Radiation Dermatitis: Types of Radiation Burn and How to Manage It?

Definition of Radiation Dermatitis or Radiation Burn

Exposure to external beam ion radiation causes several side effects and one of the most severe side effects is radiation dermatitis or radiation burn. The syndrome is also known as radio dermatitis, x-ray dermatitis, radiation skin damage or a radiation burn.

Radiation Dermatitis

Radiotherapy treatment to the different malignancies causes radiation dermatitis or radiation burn in human body. Other than in cancer patients, radiation dermatitis or radiation burn may also occur due to the radiation treatment of coronary angiography, indwelling catheter placements or procedures of embolization.

The skin cells of epidermis and endothelial present within the walls of blood vessels goes through severe damage and burning sensation due to the radiation process.

Radiation Dermatitis or Radiation Burn- Clinical Features

Radiation dermatitis or radiation burn usually noticed in the patient after the initiation of radiotherapy within few weeks. The effect of radiation dermatitis or radiation burn depends on the intensity of the dose of the radiation given to the patient and his ability to with stand it. It depends on the sensitivity of the individual’s body tissues going through the radiation process and is noticed in the same body part which is been radiated. Changes in the skin of the part are well visible.

Different Types of Radiation Dermatitis or Radiation Burn

Different Types of Radiation Dermatitis or Radiation Burn

Radiation dermatitis or radiation burn can be sorted in to two kinds, acute radiation dermatitis and chronic radiation dermatitis.

Acute Radiation Dermatitis or Radiation Burn

Acute radiation dermatitis or radiation burn is noticed in a person after the radiation process and within a period of 90 days. The patient undergoing the radiation process may experience changes in his skin which may be reddening of the skin (faint erythema) or peeling of the skin (desquamation), death of skin cells exposed to radiation (skin necrosis) or ulceration. The results actually depend on how severe the radiation process was on the particular individual.

There are four categorized stages of acute radiation dermatitis or radiation burn as classified by the National Cancer Institute, USA:

  • Grade 1: Faint erythema or desquamation – this erythema is noticed to be developed in the patient from a period ranging from just the day of the radiation to 21 days. It is caused due to the exposure of the skin to other elements from 12 Gy in the patient with some amount of phototype. This phase of erythema can appear in the patient much after the process of radiation therapy. The erythema is called brachytherapy when it is a sooner reaction. It may bring along a severe burning sensation and edema.
  • Grade 2: It shows medium erythema or patchy or a moist desquamation in the skin folds. The skin experiences a moderate swelling. It is better to radiate lesser doses in the affected regions to avoid any further loss of efficacy of secondary treatment due to tumor cell repopulation
  • Grade 3: This stage shows a confluent and moist desquamation which may increase than 1.5 cm in diameter. It also does not remain confined only to the skin folds and has severe swelling.
  • Grade 4: It experiences acute skin necrosis or ulceration of full thickness dermis of the middle skin layer. In rare cases severe tumor is noticed to bulge up which requires heavy short time radiation. It shows inflammatory plaque of a painful variety soon after the manifestation with necrotic and hemorrhagic phenomena progressing towards deep necrosis, which can expose the muscles, tendons, and bones.

Chronic Radiation Dermatitis or Radiation Burn

Chronic radiation dermatitis or radiation burn can erupt in the patient anytime from the period of a mere 15 days or a gap of up to 10 years from the date of the radiation. It is regarded as the extension of the acute process and causes rousing changes in the skin exposed to radiation.

A change the skin goes through due to chronic radiation dermatitis or radiation burn has the following properties:

  • The follicular structures, i.e. the skin pores vanishes.
  • The elastic fibers in the dermis level are usually damaged and increase in the level of collagen is also noticed.
  • The epidermis or the upper surface of the skin goes more tender.
  • The blood vessels become more prominent over the skin, medically known as telangiectasia.

Repeated radiation treatment to a cancer patient may also lead to cause secondary skin cancers. The most common of this is the basal cell carcinoma.

Radiation Recall

Though radiation recall is a rare syndrome noticed in a few patients, it may occur in the sites which were previously been radiated after chemotherapy (methotrexate or etoposide). The reaction can occur to the patient within seven days of the radiation or may be after few years.The radiation recall can cause sun burn symptoms of erythema to necrosis, ulceration, and bleeding.

Risk Factors Involved With Radiation Dermatitis or Radiation Burn

Patients who are more prone to the followings generally are more frequently affected by radiation dermatitis or radiation burn:

  • Mal-nutrition
  • Skin disease in the body existing from earlier
  • Use of skin creams on the radiated part of the skin before the radiation process
  • Skin folds overlapping
  • Over body weight
  • Repeated radiation therapy
  • Using radiation dose more than 55 Gy for a person
  • Parallel cetuximab therapy for patient who are getting radiation for malignant problems of head and neck

The risk of radiation dermatitis or radiation burn is increased due to some other syndromes and diseases. These are:

  • Connective tissue diseases ( systemic sclerosis, systemic lupus erythematosus or mixed connective tissue disease)
  • Chromosomal breakage syndromes, like bloom syndrome and Fanconi anaemia.
  • Genetic disorders upsetting epidermal DNA, like basal cell nevus syndrome
  • Diabetes mellitus
  • Damage of cell caused by radiosensitizing drug (e.g. paclitaxel or docetaxel)
  • Ataxia telangiectasia
  • Infectious diseases from HIV virus

General Management of Radiation Dermatitis or Radiation Burn

Development of some radiation dermatitis or radiation burn has been considered inevitable under certain categories of radiation due to the extreme degrees. Most patients undergoing such treatment are bound to face these consequences. However a proper planned procedure of radiotherapy can be helpful in reducing the chances of the radiation dermatitis or radiation burn due to such radiation. It can be useful in avoiding skin toxicity in the patient up to a certain level.

In order to manage the radiation dermatitis or radiation burn in patients who are receiving radiation therapy, it is essential to make sure that the dermatitis is not an outcome of any other medications, other than EFGR (Epidermal growth factor receptor) inhibitor. The dose of the radiation has to be measured correctly and changed within a small time of any occurrence of the skin changes.

Follow the below steps irrespective of the radiation dermatitis or radiation burn grades:

  • Before EGFR (Epidermal growth factor receptor) inhibitor and radiotherapy to any patient, the skin should be prepared for the process to adopt itself gently to it. A proper hygiene has to be maintained before the radiation procedure on the entire exposed portions of the skin. The patients should be advised to clean the portions with gentle soaps and washes and wipe with soft pieces of cloth or towel. Soaps sometimes can be irritating to the skin; instead a pH-neutral synthetic detergent could be used.
  • The skin healing can be faster with a topical treatment which offers better relief to the skin. The treatment varies for different portions of the skin:
    • The portion of the skin which remains moist even after the reaction can be dried with drying pastes in the folds of the skin
    • The seborrheic areas can be better treated with gels
    • Creams are beneficial in areas external to the folds of the skin and seborrheic areas
    • The moist areas can be dressed with hydrophilic dressings. Thus the moisture is absorbed and the area becomes dry. This is a faster process of skin healing.
    • Greasy products should not be used as they cannot absorb the exudates of the skin and cause super infection to the skin.

Before the radiation process begins, the use of any sort of topical moisturizer, emulsion, gel or dressing is strictly prohibited. Those can bring bolus effects to the skin by unnaturally increasing the dose of radiation in the skin epidermis level. Patients should be strictly instructed to clean and pat dry their exposed portions of the radiations before such process.

  • Corticosteroids are often used in some centers during radiotherapy in malignancies of head and neck. However it is not contra-indicated when the radiation dermatitis is present. It is always advised to limit the treatment time of the corticosteroid-containing treatment for faster healing.
  • Patients should avoid the following for a faster relief:
    • Any sort of sun exposure. Using sun block agents and covering the exposed areas with soft cotton can be beneficial
    • Skin irritants, deodorant sprays, perfumes etc. and other lotions which are alcohol based
    • Scratching the affected part of the skin
  • The consequences of the treatments of cetuximab-associated skin reactions should be reported to the same therapist and medical team.

Say No to Aloe Vera on Skin to Prevent Radiation Dermatitis or Radiation Burn

Radiation dermatitis or radiation burn can result pain and itchiness in patients and that affects their quality of life, sleep, image of the body.The occurrence of radiation dermatitis or radiation burn can go higher 95% leaning on the population of patients responding to the medical therapy. Studies justifying occurrence have primarily happened in women responding therapy for cancer of breast.

Many online sites promote aloe vera to people for treating “sunburn sort” effects from the radiation therapy. Research exhibits that aloe vera is not worthwhile for the interruption or therapy of radiation dermatitis or radiation burn, and another research described ill effect in patient as a consequences by using aloe vera.

Patients under the radiation treatment should be aware of any use of any aloe vera product. Those are not only ineffective in supplying any relief to the patient but have potential damaging capacities to occur in the future which may even worsen the condition and hinder the treatment.


Prevention of skin reactions such as radiation dermatitis or radiation burn is very crucial for the individuals so that they can have safer and efficient radiotherapy and can live a better quality of life.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:April 22, 2019

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