Skin Reactions to Radiation

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While you're undergoing radiation treatment, the first thing you'll likely notice will be a change in the color of your skin, from pink to red. If you're African American or have a dark brown or black skin tone, the redness can be harder to see but you may still have other symptoms, such as soreness or dry skin.   

Some areas of your skin may react more than others:

  • The skin in the upper inner corner of your breast can get more red and/or irritated than other areas because:
    • The angle of the radiation beam is parallel to the skin there, so the radiation skims across the skin (not just through it, as it does in other areas where the radiation beam is perpendicular to the skin).
    • This area usually has received significant sun exposure over the years, so it takes longer to heal from additional damage.
  • The skin within your armpit also tends to get more red and/or irritated than other areas because:
    • The arm rubs back and forth against the radiated skin, which is already irritated by sweat and hair.
  • The skin along the fold under your breast gets more red and/or irritated than other areas because:
    • Most bras rub this area.
    • The radiation beam skims across the skin in this region, too.
    • The skin of the fold rubs against itself.

Your skin reaction may be mild and limited just to these areas, or your skin might have a more dramatic reaction to radiation, covering more of the breast area. This is more likely to occur if:

  • Your complexion is fair and you're susceptible to sunburn.
  • You have large breasts.
  • You are receiving radiation after mastectomy, and the treatment is designed to give a high dose to the skin.
  • You've had recent chemotherapy.

As with a sunburn, the skin also may be dry, sore, and more sensitive to touch. Irritation may increase. The skin can sometimes start to peel in a dry way, like an old sunburn, or in a wet way, like a blister. If peeling happens, it tends to be toward the last third of your treatments or later. This peeling will probably be limited to a few areas of the involved skin. If the blister opens, the exposed raw area can be quite painful and weepy. Your skin reaction can become more serious if the exposed area is not treated and infection develops. Your radiation oncologist can work with you to help you manage any of these signs or symptoms. If problems become especially troublesome, your doctor or nurse might suggest taking a short break in treatment to allow your skin to recover.

These skin changes happen gradually and can be predicted in your weekly exams by your radiation oncologist and nurse. You should be aware of the range of possible skin reactions so that you're not surprised by them. Fortunately, skin irritation caused by radiation is temporary. And your doctor and nurse can give you salves, medications, and prescriptions to ease any discomfort. If you find that the pain and irritation are not getting better, talk to your doctor.

After radiation treatment ends

After you finish radiation therapy, the effects on your skin may continue to get worse for another week or so and then your skin will start to get better.

If you have peeling skin and/or wet blisters, the skin may have slowly started to grow back while you were getting treated. Now that you’ve completed treatments, pearly-pink colored patches of new skin will grow back much faster in the affected areas. The new skin is very delicate as it grows. You might still have a blister or the overlying old, dry, flaky skin covering the new skin. Don't pick at the blister or the old skin. They're protecting the new skin underneath. If you experience problems or have questions as the new skin is growing, call your radiation oncologist or nurse.

The deep redness and the sensitivity should start to go away during the first weeks after treatment. Your skin will take a bit longer to return completely to its natural color. You may find that the treated area has a tanned or slightly pinkish look to it for up to 6 months after your last session of radiation. If you have a very dark skin tone, by the end of treatment your skin can become very dark, and it may take 3 to 6 months (and sometimes a bit longer) for changes to go away.

Some people may continue to have a slightly pinkish or tan hue to their skin for years after treatment. And a few people may notice a small patch of tiny blood vessels on the skin of the radiated breast area. These vessels — called telangiectasias — look like a tangle of thin red lines. Telangiectasias are NOT a sign of cancer recurrence. They usually don't go away on their own.

If you are a smoker, stopping smoking may help your skin recover more quickly. Sometimes high oxygen therapy (also called hyperbaric oxygen) will help. If you want to get rid of the telangiectasias, laser therapy may help. Talk to a dermatologist (skin doctor) who is experienced using lasers to remove birthmarks and other skin pigmentations.

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