Wound care after radiation therapy

Advances in Skin & Wound Care, Sep/Oct 2002 by Mendelsohn, Felicia A, Divino, Celia M, Kerstein, Ernane D

Characteristic features of delayed radiation lesions are eccentric myointimal proliferation of the small arteries and arterioles, as well as telangiectasia (Figure 1). These changes may progress to thrombosis or complete obstruction. Delayed ulcers are more common than acute ulcers and tend to be the result of ischemia from the changes in small arteries and arterioles; they heal slowly and may persist for several years. Irradiated skin in the chronic stage is thin, hypovascularized, extremely painful, and easily injured by any slight trauma or infection.3,4

TREATMENT OF RADIATION-INDUCED WOUNDS

Cleansers and moisturizers

Erythema may appear in the irradiated area of the skin approximately 3 weeks into radiation treatment.5 The skin should be gently cleansed with water, normal saline, or a soap solution and rinsed thoroughly to avoid excessive irritation. Friction applied to the treated area should be minimized.6 Numerous skin care products are available that can be used to reduce discomfort (Table 1). For example, hydrophilic preparations (Eucerin; Beiersdorf, Norwalk, CT; Lubriderm; Pfizer, Inc, NewYork City, NY) that absorb water and act as mild lubricants are appropriate. Protective ointments (A D Ointment; Schering-Plough, Kenilworth, NJ) or gels are effective for protecting dry lesions. Any products that contain alcohol or menthol should be avoided because they remove natural lipids and may worsen the skin's reaction.

Dry desquamation may appear during this same period, with the patient's skin in the treated area appearing red or tanned, dry, itchy, and peeling. The products used to treat an erythematous reaction can also be applied in this situation. Hydrophilic preparations (Eucerin and Lubriderm, for example) protect and lubricate scaly or flaking skin resulting from the loss of sweat and sebaceous gland function.7 To decrease itching, products such as colloidal oatmeal bath (Aveeno Bath; Rydelle Laboratories, Edison, ND, cornstarch, and mild steroids such as hydrocortisone cream 1% or desoximetasone (Topicort; Medicis, Scottsdale, AZ) can be used.

Because it may have a drying effect, daily bathing is not recommended unless a low-- pH, moisturizing cleanser is used. Cornstarch should not be used on moist skin or in areas that become moist, such as the axilla, breast, or groin, because it may promote fungal infection. Corticosteroids should be used with caution to reduce itching because they also delay healing by inhibiting inflammation and reducing blood flow to the skin. In addition, steroids can cause atrophy of dermal collagen, which can thin the skin and increase susceptibility to infection.

By the fourth week of treatment, moist desquamation may occur, especially in patients with radiation treatment to the chest wall, supraclavicular region, axilla, groin, or under an intact breast. Astringent soaks, cleansers, antibiotics, and other irigations can be used. Hydrogen peroxide has an antibacterial effect and is effective in cleansing wounds with purulent debris. However, full-strength hydrogen peroxide is harmful to granulation tissue and must be avoided.