# Skin during and after radiotherapy: dressings, steroids and what lasts

Source: https://onco.cc/technologies/radiation-skin-recovery/  
OnCo record `radiation-skin-recovery` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Skin reactions in the treated area peak around the end of radiotherapy and heal. A thin silicone film applied from the first day cut moderate or severe reactions from 45.6 to 15.5 per cent in a randomised trial in breast cancer, and an international guideline recommends it. Permanent changes, such as fine broken veins and firmness, come later and do not reverse.

## Summary

The 2023 Multinational Association of Supportive Care in Cancer guideline used a four-round process with 42 international experts and recommended six interventions for prevention: "photobiomodulation therapy and Mepitel film in people with breast cancer, Hydrofilm, mometasone, betamethasone, and olive oil", with "Mepilex Lite dressings" recommended for management. It also says plainly that "most interventions were not recommended due to insufficient evidence, conflicting evidence, or lack of consensus to support use", which is worth knowing before buying a cream.

The strongest single trial is of the silicone film. In 376 patients with larger breasts after lumpectomy or mastectomy, grade 2 or 3 dermatitis occurred in 15.5 per cent with Mepitel Film against 45.6 per cent with standard care, grade 3 in 2.8 against 13.6 per cent, and moist desquamation in 8.0 against 19.2 per cent. Three patients removed the film early because of rash or itching.

Photobiomodulation is where the evidence splits, and the split matters in the United Kingdom. The placebo-controlled TRANSDERMIS trial of 120 patients found grade 2 or worse reactions in 6.7 per cent of the laser group against 30 per cent of the placebo group at the end of treatment. The later LABRA trial, in patients receiving the shorter hypofractionated schedule that is now standard in the National Health Service, found 10 per cent against 28 per cent, an 18-point reduction that did not reach significance, and its authors concluded that photobiomodulation "seems not able to reduce the incidence of severe ARD in breast cancer patients undergoing HF-WBI". A 2026 guidance statement reaffirms silicone film and hydrofilm, and a separate statement recommends medium-potency topical corticosteroids such as mometasone furoate 0.1 per cent cream for prevention in selected high-risk patients and for early reactions without moist desquamation.

What comes back, and when: the acute reaction recovers almost always, over two to six weeks after the last fraction, and skin colour changes fade over months. Late changes are a different thing: telangiectasia, firmness from fibrosis, loss of sweat glands and hair in the field, and altered sensation appear months to years later and are permanent. Hyperbaric oxygen is the treatment with Cochrane-level evidence for late radiation injury at specific sites, and it has its own record.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-10-02
- Tags: rejuvenation; survivorship; evidence:strong
- Principle: Radiation kills dividing basal keratinocytes, so the skin surface fails roughly two to three weeks into treatment, when the normal turnover cycle would have replaced them. A film or dressing reduces friction and preserves the moist healing environment, which is why a physical barrier outperforms most creams. Late injury is vascular and fibrotic rather than epithelial, which is why it appears later and does not resolve.
- Strengths: A randomised trial with a large effect for a cheap physical barrier; An international guideline naming exactly what is and is not recommended; Acute reactions heal in almost everyone
- Limitations: The photobiomodulation evidence is positive in conventional and negative in hypofractionated schedules; No individual randomised trial numbers verified for topical steroids, only guideline statements; Late fibrosis and telangiectasia do not reverse

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Radiation_dermatitis
- MASCC clinical practice guidelines for the prevention and management of acute radiation dermatitis (Lancet Oncol 2023): https://doi.org/10.1016/S1470-2045(23)00067-0
- Mepitel Film for the prevention of acute radiation dermatitis in breast cancer: randomised phase 3 trial (JCO 2023): https://doi.org/10.1200/JCO.22.01873
- TRANSDERMIS: photobiomodulation to prevent acute radiodermatitis, randomised placebo-controlled trial (Lasers Surg Med 2018): https://doi.org/10.1002/lsm.22804
- LABRA: photobiomodulation during hypofractionated whole-breast irradiation (Lasers Surg Med 2022): https://doi.org/10.1002/lsm.23475
- MASCC clinical practice statement: topical corticosteroids for acute radiation dermatitis (Support Care Cancer 2026): https://doi.org/10.1007/s00520-026-10659-1

## Connected records

- cancers: [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Skin cancer (all types)](https://onco.cc/cancers/skin-cancer/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/), [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Hyperbaric oxygen for late radiation injury](https://onco.cc/technologies/hyperbaric-oxygen-radiation-injury/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Photobiomodulation (low-level laser) for oral mucositis](https://onco.cc/technologies/photobiomodulation-mucositis/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/)
- institutions: [Multinational Association of Supportive Care in Cancer](https://onco.cc/institutions/mascc/)
- terms: [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/)
- bottlenecks: [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)

---
JSON: https://onco.cc/api/v1/entities/radiation-skin-recovery.json