Skin changes during and after radiation therapy
Radiation therapy passes through the skin to reach its target, and the skin in the treatment area often reacts. Radiation skin injury wound care covers those reactions when they become open, weeping or slow to heal, whether that happens during treatment or long after it ends.
Reactions fall into two groups.
- Early reactions show up during the weeks of treatment or shortly after. Skin may turn red or darker, itch, then dry and peel. In some people, especially in folds such as under the breast, in the armpit or in the groin, the skin peels to a moist, raw surface.
- Late effects are less common and can appear months or years later. Treated skin may stay thinner, drier and firmer, with less blood supply. A scrape, a biopsy or surgery in that area may heal slowly, and occasionally the skin breaks down into an ulcer without a clear injury.
Gateway arranges care for this kind of wound across the region. See wound care in St. Louis for how visits at home and in facilities are set up.
Why treated skin heals differently
Healing depends on a good blood supply and on cells that can multiply quickly to rebuild tissue. Radiation affects both. Over time the small blood vessels in the treated area can narrow, and the tissue can become stiff and scarred.
That does not mean a wound in a radiated area cannot heal. It means the wound often needs closer watching and gentler handling. Nutrition, diabetes, smoking, chemotherapy and swelling in a nearby arm or leg add to the picture. When swelling is involved, see our page on lymphedema wounds.
The oncology team leads the plan
During active treatment, the radiation oncology team sets the rules for skin care in the treatment area. Products that are fine elsewhere may not be right there, so ask that team before putting any lotion, ointment or dressing on treated skin. The treating wound clinician works within their instructions and reports back to them.
After treatment, report any new sore, lump or area of breakdown in a previously radiated site to your oncology team as well as to the wound clinician. Wounds that come directly from a tumor are covered on our cancer-related wounds page.
What the treating clinician reviews
The treating clinician will usually want to know:
- Where and when radiation was given
- The size, depth and drainage of the open area
- Signs of infection, including yeast in skin folds
- Pain, itching and how the area tolerates dressings and tape
- Current cancer treatment and other medicines
From this, the clinician chooses dressings and writes orders. Treated skin tears easily, so how a dressing is held in place can matter as much as the dressing itself. Eating enough is hard during cancer treatment, and nutrition for healing is worth raising at the visit.
Questions to ask about protecting treated skin
Ask your oncology team or the treating clinician:
- How should I wash the area?
- Which clothing fabrics and fits reduce rubbing?
- Is it safe to shave, use deodorant, or apply heat or ice here?
- How should I protect this skin from the sun?
Our guide on keeping skin healthy around a wound has more questions to ask.
Changes to report and when to call 911
Tell the oncology team or the treating clinician promptly about:
- Skin that opens, blisters or weeps
- Spreading redness, warmth, swelling or pus
- Bleeding, or a new or stronger odor
- Pain that is increasing or not controlled
- Fever or chills (if you are also receiving chemotherapy, follow your oncology team’s fever instructions without delay)
Call 911 for heavy bleeding that will not stop with pressure, trouble breathing, chest pain, confusion or fainting. Gateway is not an emergency service.
How Gateway coordinates radiation skin injury wound care
Gateway arranges wound visits with partner clinicians across Greater St. Louis and the Metro East, in homes, assisted living, skilled nursing and other settings. Cancer treatment already fills the calendar, and wound care at home can cut down on extra trips.
We request treatment summaries from the oncology office, schedule visits, arrange the supplies the clinician orders, and send updates to the oncology team and your primary care clinician. The treating clinician makes all clinical decisions. When the goal of care is comfort, the plan can center on drainage, odor and pain through palliative wound care.
Call 314-325-0126 or request care with a name and phone number only. You do not need a referral. We will confirm whether visits are available where you live, and coverage depends on the treating provider, your plan and the care needed.
Common questions
Can a radiation wound appear years after treatment ended?
Yes. Late effects develop slowly as the blood supply and tissue in the treated area change. Skin that looked healed for years can break down after a minor injury or procedure, or for no obvious reason. Tell any clinician who treats a wound there that you had radiation, even if it was long ago.
Does a sore in a radiated area mean the cancer has come back?
A sore by itself does not mean that. Fragile, previously treated skin is a common explanation. Because a new sore, lump or non-healing area can sometimes be related to cancer, your oncology team may want to examine it and may order a biopsy or imaging. Report it to them instead of waiting to see whether it heals.
Can wound visits happen while I am still having radiation treatments?
Yes, when the oncology team and the treating clinician agree on the plan. The oncology team may have instructions about what can be on the skin during a treatment session, so dressing changes are often timed around your appointments. Tell us your treatment schedule when you call.
Is hyperbaric oxygen used for radiation wounds?
Hyperbaric oxygen therapy means breathing oxygen inside a pressurized chamber at a specialized center. Physicians sometimes consider it for certain late radiation injuries. Whether it is appropriate depends on the wound, your health and your physicians’ judgment. If your clinicians recommend a referral, Gateway can help coordinate records and scheduling.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.