Everything You Need to Know About Radiation Burn Treatment

Radiation therapy is a powerful weapon in the fight against cancer, using targeted radiation beams to destroy cancer cells. However, this targeted approach can sometimes have unintended consequences, damaging healthy tissues in the treatment area. This damage manifests as radiation dermatitis, also known as radiation burn.

The statistics are quite telling: in the United States alone, millions of people undergo radiation therapy each year, and over 90% of them will experience some degree of radiation dermatitis. While the good news is that most cases are mild and manageable, it's important to understand the full picture.

While the majority of radiation burns from cancer treatment are mild, nearly 20% of patients experience more severe symptoms. These can have a real impact on daily life, causing discomfort, pain, and even impacting a patient's willingness to continue their treatment. Fear and reluctance are understandable consequences of dealing with more serious burns.

The good news is that healthcare providers are well aware of the potential side effects of radiation burn treatment, including radiation burns. They are constantly researching and developing methods to minimize the occurrence and severity of these burns. Additionally, they have established treatment protocols to manage and alleviate symptoms for patients who experience them.

This comprehensive approach ensures that patients receive not only the best possible cancer treatment but also the necessary support and care to manage any side effects, including rash from cancer.

Radiation Therapy for Cancer Treatment

According to the National Cancer Institute, over 50% of cancer patients require radiation therapy, either as a standalone treatment or alongside other therapies. Radiation therapy is a localized approach, targeting only the cancer cells and the surrounding area, rather than affecting the entire body.

  • External beam radiation therapy targets cancer cells using X-ray beams directed at them from outside the body. For example, in the case of lung cancer, a machine directs the beams at your chest, penetrating through the skin.

  • Internal radiation treatments may also be employed, where radiation sources like seeds or capsules are placed inside your body, close to the cancer.

  • Liquid radiation can be administered by ingesting it as a pill or drink, or through an intravenous (IV) line.

This evidence-based treatment has been proven to help fight cancer, and you will collaborate with your care team to understand its benefits and potential risks.

Who's Most Likely to Experience Radiation Burns?

While radiation therapy burns are a potential side effect for anyone undergoing radiation therapy, certain factors
increase the likelihood and severity. Here's a breakdown of those most

Treatment Area:
  • Sensitive Skin: Areas like the head and neck, groin, and breasts are naturally more delicate and prone to irritation. When exposed to radiation therapy, these areas are more likely to develop radiation burns.

  • Proximity to Cancer Site: Cancers located close to the skin's surface, such as skin cancer or anal cancer, require radiation beams to pass through a thinner layer of tissue. This increases the chance of the healthy skin in the path of the beam also being affected, leading to burns.
Treatment Type and Dosage:
  • Higher Radiation Doses: Naturally, the higher the radiation dose a specific area receives, the greater the risk of burns.

  • Type of Radiation Therapy: Certain types of radiation therapy, like external beam radiation, have a higher chance of causing skin damage compared to internal radiation therapy (brachytherapy).
Individual Factors:
  • Pre-Existing Skin Conditions: Existing skin problems like eczema or psoriasis can worsen with radiation therapy and make the skin more vulnerable to burns.

  • Overall Health: Individuals with compromised immune systems or chronic health conditions may experience a slower healing process and be more susceptible to developing severe radiation burns from cancer treatment.
Specific Cancers:

The type of cancer being treated can also influence the likelihood of radiation therapy burns. Here are some examples:

  • Skin Cancer: When radiation therapy is used to treat skin cancer, the cancerous area itself will naturally be exposed, increasing the risk of radiation burns in that specific location.

  • Anal Cancer: Radiation therapy for anal cancer often targets the anal and perianal regions, which are sensitive and prone to irritation. This can lead to radiation dermatitis in these areas.

  • Breast Cancer: Radiation therapy for breast cancer often targets the chest wall and surrounding areas, which can lead to radiation dermatitis in those locations.

  • Head and Neck Cancers: Treatment for head and neck cancers frequently involves radiation to the sensitive skin of the face and neck, increasing the risk of burns.

The Cause of Radiation Burns

Radiation therapy is a double-edged sword. While it effectively targets and destroys cancer cells, it can also inadvertently harm healthy tissues in its path. This collateral damage, particularly to the skin, manifests as radiation burns, also known as radiation dermatitis or X-ray dermatitis.

Radiation burns are typically caused by exposure to high levels of radiation, which can be lethal if received as a whole-body dose but may be treatable if localized or shallow.

Medical Imaging and Radiation Burns
  • Fluoroscopy: Repeated or prolonged fluoroscopy can lead to radiation burns. The Food and Drug Administration (FDA) conducted a study in 1994 on radiation-induced skin injuries from fluoroscopy and has since issued advisories to minimize such injuries. Further reviews in 2000, 2001, 2009, and 2010 have continued to address the issue.

  • X-ray Computed Tomography (CT) and Projectional Radiography: These imaging techniques can also cause radiation burns if exposure time and exposure factors are not carefully managed.
Radioactive Fallout and Radiation Burns
  • Beta burns are commonly a result of exposure to radioactive fallout from nuclear explosions or accidents. These burns were notably observed on cattle and dogs after the Trinity test, causing localized burns, temporary bleeding, and hair loss. The Castle Bravo test produced strong fallout that led to beta burns on the Rongelap Atoll residents, primarily affecting the backs of their necks and feet. Symptoms included itching, burning, subsequent hair loss, ulcers, and, in some cases, cutaneous scarring and depigmentation. Simple washing post-exposure helped prevent skin lesions.
Other Notable Incidents:
  • The Zebra test of Operation Sandstone in 1948 resulted in three men receiving beta burns on their hands while handling drone filters, requiring skin grafts due to severe damage.

  • During the Upshot-Knothole Harry test at Frenchman Flat, fallout affected local livestock, causing beta burns to sheep, horses, and cattle. Policy at the time only compensated for visible external burns, leading to many denied claims.

  • Underground nuclear testing in Nevada saw workers develop burns and skin ulcers, partly due to tritium exposure.

The Timeline of Radiation Burns

It's important to note that radiation burns from cancer treatment don't appear immediately. It typically takes about two weeks into external radiation treatment for the initial signs to show up.

The good news is that these burns are often mild and tend to resolve within two months after treatment ends. They typically occur within the treated area or the immediate surrounding skin, not elsewhere on the body.

Visible Signs/Symptoms of Radiation Burns

Recognizing the early signs of radiation burns is crucial for seeking timely radiation burn treatment and minimizing discomfort. Here's a breakdown of the visual indicators to watch out for:

Early Signs (Occur within the first few weeks of treatment):

  • Redness: The affected area may develop a reddening similar to a sunburn. Cancer skin rash is often the first noticeable symptom. .

  • Irritation: The skin may feel irritated, tight, or sensitive to touch.

  • Swelling: Mild swelling may occur around the treated area.

  • Sunburned Appearance: The skin might take on a sunburned look, with a reddish hue and potential dryness.

  • Tanning: In some cases, the treated area may develop a slight tan-like appearance.

Later Signs (May develop after a few weeks):

  • Redness: Dryness: As the radiation disrupts healthy skin cells, the area may become increasingly dry and lose its natural moisture.

  • Flaking: Dryness can lead to flaking of the skin, similar to mild dandruff but potentially more widespread.

  • Itching: Disruption of the skin barrier can cause bothersome itching, adding to the discomfort.

  • Peeling: In some cases, the dry and irritated skin may start to peel, typically in small flakes.

Severity Variations:

Radiation burns can range from mild to severe. The severity depends on several factors, including:

  • Treatment Area: Sensitive areas like the head and neck are more prone to developing severe burns.

  • Radiation Dose: Higher radiation doses increase the risk of more severe burns and cancer skin rash.

  • Treatment Duration: The longer the treatment period, the greater the cumulative damage and potential for severe burns

  • Chemotherapy: Undergoing chemotherapy concurrently with radiation therapy can heighten the risk of severe burns.

The above symptoms are a good starting point for getting the right radiation burn treatment, but it's crucial to remember that radiation burns can manifest in other ways as well. Your skin may become swollen and puffy, or develop a "moist reaction" – a wet, sore area prone to infection. This is particularly common in areas like skin folds under the breasts. Additionally, changes in skin texture or color may vary depending on the treatment area.

Types of Radiation Burns

Radiodermatitis is categorized into three distinct types: acute radiodermatitis, chronic radiodermatitis, and eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy. Additionally, there is a potential for radiation therapy to induce radiation-induced malignancies. The doctor asses the type of burn before recommending a suitable radiation burn treatment.

Acute Radiodermatitis

Acute radiodermatitis typically occurs following exposure to an "erythema dose" of ionizing radiation, which is capable of causing visible erythema within 24 hours. The condition often manifests within the initial weeks of commencing radiotherapy and is characterized by red patches on the skin. At radiation doses of 2 Gy or higher, erythema is commonly observed. This acute reaction may also present with skin desquamation or blistering in some cases.

Chronic Radiodermatitis

Chronic radiodermatitis arises from prolonged exposure to sub-erythema doses of ionizing radiation over extended periods. This exposure can lead to various degrees of skin and subdermal damage, with symptoms appearing after a latent period that can span from several months to decades. Historically, this condition was frequently observed among radiologists and radiographers who experienced constant exposure to ionizing radiation, particularly before the advent of X-ray filtering technologies. Chronic radiodermatitis often leads to the development of indurated, atrophic plaques that may appear whitish or yellowish, accompanied by telangiectasia and sometimes hyperkeratosis. Over time, this can progress to more severe conditions such as squamous and basal cell carcinomas.

Eosinophilic, Polymorphic, and Pruritic Eruption Associated with Radiotherapy

This type of skin condition primarily affects women undergoing cobalt radiotherapy for internal cancers. It is characterized by distinctive skin eruptions that are eosinophilic, polymorphic, and pruritic.

Radiation-induced Erythema Multiforme

Radiation-induced erythema multiforme may develop in neurosurgical patients who are administered phenytoin prophylactically while receiving whole-brain therapy and systemic steroids. This condition presents as a severe skin reaction mimicking erythema multiforme, a type of hypersensitivity reaction.

Prevent Radiation Burns from Cancer Treatment

Radiation therapy is a powerful tool in fighting cancer but it sometimes leaves its mark on healthy tissues in the form of radiation burns. Thankfully, there are proactive steps you can take to minimize the risk and severity of these burns, promoting a smoother treatment journey. Here's a comprehensive guide on preventing these burns that can come before the radiation burn treatment:

Before Treatment:

  • Nurturing Your Skin: Healthy skin is your first line of defense for radiation burn treatment. Discuss a skincare routine with your doctor. They can recommend gentle cleansers and moisturizers suitable for the specific needs of your skin during radiation therapy.

During Treatment:

  • Gentle Touch: It might be tempting to scratch or rub itchy areas, but resist the urge! This can worsen the burn and delay healing.
  • Showering Wisdom: Maintain proper hygiene by showering or bathing daily with lukewarm water and mild soaps approved by your healthcare team. Avoid hot baths or excessive scrubbing. Pat your skin dry gently with a towel, being careful not to remove any treatment markings.
  • Temperature Control: The treated area will be sensitive to extremes. Avoid hot tubs and saunas, and bundle up in cold weather to minimize discomfort.
  • Sun Protection: Radiation therapy heightens your skin's sensitivity to sunlight. When outdoors, prioritize sun-protective clothing with a UPF rating, including a wide-brimmed hat and long sleeves. Ask your doctor if sunscreen is recommended for the treated area.

Product Precautions:

Certain skincare products can irritate the already-compromised skin during radiation therapy. Avoid the following when you have radiation therapy burns:

  • Antiperspirants/Deodorants: Opt for gentle, fragrance-free alternatives.
  • Talcum Powder: This can trap moisture and worsen irritation.
  • Perfumes and Lotions with Strong Fragrances: These can irritate the skin.
  • Hair Removal Products: Chemical hair removal methods can be particularly harsh. Discuss alternative methods with your doctor.
  • Bubble Bath Products: Avoid harsh ingredients and potential allergens.
  • Makeup: Minimize makeup use on the treated area. Consult your doctor for recommendations on gentle makeup options.

Clothing Comfort:

  • Loose-Fitting Fabrics:Wear soft, comfortable clothes made from breathable materials like cotton to prevent rubbing and irritation. Avoid tight-fitting clothing or garments with elastic that might constrict the treated area.
  • Moisture Management:

  • Cool, Humid Air:If possible, use a humidifier to create a cool, moist environment that soothes your skin.
  • Area-Specific Care:

  • Rectal Irradiation:After bowel movements, use unscented baby wipes or a gentle stream of water from a spray bottle to cleanse the area and minimize irritation and burns.
  • Understanding Degrees of Radiation Burns

    Radiation burns from cancer treatment are categorized by degree based on the severity of the damage. Just like thermal burns caused by heat:

    • First-degree Burns: These are the mildest forms. They manifest as red, dry skin with moderate pain and itching.
    • Second-degree burns: More severe than first-degree burns, these involve red, moist skin with blisters. The pain and itching can range from mild to severe.

    First Aid for Rash from Cancer and Other Burns

    Taking good care of your skin during and after radiation therapy is crucial. Here are some basic first-aid tips for radiation burn treatment:

    • Follow Doctor's Orders: Adhere to your healthcare provider's specific instructions for skin care during treatment.
    • Monitor Changes: Be observant of any skin changes or worsening symptoms, and consult your doctor promptly if needed.
    • Seek Emergency Care (Infection Signs): If you experience radiation burns and develop a fever, unusual redness, pus drainage, or a foul odor from the burn site – these could be signs of infection and require immediate medical attention.

    Radiation Burn Treatment Options

    Wondering “What should you put on your skin after radiation”? Managing these burns effectively is crucial for patient comfort and the continuation of cancer treatment. Treatment strategies are broadly categorized into pharmacological treatments and natural remedies for radiation burns.

    Basic Care as a Part of Radiation Burn Treatment

    • Gentle Care for Skin Cancer: Washing the treated area daily is essential to remove bacteria and prevent infection. However, be incredibly gentle. Use warm water only, and avoid harsh scrubbing or washcloths that can irritate the already sensitive skin. Instead, opt for your hands to gently splash water onto the area.
    • Low-pH Cleansers: If you need to cleanse further, use a gentle, low-pH cleanser recommended by your healthcare team. Apply it with your hands and rinse thoroughly with warm water. Skip the washcloths or loofahs – they can be too abrasive.
    • Respect the Lines: Technicians may draw lines on your skin to guide treatment. Don't scrub or try to remove these markings. This can irritate the skin. Let them fade naturally.
    • Shaving: For the duration of radiation therapy, it's best to avoid shaving the treated area altogether. Shaving can aggravate the skin and increase the risk of a painful rash. Discuss alternative hair removal methods with your doctor if needed.
    • Hydration: Moisturizing the treated area daily is crucial for promoting healing and reducing discomfort. However, only use products recommended by your healthcare team. Apply the moisturizer as directed, avoiding any open wounds.

    Natural Remedies for Radiation Burns

    Natural remedies for radiation burns often serve as supportive care to alleviate symptoms associated with radiation burns. They are generally used for radiation burn treatment because of their soothing, anti-inflammatory, and healing properties.

    1. Aloe Vera

    Description: Aloe vera gel is known for its soothing and cooling properties in radiation burn treatment. It helps reduce inflammation and accelerate skin healing.

    Application: Apply pure aloe vera gel directly to the affected area several times a day, especially after bathing. Ensure the product is free of alcohol and fragrances to avoid irritation.

    2. Calendula

    Description: Calendula has anti-inflammatory and mild antibacterial properties, which can promote wound healing and reduce discomfort during radiation burn treatment.

    Application: Use a calendula ointment or cream on the affected skin. Alternatively, use calendula tea bags cooled in the refrigerator as a compress for soothing relief.

    3. Coconut Oil

    Description: Coconut oil provides moisture to dry and peeling skin, which is common with radiation burns. Its fatty acid content also helps reinforce the skin’s lipid layer.

    Application: Apply cold-pressed, unrefined coconut oil gently to the skin, ensuring coverage over dry areas without applying pressure.

    4. Oatmeal Bath

    Description: Oatmeal possesses anti-inflammatory and soothing properties that can relieve itching and irritation in radiation burn treatment.

    Application: Add finely ground colloidal oatmeal to lukewarm bath water and soak for 15–20 minutes to soothe larger areas of affected skin.

    5. Honey (Medical Grade)

    Description: Honey is effective for wound healing and antibacterial action. Medical-grade honey (like Manuka) is specifically prepared for therapeutic use in radiation burn treatment.

    Application: Apply a thin layer of medical-grade honey to the affected area, covering it with a sterile bandage if necessary.

    Pharmacological Treatments

    Pharmacological treatments involve the use of medications and topical treatments prescribed by healthcare providers to manage pain, prevent infections, and facilitate healing.