Loading
Radiotherapy often makes the treated skin pink or darker, dry, itchy and sore, and sometimes it peels. Wash the area gently with water and mild soap, use your usual moisturiser and keep using deodorant unless it stings. If your risk is high, as with breast or head and neck treatment, your team may suggest a thin film dressing or a steroid cream from the start. Report blisters or pain.
Prevention. The MASCC 2023 Delphi guideline (42 experts, interventions reaching 75% consensus) recommends six interventions for prevention: photobiomodulation and Mepitel film in breast cancer, Hydrofilm, mometasone, betamethasone and olive oil; most others were not recommended for lack or conflict of evidence. Its systematic review found that washing with water and soap and deodorant use do not worsen dermatitis but did not find enough evidence to recommend them for prevention. Two 2023 meta-analyses go further: washing with or without soap reduced severe dermatitis (OR 0.32) and moist desquamation (OR 0.25), and deodorant made no difference, so the evidence does not support advising against it. The Canadian breast Delphi (2025) reached consensus for education, moisturising and washing for every patient, and Mepitel film and mometasone for high-risk patients. MASCC clinical practice statements since then recommend Mepitel film or Hydrofilm prophylaxis in breast and selected head and neck cancers (2025), medium-potency topical steroid such as mometasone furoate 0.1% for high-risk head and neck and breast patients (2026), and barrier-forming agents, StrataXRT having the most evidence, where the contour is irregular (2026). The ONS guideline (2020, GRADE) made a conditional recommendation for deodorant and suggested against emu oil, calendula and non-steroidal agents.
Management. MASCC 2023 recommends Mepilex Lite dressings for established dermatitis; the 2026 steroid statement allows topical steroid for early dermatitis without moist desquamation and asks for weekly skin review, stopping the steroid if moist desquamation appears. Most of this rests on abstracts; the full MASCC 2023 text and the UK Society of Radiographers guideline could not be read.
Why: Knowing what to expect helps people look after their skin and report changes early; some treatments, like film dressings, only help if started at the beginning.
“After the four rounds, consensus for recommendation was reached for 3 prevention interventions in both low- and high-risk patients: prevention care education, moisturizing, and washing.”
International Journal of Radiation Oncology, Biology, Physics 2025 · Delphi consensus (19 Canadian experts, breast cancer)
Why: Pooled trials found washing led to fewer severe skin reactions and less peeling, and people feel better for it.
“Given the QoL benefits of washing, it should be advocated as part of routine skin care during RT.”
Supportive Care in Cancer (Chan et al.) 2023 · Systematic review and meta-analysis of randomised trials
Why: Trials found deodorant did not make skin reactions, itching or pain worse.
“As such, the current evidence does not support recommendation against antiperspirant/deodorant use during RT.”
Supportive Care in Cancer (Salvestrini et al.) 2023 · Meta-analysis of five randomised trials
Why: A thin film protects the skin from friction and has reduced the severity of reactions, especially peeling, in several trials.
“Prophylactic use of Mepitel Film and Hydrofilm is recommended for reducing the severity of ARD in breast cancer and selected head and neck cancer patients.”
MASCC (Supportive Care in Cancer) 2025 · MASCC clinical practice statement (expert consensus on a literature review)
Why: A steroid cream calms the inflammation that causes redness and itching, and several trials found fewer and milder reactions with it.
“TCs are recommended for the prevention of ARD in selected patients with head and neck and breast cancers at a high risk of ARD.”
MASCC (Supportive Care in Cancer) 2026 · MASCC clinical practice statement (expert consensus on a literature review)
Why: A gel that dries into a film can cover curved or folded skin where a dressing will not stay on.
“Barrier-forming topical agents are recommended for patients undergoing radiotherapy who are at considerable risk of developing high‑grade ARD, particularly in treatment sites with irregular anatomical contours, such as head and neck cancers.”
MASCC (Supportive Care in Cancer) 2026 · MASCC clinical practice statement (expert consensus on a literature review)
Why: Reactions build up over the course and often peak after it ends; once the skin is broken a steroid cream is no longer the right treatment.
“Healthcare professionals should monitor patients' skin weekly during radiation and guide steroid use, discontinuing it if moist desquamation or other complications arise.”
MASCC (Supportive Care in Cancer) 2026 · MASCC clinical practice statement (expert consensus on a literature review)
Why: A soft dressing protects broken skin, eases pain and lets it heal without sticking to the wound.
“Mepilex Lite dressings were recommended for the management of acute radiation dermatitis.”
MASCC (Lancet Oncology; Behroozian et al.) 2023 · Delphi consensus (at least 75% of 42 experts)
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
For everyone: education before treatment, gentle washing with water with or without mild soap, a moisturiser the patient likes, and their usual deodorant (Chan 2023 and Salvestrini 2023 meta-analyses; Canadian Delphi 2025; ONS 2020 conditional for deodorant). For high-risk patients, prophylaxis chosen by site: Mepitel film or Hydrofilm in breast cancer (MASCC 2023, 2025), medium-potency topical steroid such as mometasone furoate 0.1% in breast or head and neck cancer (MASCC 2023, 2026), photobiomodulation in breast cancer where available (MASCC 2023), or a barrier-forming agent on irregular contours (MASCC 2026). Weekly skin review; Mepilex Lite for established dermatitis (MASCC 2023). Where the sources differ: the MASCC 2023 systematic review found that washing and deodorant do not worsen dermatitis but judged the evidence insufficient to recommend them for prevention, while the 2023 washing meta-analysis found a reduction in severe dermatitis and recommends washing as routine care; the Canadian panel recommended washing for all. None of the sources read advises against washing or deodorant.
MASCC (Lancet Oncology; Behroozian et al.) 2023 · MASCC (EClinicalMedicine) 2023 · MASCC (Supportive Care in Cancer) 2025 · MASCC (Supportive Care in Cancer) 2026 · MASCC (Supportive Care in Cancer) 2026 · Supportive Care in Cancer (Chan et al.) 2023 · Supportive Care in Cancer (Salvestrini et al.) 2023 · International Journal of Radiation Oncology, Biology, Physics 2025 · Oncology Nursing Society (Oncology Nursing Forum) 2020
Where it differs: Older patient information told people to keep the treated skin dry, avoid soap and stop deodorant for the whole course.
Evidence: Not supported by any source read: washing reduced severe dermatitis in pooled trials (OR 0.32, 95% CI 0.19 to 0.55), and deodorant did not change grade 1 or worse, grade 2 or worse, or grade 3 dermatitis in five trials. How many departments still give this advice was not measured by any source read.
Supportive Care in Cancer (Chan et al.) 2023 · Supportive Care in Cancer (Salvestrini et al.) 2023 · MASCC (EClinicalMedicine) 2023
Where it differs: Some departments prescribe a steroid cream such as mometasone from the first day for all patients.
Evidence: MASCC 2023 recommends mometasone and betamethasone for prevention without restricting them to high-risk patients in its abstract; the 2026 MASCC statement and the Canadian panel recommend them for high-risk patients. The systematic review found mometasone effective across eight randomised trials of mixed quality.
MASCC (Lancet Oncology; Behroozian et al.) 2023 · MASCC (Supportive Care in Cancer) 2026 · International Journal of Radiation Oncology, Biology, Physics 2025 · MASCC (EClinicalMedicine) 2023
Where it differs: Low-level red or near-infrared light is applied to the treated skin from the start of treatment.
Evidence: Recommended by MASCC 2023 for prevention in breast cancer. Needs a device and staff time; one trial in 46 head and neck patients found grade 2 to 3 dermatitis in 28.6% with it against 77.8% without (reported in the MASCC systematic review).
MASCC (Lancet Oncology; Behroozian et al.) 2023 · MASCC (EClinicalMedicine) 2023
Where it differs: Many departments and patients use aloe vera, calendula, emu oil or other non-steroidal creams to prevent reactions.
Evidence: ONS 2020 suggested against emu oil, calendula and non-steroidal interventions and recommended aloe vera only within a trial; the MASCC 2023 systematic review found most such interventions unsupported, and MASCC 2023 recommended olive oil as the only one of these to reach consensus.
Oncology Nursing Society (Oncology Nursing Forum) 2020 · MASCC (Lancet Oncology; Behroozian et al.) 2023 · MASCC (EClinicalMedicine) 2023
Old advice told people not to wash the treated area or use deodorant during radiotherapy. Pooled randomised trials found that washing, with or without soap, reduced severe skin reactions, and that deodorant made no difference to them, so neither ban is supported.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Prevention: photobiomodulation and Mepitel film in breast cancer, Hydrofilm, mometasone, betamethasone and olive oil “Six interventions could be recommended for the prevention of acute radiation dermatitis: photobiomodulation therapy and Mepitel film in people with breast cancer, Hydrofilm, mometasone, betamethasone, and olive oil.” | Delphi consensus (at least 75% of 42 experts) | MASCC (Lancet Oncology; Behroozian et al.) 2023 |
| Most interventions were not recommended “Most interventions were not recommended due to insufficient evidence, conflicting evidence, or lack of consensus to support use, suggesting a need for further research.” | Delphi consensus | MASCC (Lancet Oncology; Behroozian et al.) 2023 |
| Washing and deodorant do not worsen dermatitis but are not proven to prevent it “Based on evidence from multiple RCTs, aluminum/deodorant use and washing with water and soap do not worsen ARD, but there is insufficient evidence to support their use in the prevention of ARD.” | Systematic review (149 randomised trials among 235 studies) | MASCC (EClinicalMedicine) 2023 |
| Washing with or without soap reduces severe dermatitis and moist desquamation “Washing with or without soap significantly reduced the incidence of severe RD (OR: 0.32, 95% CI: 0.19-0.55, p < 0.01) and moist desquamation (OR: 0.25, 95% CI: 0.12-0.52, p < 0.01).” | Meta-analysis of two randomised trials | Supportive Care in Cancer (Chan et al.) 2023 |
| Medium-potency steroid preferred “Medium potency TCs, such as mometasone furoate 0.1% cream, are preferred.” | MASCC clinical practice statement | MASCC (Supportive Care in Cancer) 2026 |
| Among barrier-forming agents, StrataXRT has the most evidence “Among these agents, StrataXRT currently has the most robust supporting evidence.” | MASCC clinical practice statement | MASCC (Supportive Care in Cancer) 2026 |
| Conditional recommendation for deodorant; aloe vera and oral curcumin only within a trial; against emu oil, calendula and non-steroidal interventions “The panel agreed on eight recommendations and made a conditional recommendation for deodorant/antiperspirant.” | GRADE (ONS); the individual grades are in the full text, not read | Oncology Nursing Society (Oncology Nursing Forum) 2020 |
Shares Radiation dermatitis (skin reaction), Breast cancer (all types).
Shares Tell people having radiotherapy that they can wash the treated skin and use deodorant, Breast radiotherapy positioning, immobilisation and daily set-up verification, Breast cancer (all types).
Shares Breast radiotherapy positioning, immobilisation and daily set-up verification, Radiotherapy, Breast cancer (all types).
Shares Breast radiotherapy positioning, immobilisation and daily set-up verification, Radiotherapy, Head and neck squamous cell carcinoma, Breast cancer (all types).
Shares Photobiomodulation (low-level laser) for oral mucositis, Head and neck squamous cell carcinoma.
Shares Photobiomodulation (low-level laser) for oral mucositis, Head and neck squamous cell carcinoma.
Shares Photobiomodulation (low-level laser) for oral mucositis, Head and neck squamous cell carcinoma.