More than half of people with cancer diagnoses will undergo palliative or curative external beam radiation therapy at some point in their treatment, and the vast majority of those who do — particularly those treated for sarcomas, breast cancers, or head and neck cancers — will experience radiation dermatitis, a potentially debilitating adverse effect.1-4 Severe radiation dermatitis occurs in up to 25% of patients and can profoundly degrade patients’ quality of life and disrupt radiotherapy schedules.1,2

The condition is the most common adverse event for patients undergoing cancer radiotherapy.1

Acute radiation dermatitis occurs within weeks of treatment initiation and lasts up to a month after radiotherapy has been completed.1,2 Symptoms include skin discoloration (erythema, usually redness), localized skin edema, desquamation (thinning, dry, and peeling skin), and ulceration. Patients report experiencing localized skin discomfort and pain or burning sensations. Several radiation dermatitis severity grading systems exist, including the Common Terminology Criteria for Adverse Events (CTCAE) and the Radiation Therapy Oncology Group (RTOG) toxicity scoring system.

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Chronic radiation dermatitis, caused by disrupted inflammatory and fibrotic cytokine regulation, appears after radiotherapy has been completed and can last for months or years; symptoms include fibrotic, ulcerating, and necrotic wounds. Chronic radiation dermatitis-associated fibrosis can cause lymphedema.4

Sparing healthy, nontarget tissues from irradiation to the greatest degree possible with shielding, positioning, radiation beam shaping, and intensity modulation is key to reducing the risk and severity of radiation dermatitis. Even so, most patients will develop the condition to some degree.

Management involves avoiding skin irritation.1 Patients undergoing radiotherapy should wear loose-fitting clothing and avoid sun exposure and cosmetic skin products.1,4 However, because of an immature and inconsistent evidence base for managing radiation dermatitis, treatment standards vary from facility to facility.1

Patients searching the Internet and social media platforms for advice on relief from radiation dermatitis encounter voluminous non-evidence-based advice, frequently describing aloe vera products’ claimed benefits. A recent Google search for “radiation dermatitis” and “aloe vera,” for example, yielded more than 40,000 websites, including several skin cream products marketed as treatments. A search of for “aloe” and “radiation” identified more than 500 products. Among researchers, however, the potential benefits of topical aloe vera has been controversial.5 

In an attempt to clarify ambiguities and identify evidence-based recommendations for the clinical management of radiation dermatitis, the International Society of Nurses in Cancer Care (ISNCC) convened an 18-member interdisciplinary expert panel early in 2020 to systematically review the published research literature.1 Panelists reviewed 36 high-quality, randomized, controlled clinical trials of experimental topical treatments of cancer radiation dermatitis published between 2012 and 2020.1 Their consensus recommendations were published in September 2021.1