USMLE Prep - Medical Reference Library

Radiation Dermatitis - Prevention and Skin Care

System: Radiation Oncology • Reviewed: Aug 31, 2025 • Step 1Step 2Step 3

Synopsis:

Advise gentle washing, moisturizers, and friction reduction; use topical steroids for erythema and manage moist desquamation with dressings and infection control.

Key Points

  • Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
  • Use system-specific risk tools to guide testing and disposition.
  • Order high-yield tests first; escalate imaging when indicated.
  • Start evidence-based initial therapy and reassess frequently.

Algorithm

  1. Primary survey and vitals; IV access and monitors.
  2. Focused history/physical; identify red flags and likely etiologies.
  3. Order system-appropriate labs and imaging (see Investigations).
  4. Initiate guideline-based empiric therapy (see Pharmacology).
  5. Reassess response; arrange consultation and definitive management.

Clinical Synopsis & Reasoning

For Radiation Dermatitis Prevention And Care, frame the differential by acuity and pathophysiology, then align diagnostics to the leading hypotheses. Prioritize stabilization while obtaining high‑yield studies such as CBC (Baseline hematology), BMP (Electrolytes/renal). Incorporate bedside imaging and targeted labs to define severity and identify complications; synthesize results with clinical trajectory to refine the working diagnosis and disposition needs.


Treatment Strategy & Disposition

Initiate disease‑directed therapy alongside supportive care, titrating to objective response. Pharmacologic options commonly include Analgesia/Antipyretics. Use validated frameworks (e.g., Do and Do Not) to guide escalation and site of care. Address precipitating factors, de‑escalate empiric therapies with data, and arrange follow‑up for monitoring and risk‑factor modification; admit patients with instability, high risk of deterioration, or needs for close monitoring.


Epidemiology / Risk Factors

  • Risk factors vary by condition and patient profile

Investigations

TestRole / RationaleTypical FindingsNotes
CBCBaseline hematologyAbnormal counts
BMPElectrolytes/renalDerangements

Do and Do Not

ActionComment
Use mild soap and pat dryYes
Avoid adhesive friction and tight garmentsYes
Apply unknown home remediesAvoid

Pharmacology

MedicationMechanismOnsetRole in TherapyLimitations
Topical corticosteroid (appropriate potency)Anti-inflammatoryDaysSymptomatic reliefSkin atrophy
Antihistamine (sedating at night)H1 antagonismHoursPruritus controlSedation

Prognosis / Complications

  • Prognosis depends on severity, comorbidities, and timeliness of care

Patient Education / Counseling

  • Explain red flags and when to seek emergent care.
  • Reinforce medication adherence and follow-up plan.

Notes

Document grading with a standard scale. Consider partial treatment breaks only when essential.


References

  1. MASCC skin toxicity guidelines — Link
  2. ASTRO patient care resources — Link