Skincare advice following radiotherapy (breast)

Patient name:
Date of birth (DoB):
Hospital number:
NHS number:

The purpose of this leaflet is to provide some additional information (also see Advice following radiotherapy – breast, document ID 100736) for you and your GP that may help to manage early skin changes that occur during and in the weeks after you have finished radiotherapy treatment.

Section 1: Information for GP

Your patient (named above) is completing a course of radiotherapy treatment for breast cancer and currently requires the following skincare products (tick as appropriate):

☐ Epimax cream
☐ Flamigel RT
☐ 1% Hydrocortisone cream
☐ 1% Flamazine cream
☐ Flaminal Hydro
☐ Flaminal Forte
☐ Activheal hydrogel dressing
☐ Atrauman (or similar) dressings and non adhesive absorbent dressings
☐ Tegaderm or Activheal non-adhesive foam dressings

I would be grateful if you can prescribe a further supply on request from the patient as required.

As the side effects peak after radiotherapy treatment has completed, it is possible that your patient may require additional skin care products that have not been specified above. Please refer to section 2 below for information on suggested interventions, or contact the advanced practitioner in breast radiotherapy for more information.

Contact details

For further information, please contact:

Advanced Practice Radiographer in Breast Radiotherapy
Radiotherapy Department, Box 193, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ
(01223) 256710 (answerphone)
Email Poppy Howe (Advanced Practice Radiographer)

Many thanks,

Print name:
Signature:
Designation:
Date:

(To be signed by oncologist or advanced practice radiographer.)

Section 2: Skin changes and suggested interventions - information for the patient

Changes to your skin peak approximately two weeks after treatment and take several weeks to settle down. Further information is available in the Advice following radiotherapy - breast leaflet. Please find below some advice that may help you to look after your skin following radiotherapy:

• Red/ red-brown/ darker areas of skin – moisturise with your own choice of moisturiser/ Epimax cream
• Moisturising skin two to three times daily is usually adequate. You may like to store your cream in the fridge.
• If skin begins to look red and shiny – stop moisturiser on these areas. (If this occurs it is most likely to be under the breast or in the armpit, along your bra line or above the collar bone if these areas are within the treated area.)
• Wear your bra if that is how you are most comfortable. A cotton handkerchief between your bra and skin may help minimise friction, particularly when your skin is sore. Avoid fastening your bra tightly; a bra extension is often useful and avoid underwired bras.
• If the skin is pink/ red/ darker or there is dry desquamation (skin may look like its peeling/ flaking):

☐ Flamigel RT may be used three times daily (it should not be used on blistered/ broken or moist areas)

• If your skin is itchy use (tick as appropriate):

☐ Epimax cream two to three times daily

☐ 1% hydrocortisone cream may be used one to two times daily sparingly. It may be advisable to check with your GP or radiotherapy team before using. (Do not use hydrocortisone cream on broken skin.)

• Your nipple and areola (area around the nipple) may become darker/ flaky and very occasionally moist/ crusts.
• If your skin breaks it may look moist, red and shiny, like the appearance of a burst blister. It has been advised that you use (tick as appropriate):

☐ 1% Flamazine cream two times daily sparingly (this cream may mark your clothing but will usually wash out). It can be used on red areas and broken skin. Store in the fridge and discard tube after seven days.

☐ Flaminal Hydro/ Flaminal Forte can be used on broken skin that looks red and moist. It may have a cooling effect which may sooth pain. It hydrates dry wounds and absorbs excess exudate (discharge) from wet wounds. It builds a semi-permeable film on the wound. Applied directly to the wound. It can be used with or without a non-adhesive dressing. It can remain on a wound for one to three days, as long as the gel remains unaltered. If required reapply. Store at room temperature.

☐ Activheal gel can be used to cool the surface of broken skin and may help alleviate pain. The product can be refrigerated to increase this effect. The gel may need to be covered with a dressing, depending on the site of the wound/ broken skin. Do not use if infection is suspected. Activheal gel can be applied one or two times daily as required

☐ Dressings (often useful for under the breast):

• Atrauman dressings (or similar). Cover with non-adhesive absorbent secondary dressing.
• Tegaderm or ActivHeal non-adhesive foam dressing (or similar)
• Hold in place with your bra or netting/ tubifast. Avoid using tape within the treated area to secure dressings. Netting/ tubifast – cut the gusset in a pair of netting pants and wear like a 'boob tube'. Cut additional arm holes if you wish to make into a vest to hold dressings in place. (Dressings can be used alone or with 1% Flamazine cream, Flaminal Hydro/Forte or Activheal hydrogel.)
• Alternatively – Allevyn Lite dressings can be used which have a silicone adhesive and can be helpful to mould and keep in place within the inframammary fold (underneath the breast). Please try to avoid the adhesive element on any areas of broken skin. Atrauman dressings (or similar). Cover with non-adhesive absorbent secondary dressing.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one-to-one care is required.