undergoing radiotherapy. J ET Nurs. 1993;20:152-7.

Bjornberg A, Hellgren L, Magnusson B, Mattsson I, Rosenberg B. Topical treatment of radiation dermatitis with betamethasone- 17 -valerate, Vaseline and eucerine-.a doubleblind comparison. Clin Radiol 1967;18:463-4.

Potera ME, Lookingbill DP, Stryker JA. Prophylaxis of radiation dermatitis with a topical cortisone cream. Ther Radiol. 1982;143:775-7.

Hotter AN. Wound healing and immuno-compromise. Nurs Clin N Am. 1990;25:139-203.

Michalowski AS. On radiation damage to normal tissues and its treatment. Acta Oncol. 1994;33:139-57.