Skin care during radiation treatments

Q: I’m starting radiation soon for breast cancer. How can I help keep the treatments from burning my skin?
During radiation treatments for cancer, nearly eight out of 10 people will develop some form of skin irritation called “radiation dermatitis." Radiation often creates redness and warmth to the area, much like having a mild rash. Your skin may become more sensitive to touch and feel "tight." Continued radiation treatments can create dryness and itching and cause skin to peel, exposing raw red patches that may ooze clear fluid.
Skin damage from radiation is more likely if another skin surface rubs up against the skin being treated, like under your armpits or breasts.
People who are smokers, have diabetes, or had a previous surgical procedure in the treated area are much more likely to develop radiation dermatitis.
Post-radiation skin irritation tends to peak about a week after treatment. The higher the number of radiation sessions, the greater your risk of skin inflammation. To reduce your risk of developing radiation dermatitis, treat your skin with extra care. It's essential to avoid rubbing or scratching the area being radiated. Drinking plenty of water and applying moisturizing cream to the area faithfully can also help keep your skin from blistering or peeling.
It’s okay to wash your radiated skin with soap. Washing gently with mild soap and water has been shown to cause less skin reaction than just rinsing with water. Most patients starting radiation treatment are advised to use a "mild, non-alkaline soap, preferably unscented."
Very little guidance exists on which soaps are best to use when undergoing radiation. There's no clear evidence that any specific soap is superior. Mild soaps like Dove®, Ivory®, or Neutrogena® are considered safe, while highly scented soaps such as Coast® and Irish Spring® should be avoided.
You can safely wear deodorant or antiperspirant during treatment unless the skin of your armpit develops a cut, scratch, or blister.
Applying a moisturizer after radiation sessions is one of the best ways to protect your skin from dryness, irritation, and skin breakdown.
Your skin consists of layers of flat cells that form a flexible, self-renewing barrier, protecting you from exposure to infection and toxins. Although your skin cells start out nice and plump, as they get closer to the surface, they gradually dry out, creating thin, overlapping layers that are water-resistant. As the top layer of flattened skin cells rubs or flakes off, it is replaced by the cells underneath.
Ceramide molecules support the barrier function of healthy skin. A lower level of ceramide is found in dry, damaged skin than in healthy skin. Applying ceramide-rich creams can help heal skin damage. Lotions and creams containing these vitally important compounds can restore skin integrity faster than creams containing only traditional moisturizing agents.
CeraVe® Moisturizing Cream has 3 essential ceramides. Last year, I compared it to my previous favorite, Arbordoun’s Abundantly Herbal Calendula Cream, because I wanted to determine if the claims about ceramides were accurate. My skin absorbed CeraVe® quickly, it didn’t feel greasy, and my skin felt smoother for hours.  
Calendula is a natural source of soothing relief from skin irritation. Arbordoun’s Abundantly Herbal Calendula Cream® containing olive oil, calendula, and lavender also works well to protect your skin from radiation damage. Unlike CeraVe®, Arbordoun’s takes time to become completely absorbed. I always let it soak into my skin for about 5 minutes before putting on clothes, so the fabric doesn't stick to it.
You can also apply pure Aloe Vera juice directly to your skin for protection. After each radiation session, my stepmother, Joyce, applied Trader Joe’s Aloe Vera Juice straight from the bottle, and didn't develop any burns.
Here are 5 tips to help protect your skin during radiation treatment:
1.    Don’t rub or scratch the treated area.
Itching causes the urge to scratch, even when you sleep. Keeping your fingernails cut short and wearing cotton gloves or socks over your hands at night helps protect your skin.
2.    Avoid hot water and strong soaps.
Use lukewarm water and mild soaps when washing or bathing.  
3.    Be gentle.
When bathing, avoid harsh scrubbing tools like exfoliating cloths, rough washcloths, or loofahs.
4.    Keep yourself hydrated.
Irritated skin loses water more quickly, making it feel dry and itchy. Drinking plenty of water helps keep your skin well hydrated.
5.    Apply a soothing cream.
Support the barrier function of your skin by protecting it after each radiation treatment. Moisturizing creams containing either ceramide (CeraVe®, Curel®) or calendula can help you avoid radiation dermatitis.  

Dr. Louise Achey, Doctor of Pharmacy, is a 42-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com. C 2021 Louise Achey