Radiation therapy can be life saving and can improve a patient's overall quality of life. However, skin changes related to radiation therapy can be not only painful but also lead to desquamation, infection, ischemia, and necrosis in an already compromised patient population. WOC nurses can play a pivotal role in promoting skin integrity and timely intervention when skin problems occur. Radiation therapy is sometimes labeled "the gift that keeps on giving" due to the early and late complications associated with treatments.

The skin, especially the stratum germinativum and stratum spinosum in the epidermis, is sensitive to ionizing radiation.1 The epidermal appendages: hair follicles, sebaceous glands, and nails are also affected, resulting in impaired strength and elasticity of the skin, immune compromise, vulnerability to chemical and mechanical trauma, and delayed healing.2 Early skin reactions can range from mild to severe and may begin to appear in patients after several treatments. Since the ionizing radiation is cumulative, a larger number of treatments and higher total doses increase the risk of adverse skin reactions.1 Adverse skin reactions are most likely to occur near the end of treatment, but delayed reactions may occur months or even years after therapy has ended. They may be precipitated by trauma, chemical or allergic irritant dermatitis leading to infection, ulceration, and necrosis. Karagas and colleagues3 noted an increased risk of development of basal cell and squamous cell skin carcinomas in patients treated by ionizing radiation.

At the present time there are no standard guidelines for skin care during and after radiation therapy.4 Topical creams and dressings containing heavy metals are avoided during radiation therapy because they are hypothesized to have the potential to disperse radiation and exacerbate the risk of skin damage.1 Skin care during and after radiation therapy focuses on preventing trauma, avoidance of any chemicals that may precipitate a skin reaction, pain management, and rapid intervention should an injury occur. A variety of topical therapies have been identified as helpful in promoting a moist healing environment. They not only promote dermal regeneration and epithelial migration; they also relieve associated pain. In recent years, silver-impregnated dressings have been widely used in burns and other types of acute and chronic wounds.4 They have also been used for the management of moist desquamation of the skin associated with radiation therapy because of the multiple shared goals for wound management in these differing clinical scenarios (promotion of healing, prevention of infection, and management of pain).

Fortunately, advances in the delivery of radiation therapy have improved survival outcomes for patients with cancer. Despite these improvements in dosage and delivery, radiation therapy related early and late alterations in the skin remain common. Skin reactions are compounded in patients receiving both chemotherapy and radiation therapy. Since concurrent therapies in treating cancer are increasingly common, the number of patients experiencing skin complications will increase.4 We owe it to our patients to conduct research that will help us develop evidence-based guidelines for the care and treatment of radiated skin.

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