Forde E, Van den Berghe L, Buijs M, Cardone A, Daly J, Franco P, Julka-Anderson N, Lechner W, Marignol L, Marvaso G, Nisbet H, O'Donovan A, Russell NS, Scherer P.

Radiother Oncol. 2025

Background: There is a substantial body of literature addressing the prevention, acute management, and follow-up care of radiation induced dermatitis. The quality and application of this evidence, however, is inconsistent and its interpretation varies widely. While several national guidelines have been developed to standardise practices locally, many of these resources are not publicly available. On behalf of the European Society for Radiotherapy and Oncology (ESTRO) Radiation Therapist (RTT) Committee, an international writing group consisting of 12 experts from radiotherapy and two patient representatives composed a recommendation document for the management of radiodermatitis. Recommendations are labeled based on the level of evidence.

Main body: The consensus for these recommendations was generated based on available international guidelines, and supplemented with evidence-based review articles on the topic. These recommendations focus on the prevention and practical management of early stage radiodermatitis by avoiding skin trauma and maintaining hygiene. Addressing pain and inflammation in higher grades is also covered. The current literature refutes some of the traditional recommendations, especially restricting washing as well as the use of deodorant or the potential dose build-up of lotions which has been included and rectified in recent guidelines. In addition, the importance of grading the severity, including a baseline assessment is presented. The benefit of clear, and non-contradictory communication within the multidisciplinary team as well as patient involvement (e.g. PROMs or similar) is highlighted. Furthermore, the importance of recognising different skin types and skin tones, and the impact on how radiodermatitis changes these in their appearance is stressed.

Summary of management recommendations:

General management/prevention:

• To ensure good hygiene the skin should be washed daily, preferably with lukewarm water and gently drying of the treatment area.
• The use of deodorant is allowed unless the skin is broken.
• Skin irritation due to friction and abrasion in the treatment area should be avoided through the wearing of loose fitting (preferably cotton, linen, or silk) clothing, avoidance of excessive rubbing, trauma, jewelry or adhesives.
• Sun exposure to the area treated should be avoided. Protect the (irradiated) skin from exposure to the sun by covering the skin. After treatment a high SPF (SPF50) or sunblock is recommended. Apply moisturizing cream/lotion to hydrate the irradiated skin. Application of cream/lotion directly/shortly before treatment is acceptable.

 Management of Grade 1 radiation induced dermatitis

• Continue general management/ prevention Apply moisturizing cream/lotion to hydrate the irradiated skin.
• Application of cream/lotion directly/shortly before treatment is acceptable.
• The continued use of corticoid creams or topical steroid can be considered (but only when the skin is not broken).

Management of Grade 2 radiation induced dermatitis

• Continue general management/ prevention Treat areas with intact skin same policy as grade 1