There is no current evidence to support the use of aqueous cream versus any other moisturising brand or indeed using nothing whilst undergoing radiotherapy treatment. Has anyone looked into doing any form of trials to determine which works best?
Participated in an inhouse trial of commercial skin care products Aloe Vera and Vitamin E cream about 20 years ago. We randomised a pile of radiotherapy breast patients and provided them one or the other at the time these were the two products that were being recommended as the "best thing since sliced bread"! We assessed the skin reaction in ways 1. Dr assessment (somewhat subjective) and 2. Tristimulus colorimeter (a little bit more scientific). To ensure that we were sampling correctly on a regular basis a few regions were Identified by indelible marker, markings were sufficiently separated from the measurement point to avoid any cross influence. We measured skin colour behind the ear, inner aspect of upper arm and on the breast in the centre of the treatment field, all these points were measured before treatment commenced and then throughout treatment up to a follow-up appointment (can't remember exactly how long). Prior to all measurements we also measured a reference white sample to ensure equipment was performing correctly. Because we were physicists and hate statistics (well doing the math) the local university provided the expertise for the analysis of all the data generated. The long, tall and short of all the data generated, equipment performed perfectly and had zero deviation (Varian Optical) there was no difference in the measured skin colour behind the ear or under arm. There were changes on the breast increasing reddening (as expected) and whilst the data appeared to show favour for aloe vera statistically no difference could be found.
Please check this publication Zang_Y_Support_Care_Cancer_2013_21_1025
Christian surber I cannot finfd this publication, would you be able to be more specific. Thankyou
@ Lindsay: Do you know if there are public documents/reports on that study?
Giacomo..................hmmmm....... good question......... but the most important point here is "20yrs ago". There may well have been a hard copy version of the paper at one stage whether it still exists in the Uni library is another question.
Simple answer; DON'T KNOW!!!
Best thing is to exam all the skin - every year - in search of atrophic or keratotic skin, and also avoid sun exposure. The skin that undergoes radiotherapy is more prone to skin cancers . If it happens one could think on 5% imiquimod cream therapy first
An animal study indicates that topical vitamin C is beneficial in reducing radiation-induced oral mucositis. Perhaps topical vitamin C might also be beneficial for skin exposed to radiation.
Two articles summarize the current, yet limited knowledge on this issue:
Ward et al., Cutaneous manifestations of acute radiation exposure: a review. Int. J. Dermatol. 2012, 51: 1282-91
Titaree Suwannalai, Prevention and management of acute radiation dermatitis by the topical agents: a literature review. J. Thai. Soc. Therap. Radiol. Oncol. 2010, 16 (1): 27-40
a very recent paper described a beneficial effect of Mepitel (R) patchs during irradiation. It was a paired analysis during breast cáncer RT. Some part of the breast was naked and another part was treated with the patch. The results were impresive. Unfortumately I don't remember the journal
Type these numbers into pubmed
10.1007/s00520-013-1896-2
10.1007/s00520-012-1622-5
and you will be guided to the paper!
PATIENT & CAREGIVER EDUCATION
Skin Care Guidelines for Patients Receiving Radiation Therapy
This information describes skin reactions to look out for during your radiation therapy and how to manage them.
Skin Reactions From Radiation Therapy Skin changes are common and expected during radiation therapy. Each person reacts to treatment in a
different way. The likelihood and severity of a skin reaction depends on:
The area being treated, The type and dose of radiation given, Whether or not you are also getting chemotherapy.
After 2 or 3 weeks of radiation therapy,The skin may become pink or tanned. As treatment continues, the skin may become bright red or very dark. the skin may also feel dry and itchy and look flaky. Some people develop rash or blisters in the treatment area. These blisters may open and peel. Skin reactions will most likely improve 3 to 4 weeks after your treatment is finished.
Talk to the radiation oncologist or dermatologist about using steroid cream to prevent skin reactions.
Caring for Your Skin During Radiation Therapy:
* Keep your skin clean
* Bathe or shower daily using warm water and a mild, unscented soap.
Examples of soaps you can use include Neutrogena®, Dove®, baby soap,
Basis®, and Cetaphil®. Rinse your skin well and pat it
* Dry with a soft towel.
* When washing, be gentle with your skin in the area being treated. Do not use
washcloth or a scrubbing cloth or brush.
* The tattoo marks you received before treatment are permanent and won’t wash
off. You may get other markings during treatment such as an outline of your
treatment area with a purple felt-tipped marker. You can remove these
markings with mineral oil when your radiation oncologist says it’s okay.
* Do not use alcohol or alcohol pads on the skin in the area being treated.
Moisturize the skin often from the first day of your treatment to minimize the
reaction. There is no evidence that any one moisturizer is better than another.
Do not wash off the moisturizer before your treatment.
* Avoid irritating your skin in the treatment aream Wear loose-fitting, cotton
clothing over the treated area.
* Do not use any of the following in the area being treated:
----Makeup
----Perfumes
----Powders
----Aftershave
* Nonaluminum-based deodorant can be used on intact skin in the area being
treated. Stop using it if your skin becomes irritated.
* Do not shave the treated skin. If you must shave, use only an electric razor.
* Do not put any tape on the treated skin.
* Do not letthe treated skin come into contact with extreme hot or cold
temperatures. This includes hot tubs, water bottles, heating pads, and ice
packs.
* Do not apply any patches to the treated area, including pain patches.
* If you have no skin reactions, you can swim in a chlorinated pool. However, be
sure to rinse off the chlorine right after getting out of the pool.
* Avoid tanning or burning your skin during and after you are finished with
treatment, and wear loose-fitting clothing that covers you as much as
possible.
Normally, following radiation therapy to the scalp, the hair takes a long time to regrow. However, with patients who have applied aloe vera immediately after radiation, the hair has grown back amazingly quickly.
we did a trial (unpublished yet) with different brands released specific for RT and all behaved similar in terms of dermatitis. Only little differences appeared in subjective patient satisfaction
At my radiotherapy centre we carried out a small study with aqueous v aloe vera and found no difference in outcome, but more patients were allergic to aloe vera. We use hydrosorb for its soothing properties on unbroken skin and we are trialling polymem on broken skin. Patients can use simple soap, unperfumed.
One thing for certain is avoid Aqueous cream BP - it has too high a dose of SLES and de-stabilises the stratum corneum. Paradoxically it is recommendeed by dermatologists even though patients know that it stings the skin and makes them feel uncomfortable. I recommend vitamin A cosmetic creams to patients because they are supportive of the skin and promote rapid return to normal. They do not interfere with the radiotherapy or irritate the skin.
The vitamin A that some of my patients have used with radiotherapy contains retinyl esters which are gentle for the skin. The vitamin A absorbs energy in the region of about UVB bordering on UVA and would not interfere with the radiotherapy even though the cream also contains antioxidants in probably the highest levels onthe commercial market. I did not find anything fresh in the make face look fresh website, and for me certainly not contributing to the question.
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