EXTRINSIC FACTORS

• Radiotherapy dose, fractionation, site and modality
• Bolus
• Radiosensitizers eg Cisplatin, 5-Flurouracil

CHEMICAL, THERMAL, MECHANICAL IRRITANTS

• Perfume, aftershave
• Extremes of temperature
• Friction from tight clothing

Untitled Slide

2010/11

• Extensive lit review over 300 articles from 1980-2010
• Included two systematic reviews of the literature ( Bolderston, Kedge )
• Audit of clinical practice 54 responders response 81%

CONTRAINDICATED PRODUCTS 2011

• Topical antibiotics
• Topical steroids
• Gentian violet

THINGS TO THINK ABOUT

• Extent of reaction is genetically predisposed
• Intrinsic and extrinsic factors also impact
• Comparing data accross studies is difficult
• Some control arms using products that may exhaserbate reactions
• How much skin care advise is based on research evidence?

LOOKING TO THE FUTURE

• New high quality trials
• Research on new products before they are introduced without evidence
• Designs need to allow for assessor blinding
• Comparators should be best evidenced practice or no intervention.
• Auditing of current skin reactions as normal practice

LOOKING TO THE FUTURE

• Investigation of wet vs dry shaving
• Evaluation of treatment aftercare to assess consistency
• Patient preferences and compliance with skin care regimens

BACKGROUND

• Turesson-number of basal cells in the epidermis declines during RT
• Caused by increased cell cycle and reduced mitosis
• This causes thining of the epidermis and
• An inflammatory reaction
• Variation in reaction appears to be genetic predisopsition

THINGS TO THINK ABOUT

• Extent of reaction is genetically predisposed
• Intrinsic and extrinsic factors also impact
• Comparing data accross studies is difficult
• Some control arms using products that may exhaserbate reactions
• How much skin care advise is based on research evidence?

THINGS TO THINK ABOUT

• Variation in ingedients of products with same name
• Cost of the products where scientific basis is suspect
• Assessment tools across studies vary
• Patients' skin care regimen beyond the intervention
• Patient compliance

AREAS OF CONSENSUS

• Aqueous cream not to be used as a leave on moisturiser
• Deodorant can be used-non-aluminium (Wong, Watson)

INTRINSIC FACTORS

• Age
• Nutrition
• Smoking/alcohol use
• Co-morbidities
• Previous damage

INTRINSIC FACTORS

• Obesity
• Trauma
• Infection
• UV-exposure