Journal of Community Nursing - page 18

SKIN CARE
basal layer is unable to recover,
resulting in exposed dermis and
leakage of serous fluid (moist
desquamation).
The treatment field now starts
to appear blistered, moist and
increasingly oedematous, often
accompanied by light or heavy
exudate — moist desquamation can
be partial or confluent (
Figure 3
).
The area can feel extremely tender,
sensitive and painful. The exudate is
normal and rich in nutrients, helping
to provide a moist wound healing
environment that supports the growth
and migration of new skin cells across
the area of the skin reaction.
Additionally, exudate bathes
exposed nerve endings within
the area of moist desquamation,
decreasing discomfort and
providing pain relief. Cleansing of
the skin reaction to remove exudate
is, therefore, not advised. Skin
necrosis is rarely seen, primarily
due to the advanced techniques
used in the delivery of radiotherapy.
Post treatment
The severity of skin reactions
may increase for 7–10 days after
radiotherapy has finished, in
line with the time it takes for the
damaged basal cells to reach the
outer epidermis. This is often
referred to as the ‘peak’ period,
when the side-effects can be at
their worse.
After this, side-effects will
gradually start to settle down and
the condition of the skin will slowly
T
his article highlights the
myth that radiation burns
are an adverse effect of
treatment. The acute reaction of
the skin to radiotherapy is well
explained as being a normal
response of damaged cells. The
author outlines how important
communication is in relation to
the patient’s role in maintaining
skin integrity and promoting
quick healing. Awareness of good
skin care regimens using soap-
free cleansers and emollients is
vital when managing patients
undergoing such traumatic
treatment programmes.
The use of assessment tools and
pathways can help considerably
when choosing treatments,
and the author has helpfully
highlighted recent research,
as well as the fact that more is
needed in this area to support
clinical practice.
Figure 2.
Examples of skin demonstrating dry desquamation.
Figure 3.
Examples of moist desquamation.
Expert commentary
Sara Burr, Community Dermatology Specialist Nurse, Community,
Nursing and Therapy, Norfolk Community Health and Care
NHS Trust
improve. Between two and three
weeks post completion, following
the ‘peak’ reaction, the basal layer
will be recovering as the balance
is restored between new cell
production and cell loss. At 4–6
weeks following the completion
of radiotherapy, the skin should
be healing well and may even be
fully healed in a large number
of patients, although it may still
appear hyperpigmented.
Assessment and
management
Assessment of the skin forms an
integral part of the patient’s holistic
care and starts with asking the right
questions — what, why and how?
18 JCN
2013,Vol 27, No 4
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