Page 22 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

or three of treatment (Korinko & Yurick, 1997). The patient may experience dryness, pruritus,

or flaking of the skin, or dry desquamation (Maddocks-Jennings, Wilkinson, & Shillington,

2005). The recommended management of cutaneous side effects is to “avoid trauma, protect

skin with creams and lotions as prescribed” (Newton et al., 2009, p. 141).

At doses of 30-40 Gy, extra capillary cell injury occurs with increased capillary blood

flow, hyperemia, and edema. When severe, there is epilation leading to moist desquamation that

can occur at doses 45 to 60 Gy (McQuestion, 2011). With moist desquamation, the dermis is

exposed; the treatment field is moist, tender and red with oozing and leaking of serous fluid.

These reactions may also be accompanied by light or heavy exudate and rarely progresses to

ulceration, with discomfort ranging from mild irritation to severe pain (Porock & Kristjanson,

1999; Sparks, 2007).

Factors affecting the degree of skin reaction include both patient related factors and

treatment related factors. Individual or patient related factors include their usual skin care

routine, presence of skin folds, concurrent chemotherapy, immunotherapy or targeted therapies,

associated medical conditions or comorbidities such as diabetes or renal failure, older age

compromised nutritional status, chronic sun exposure, higher body mass index, smoking and

environmental conditions (Macmillan et al., 2007; Maddocks-Jennings, Wilkinson, &

Shillington, 2005; McQuestion, 2011). Treatment related factors for skin reactions include

volume of tissue irradiated, the treatment technique, radiotherapy with a bolus, the type of

radiation and energy, the site of radiation field and the dose, time and fractionation parameters

(Macmillan et al., 2007; Porock, Nikoletti, & Kristjanson, 1999). Re-epithelialization occurs

after two to four weeks of treatment completion (Sparks, 2007).