What is a radiation skin reaction?

Although radiation does not burn you, changes to your skin may look like a sunburn. Changes appear slowly over time and only in the treatment area. This is normal during treatment.

Your treatment team will show you the area that treatment may affect. They can also explain what you will see with your skin during treatment.

Why is it important to take care of my skin during radiation therapy?

Taking care of your skin in the treatment area will help:

• reduce the changes
• reduce any soreness
• reduce the risk of infection
• help your skin heal after treatment

What can I do to prevent a reaction?

You cannot prevent a skin reaction, but you can reduce the effects.
To reduce a skin reaction:

• Keep your skin clean. Wash every day with a mild soap and rinse with water.
• Apply moisturizer (lotion or cream) a few times a day before you start treatment, or on the first day of your treatment. Keep using moisturizer on skin that is intact (skin is not broken or open). Use the moisturizer until you are told to use something else.
• Protect your skin from other sources of damage. The sun and extreme heat and cold can damage your skin.

Caring for my skin during treatment

What do I do if my skin is sore?

Your skin may feel sore during your treatment. It may also be red and swollen. Your skin may feel dry, tight and itchy.

Do these things if your skin is sore:

• Use a moisturizer with no perfume or scent on the sore area often.
• Keep washing the sore area.
• Tell your doctor if your skin keeps itching. They can prescribe medicated cream (contains medicine).

What do I do if my skin is dry and flaky?

Your skin may feel dry and flaky. This may cause it to itch. Your skin may also be red and sensitive (prone to damage). You may notice you sweat less.

Do these things if your skin is dry and flaky:

• Let the skin peel off by itself. Do not peel off loose skin.
• Use unscented (no scent or perfume) moisturizer on the sore area often.
• Tell your doctor if your skin keeps itching. They can prescribe medicated cream (contains medicine).
• Do a saline soak or a sitz bath.

What do I do if my skin is open and moist?

Some of your skin may:

• peel off
• be open and moist
• weep (ooze)

A nurse can check and bandage your skin. The nurse can also help you with medicated cream and pain medicine.

Do these things if your skin is open and moist:

• Do a saline soak or sitz bath often.
• Gently wash the area using a spray bottle with a soft mist.
• Use a barrier cream on the open skin. Stop using moisturizers on the open skin. You can still use unscented moisturizer on intact skin.
• Use a medicated cream if prescribed by your doctor.

What do I do if my skin is bleeding, blistered or infected?

See a nurse if your skin is bleeding, blistered or infected. Your treatment team will help take care of your skin. Do not treat this reaction on your own.

How do I wash my skin in the treatment area?

Keep your skin clean to prevent infection.

1. Wash your skin gently using lukewarm water. Avoid very hot and very cold water.
2. Use mild unscented soap (such as Dove, Neutrogena, Aveeno, Pears). You may also use baby soap in the treatment area. Use baby shampoo if your scalp is in the treatment area.
3. Use a clean, soft towel to pat your skin dry. Avoid rubbing your skin.

Can I use moisturizer on my skin that is in the treatment area?

You can use normal moisturizer as soon and as often as you wish. Use an unscented moisturizer often if your skin is dry.

1. Wash your hands before using moisturizer.
   Washing your hands helps prevent infections if your skin is cracked or peeled.
2. Use an unscented, moisturizer without lanolin (a type of oil used in creams and lotions).
   If you need help choosing a cream, talk to your pharmacist or health care team.
3. Do not use aloe vera gel on dry, sore skin.
   Aloe vera gel can make your skin sorer.

Can I use antiperspirant or deodorant (products used to hide or reduce body odour)?

You can use these products in the treatment area if your skin is intact.

Use an unscented deodorant. This is less likely to make your skin red, sore or itchy.

How do I shave my skin in the treatment area?

It is okay to shave your skin. Use an electric razor. Try shaving less often. Avoid shaving the treatment area if it is sore.

Do not use these products as they may cause more soreness:

• a bladed razor
• shaving cream
• aftershave
• products with alcohol

What kind of clothing should I wear?

Wear soft, loose clothing in the treatment area. Make sure to cover your skin to protect it from sun, heat, and cold. Stay in the shade when you can.

Examples:

What else should I avoid?

Your skin will be sensitive (prone to damage) during treatment. You should avoid swimming and hot tubs if the skin in the treatment area will be in the water.

During treatment avoid using:

• powders, such as cornstarch or baby powder
• tape, bandages and adhesives (such as glue)
• heating pads and cold packs
• scented products, such as makeup, perfume or cologne
• sunscreen

Caring for my skin after treatment

Keep caring for your skin as described above until it has healed. A skin reaction often improves 2 to 3 weeks after treatment. Your skin colour should return to normal 3 to 4 weeks after treatment. Your skin will still be sensitive after it heals.

Do these things after your skin heals:

• Be gentle with skin in the treated area.
• Use moisturizer at least once a day.
• Do not expose the treated area to the sun.
• Use sunscreen with SPF 30 or higher if you go in the sun. Reapply often.

How to do a saline soak and sitz bath

What is a saline soak?

A saline soak is used to bathe skin in the treatment area. It will help keep the skin clean and avoid infection. It may also help to increase your comfort level.

A saline soak can help reduce:

• swelling
• soreness
• redness
• itchiness

Where can I buy saline solution?

You can buy sterile saline solution at any drugstore. Only buy saline solution that is 0.9%. If you buy sterile saline, you can use it right from the bottle. You do not need to boil the sterile saline.

Important: Do not use saline solution that is made for contact lenses. This type of saline solution has preservatives (a substance to prevent products from going bad). Preservatives may irritate (make itchy, red, sore) your skin.

You can also make saline solution at home.

How do I make saline solution at home?

Things you will need:

• A clean pot to boil water
• Clean jar with a lid
• Clean soft cloth (a thick face cloth or J-cloth)
• Table salt
• Clean bowl

1. Pour 4 cups (1 litre) of tap water into a pot. Add 2 level teaspoons (10 millilitres) of table salt.
2. Bring the water to a boil. Mix until the salt is dissolved. Allow the water and salt (saline) solution to cool.
3. Pour the cooled saline solution into a clean jar. Cover the jar with a lid.
4. Write the date the solution was made on the jar.
5. Store the saline solution on the counter or in the fridge. Most people like it at room temperature.
6. Throw away any unused saline after 2 days

How do I do a saline soak?

1. Wash your hands.
2. Place a clean, soft towel in a bowl. A thick facecloth or J-cloth works best.
3. Wet the cloth with saline.
4. Gently squeeze the cloth to wring out extra liquid. Place the cloth over the affected skin for 5 to 10 minutes. Do not leave the cloth on your skin too long or it will dry out. Avoid rubbing your skin.
5. Remove the cloth.
6. Let the area air dry for 1 to 2 minutes.
7. Repeat these steps on other affected areas. Wash your hands and use a new cloth and bowl each time.
8. You should apply a saline soak 3 to 4 times a day or more. Do the saline soak more often if it provides you comfort. Keep doing the saline soaks until the area heals, even after treatment has finished.
9. Apply a lotion or cream after the skin is dry.

What is a sitz bath?

A sitz bath is used to soak the skin around the pelvis and groin. It is usually done in your bathtub. It can also be done in your toilet using a plastic sitz bath. You can buy a toilet sitz bath at a drug store. Choose the option that allows you to fully soak the affected area.

Sitz baths can be made using:

• baking soda (not baking powder)
• table salt
• Epsom salt

How often should I take a sitz bath?

You can take a sitz bath as many times as you need. It is usually done 3 to 4 times a day. You can take a sitz bath after each bowel movement (poo) if your anal area (bum) is sore.

How do I take a sitz bath?

1. Fill the bathtub about 13 cm (5 inches) deep with warm water. The water should be about 37 °C to 39 °C (99 °F to 102 °F). Do not use hot water. Test the water using your wrist. If it feels hot on your wrist it is too hot to soak in.
2. Choose 1 of these salts:
   • baking soda
   • table salt
   • Epsom salt
3. Add the salt you chose to the bath. Do not use all 3 salts. Mix the water to dissolve the salt.

Type of salt	Amount (for toilet sitz bath)
Baking soda (sodium bicarbonate)	½ cup (125 millilitres)
Table salt	¾ cup (190 millilitres)
Epsom salt	¾ cup (190 millilitres)

4. Sit in the bath and soak your buttocks (bum) for 10 to 15 minutes. Use a piece of foam to raise your buttocks off the bottom of the tub. This will help expose the affected area to the bath water.
5. Dry your bum using a clean, soft towel. Avoid using a terrycloth towel, as it leaves lint on your skin. You can also:
   • lie down and let the affected area air dry
   • use a fan to dry the affected area
   • use a hair dryer on the cool setting
6. Clean the bathtub after each use. Use fresh water and baking soda or salt each time you soak.

How do I use a toilet sitz bath?

1. Lift the toilet seat and put the plastic sitz bath in the toilet bowl.
2. Fill the sitz bath 2/3 full with warm water. The water should be about 37 °C to 39 °C (99 °F to 102 °F). Test the water using your wrist. If it feels hot on your wrist it is too hot to soak in. Do not use hot water.
3. Add one of the listed salts to the bath. Do not use all three salts. Mix the water to dissolve the salt.

Type of salt	Amount (for toilet sitz bath)
Baking soda (sodium bicarbonate)	½ to 1 level tablespoon (10 to 15 millilitres)
Table salt	1 to 2 teaspoons (5 to 10 millilitres)
Epsom salt	1 to 2 teaspoons (5 to 10 millilitres)

4. Sit in the sitz bath and soak your buttocks (bum) for 10 to 15 minutes. Your buttocks should not touch the bottom of the sitz bath. Extra water will run into the toilet through the holes.
   
5. Dry your bum gently with a clean, soft towel. Avoid using a terrycloth towel, as it leaves lint on your skin. You can also:
   • lie down and let your skin air dry
   • use a fan to dry your skin
   • use a hair dryer on the cool setting
6. Clean the toilet sitz bath after each use. Use fresh water and baking soda or salt each time you soak.