The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline


Goals of work

To develop a practice guideline report on the questions: What are the optimal methods to prevent acute skin reactions (occurring within the first 6 months of irradiation) related to radiation therapy? What are the optimal methods to manage acute skin reactions related to radiation therapy?

Materials and methods

Cancer Care Ontario’s Supportive Care Guidelines Group (SCGG) conducted a systematic review of literature on this topic. Evidence-based recommendations were formulated to guide clinical decision making, and a formal external review process was conducted to validate the relevance of these opinions for Ontario practitioners.

Main results

Twenty-eight trials meeting the inclusion criteria were identified. Of the twenty-three trials that evaluated preventative methods, washing was the only practice which significantly prevented skin reaction. Some evidence suggested topical steroid creams and calendula ointment might be effective. None of the five trials evaluating skin reaction management detected a positive effect using steroid cream, sucralfate cream, or dressings.


Skin washing, including gentle washing with water alone with or without mild soap, should be permitted in patients receiving radiation therapy to prevent acute skin reaction. There is insufficient evidence to support or refute specific topical or oral agents for the prevention or management of acute skin reaction. In the expert opinion from the SCGG, the use of a plain, non-scented, lanolin-free hydrophilic cream may be helpful in preventing radiation skin reactions. In addition, a low dose (i.e., 1%) corticosteroid cream may be beneficial in the reduction of itching and irritation.

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  1. 1.

    “Gentle washing” involves using lukewarm water and taking care not to rub the skin. Showers should also be lukewarm and should have low pressures.

  2. 2.

    “Mild soap” is defined as a pH-balanced, non-scented product that does not contain lanolin. There is no evidence to suggest that one type of mild soap is preferable to another. However, in one study that rated the irritant quality of 18 soaps, “Dove” was the only soap classified as mild and may, therefore, be considered [17].


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The PEBC is sponsored by, but editorially independent of, Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

The SCGG would like to thank Ms. Karima Velji for her contribution during the initial stages of the development of the guideline and Ms. Julie Wilson for assisting in the preparation of this manuscript.

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Corresponding author

Correspondence to Rebecca K. S. Wong.

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A complete list of Supportive Care Guidelines Group members is available at:

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Bolderston, A., Lloyd, N.S., Wong, R.K.S. et al. The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline. Support Care Cancer 14, 802 (2006).

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  • Practice guideline
  • Systematic review
  • Acute skin reactions
  • Radiation therapy