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Introduction

The Society and College of Radiographers (SCoR) last reviewed UK radiotherapy centre skin care practice in 2000 and produced accompanying guidelines for radiotherapy departments1.  A decade later, it is timely to re-assess what is actually happening in clinical practice with an aim to updating information thereby assisting continuity and consistency of patient care.

Skin reactions from external beam radiotherapy are one of the most common side- effects from treatment and are a factor which can limit dose. Megavoltage linear accelerators with skin sparing capabilities have significantly reduced the severity of reactions from radiotherapy2. However, accelerated dose schedules with combined radiation chemotherapy regimens3 have increased the condition. The most severe reactions tend to be in seen in those patients receiving high doses to large fields. Recently the use of Intensity Modulated Radiotherapy (IMRT) has been shown to offer the opportunity to reduce skin toxicity in some cases, especially the rates of dry and moist desquamation when treating cancers in the head and neck region4-10,111,112.

Despite changes in practice and published guidelines1,11,12, radiotherapy skin care appears to have changed little over the years with centres caring for their patients’ skin in different ways; many relying on tradition rather than researched methodology. Consequently, a plethora of agents is being used on the skin in a non-standardised fashion13,14.

Although it is unlikely that radiation reactions can be completely prevented, the current driver for many research projects is to minimise and delay the onset of symptoms. This is important to ensure that treatment is given as prescribed without interruption as delays within a course of radiotherapy have been shown to affect the treatment outcome15.

The extent of skin reaction is often dependent upon the clinical site being treated. For example, radical head and neck cancer radiotherapy usually requires an immobilisation device and these patients often receive combination chemotherapy. This can make these patients very vulnerable to intensified skin reactions and it is known that interruptions in radiotherapy for this category can have a detrimental effect to treatment outcome15.

The use of an effective evidence-based skin care protocol and monitoring system16,17 would assist in a researched approach to radiation skin care management, aiding product evaluation and justification of practice.

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