Caring for your skin in vulval, groin and anal region (perineum) during pelvic radiotherapy

This patient leaflet contains information and advice to help you to look after yourself during and after radiotherapy treatment. You may find it helpful to share it with your family and/or carer’s family. If you have any questions or queries about your radiotherapy treatment or the information given to you please speak to a member of the radiotherapy team – contact details are available at the end of this leaflet.

Skin care

Skin reactions in the area of the perineum are common as the skin is very delicate. Each person’s skin reacts to radiotherapy in a different way. Radiotherapy sometimes can cause some reddening, soreness or irritation to the skin within the treatment area.

This irritation may be more noticeable in the groin, vulva, in the skin folds and between the buttocks. Sometimes the skin soreness is mild but in other cases the reaction is more severe. Where two skin surfaces are in contact you may have a more severe reaction.

Changes to the skin typically tend to occur part way through treatment, though it is not uncommon to see some changes earlier. For most people the skin changes peak one to three weeks after treatment then gradually settle down.

The sensitive area will be assessed on a regular basis during the course of your radiotherapy and you may be given further tailored advice to help you to look after your skin during and after your radiotherapy.

The following advice should help you to look after your skin during and after radiotherapy

It is advisable to start following these guidelines from the start of your radiotherapy treatment and continue until any changes to your skin subside.

• Avoid wearing tight, lacy underwear or clothing which rubs against the treatment area. Wear loose fitting cotton underwear
• Use soft toilet paper
• Wash daily in warm water with a mild, non-perfumed soap, such as Simple soap. Alternatively a soap substitute such as aqueous cream, or Diprobase can be used to help to keep the skin moisturised.
• Avoid rubbing the skin and gently pat dry with a soft, clean towel or use a hairdryer on a cool setting.
• Bathing and showering are both OK, but do not use bath oils, bubble bath or perfumed shower gel and avoid soaking in the bath for too long
• Avoid swimming, jacuzzis, hot tubs, sauna and steam rooms during treatment
• Avoid sun exposure within the treated area as your skin will be very sensitive. Sun beds are not recommended during or after radiotherapy.
• You will lose pubic hair in the area. Do not wax or use hair removal creams or shave in the treatment area as this can irritate the skin
• You can use some creams or lotions on treated skin (providing the skin is not broken) such as E45 or Diprobase. You can buy these creams over the counter without a prescription.Flamigel RT may be given to you by your treatment team. The aim of the cream is to provide an optimal moist healing environment. You should apply all over the area that is showing signs of redness / itching and / or dryness as a result of radiotherapy treatment.

Before using the recommended creams and / or lotions:

Ensure you are not allergic to any of the ingredients found in the product by checking the leaflet provided. Please complete a patch test on the back of your hand and ensure the product does not cause any reddening, burning, stinging or pain on application.

If the patch test does not cause any discomfort:

• Ensure the area is clean and dry and wash your hands before application.
• Apply a thin layer of the product three times daily to the affected area.
• Allow time for the cream to be absorbed into the skin before dressing.
• Do not use the creams on areas of the skin that have become moist and are beginning to weep (you will need an alternative cream for this areas)

If your skin becomes pink, itchy and sore or you notice any areas of broken skin please tell the staff who are looking after you. Your doctor / nurse / radiographer may advise you to use other creams and medications Hydrocortisone / Flamazine cream / Flaminal hydro / Flaminal forte can be applied twice daily sparingly, increasing the frequency of application if the skin becomes dry/sore. These will be dispensed by your clinical team, or we can advise your GP.

• Flamazine cream (which may leave a mark on your clothing) can be used on red areas and broken skin. You should store it in the fridge and discard after seven days.
• Hydrocortisone cream should only be applied to areas of the skin that are NOT broken. Storage of these products in the fridge may help to reduce inflammation / irritation.
• There is no specific minimum time for application prior to treatment, but the time period should be sufficient to allow the cream to be absorbed so as to avoid an excessive residual layer of cream on the skin during treatment. If there is excess of cream on the skin prior to treatment, it may be gently removed before the treatment session.
• Regular painkillers may be given if the skin is broken, ranging from paracetamol to morphine – your radiotherapy team will advise you on this.
• As much as possible allow air to get to the area being treated. For example, when you are at home remove your underwear and pads and direct a cold air fan at the area. A hairdryer on a cold setting can be used as an alternative.
• Walking around often makes the pain worse – lie on a bed whenever possible and direct a cold air fan to the area.
• If it is uncomfortable when you urinate, try different positions on the toilet or use a bowl of clean water to cleanse the area as you pass urine.

If your skin becomes very sore you may need a break in your treatment but your radiotherapy team will try to avoid this if possible.

After your radiotherapy course has finished

You may find that for a few weeks after your treatment has finished any reaction that you have had may get a little worse before it starts to get better. Changes to the skin often peak between one to three weeks after treatment has finished but this can vary person to person. The skin often takes a few weeks to settle. It is advisable to continue with your skincare and pain relief during this time. You can start to reintroduce your usual products once you feel your skin is settling down. If irritation occurs wait a few more days then try again.

Some skin within the treated area may become broken AFTER you have been treated with radiotherapy. Though this may be uncomfortable and unpleasant at the time, the broken skin should heal and the skin changes settle down. If you develop broken skin after completing your radiotherapy, it is advisable to see your GP and take this information with you. Please do contact us if you are concerned.

Please do not hesitate to get in contact (telephone number below) if you are unsure about any of the information given.

Lower GI Clinical Nurse Specialist Team 01223 348126 Mon - Fri – Please leave a message your nursing team will aim to respond within 48 hours as they are clinically (not office) based.

Contacts / further information

Cancer Information and Support Service

The Cancer Information and Support Services ‘The Pod’ is located in the Oncology department. This is a drop in service, so no appointment necessary.

The team offer support, advice and information to anyone affected by cancer. The service can provide practical and emotional support as well as help and advice with grant applications and referral and signposting to benefits advice.

The Maggie’s Wallace Cancer Support Centre

21 Milton House, Puddicombe Way, Cambridge. CB2 0AD

Maggie's website (opens in a new tab)

Information for GP / nurse

This information should be shared with your GP if you attend for an appointment

Please find below a brief summary for the management of moist desquamation in the vulva, groin and perineum following pelvic radiotherapy, in accordance with our departmental guidelines.

• E45 or diprobase can still be applied to areas of skin that are not broken.
• Flamazine cream should still be applied to areas of skin that ARE broken.
• Encourage the patient to allow air to get to the areas of skin that are broken / sore. For example when the patient is at home encourage them to allow air to circulate around the treatment area, by removing underpants / pads and directing a cold fan at the area.
• Flamigel RT can be used at the point of brisk erythema to help prevent moist desquamation. Some patients may be given this during their radiotherapy but can also be prescribed by the GP.
• Swab if there are signs of infection
• Suggest regular analgesia