Skin peeling after radiation

[greenbear]

I had neoadjuvent chemotherapy with taxol and herceptin followed by surgery ( central quadrant excision and reconstruction with latismal dorsi flap) . I had a pCR. I then had adJuvent FEC chemo and am now on 17 dose Herceptin and have taken the first loading dose. I have had 25 doses of radiation and three booster doses. Since yesterday I noticed skin peeling in a small area below the areola and a sticky liquid oozing. My radiation oncologist has prescribed 1% gentian violet application to the affected area. Otherwise talcum powder only has been permitted for the rest of the breast. This area is not in the field of booster radiation. Is this normal and is the medication sufficient? How long would it take to heal? I am now wearing very loose clothing. I have to get back to work by 1st Jan. Will I be able to wear normal clothes by then?

[greenbear]

Incidentally I am having 3DCRT radiation and have completed 3 out of 6 booster radiations. Any suggestions Dr. Rohit. Shall be grateful for a response from you.

[kontak TeamBCI in reply to greenbear]

Hi greenbear - my sister also had faced the problem of skin peeling - she was also prescribed the violet lotion - it will take atleast a couple of days - 10 to 15 days - she was also applying plain coconut oil - see if you can also use it. It will have a soothing effect on the skin

[greenbear in reply to kontak]

Thanks kontak for your reply. I will ask my doctor about the coconut oil. Did your sister apply it while the radiation was going on or after it was over.

[manish_vkg TeamBCI in reply to greenbear]

Greenbear, skin peeling and burning sensation is common side effect of radiation, usually everyone face the same issue and recovery depends on skin type...generally it will take 15-20 days after radiation to rid off from peeling issue...if u dont feel comfortable with voilet lotion then u can use bactigrass strips..

[greenbear in reply to manish_vkg]

shall check out bactigrass strips. can it be used while radiation is going on. thanks for this info.

[manish_vkg TeamBCI in reply to greenbear]

As i know it can be used during radiation and my wife used to use the same...dr. Rohit already explained everything very well so i think now u can easily decide, what to use...

[greenbear in reply to manish_vkg]

ofcourse I shall be following dr rohit"s advice. thats the reason I posted this on this forum. But I think bactigrass strips may help when i get back to work as i will have to wear normal clothes and this may help avoid friction. so thanks

[kontak TeamBCI]

After the radiation is over then only can apply

[roxboxfox RadiationOncologist]

When we were at Tata Hospital in 2000, we used to advocate and recommend Gentian Violet Paint as it was quite cheap and did what our bosses and seniors advocated.

I moved to UK in 2005, and my perception changed by the practices prevalent in UK, which is evidence based. My bosses there had different views, .......

Despite its use in practice and as a control in past trials, gentian violet is no longer recommended by the Department of Health in the United Kingdom because of its carcinogenic potential in animals (Kedge, 2009). The tissue-damaging potency of crystal violet dyes was demonstrated in experimental models of rats and rabbits. In addition, the tissue-irritating effect of gentian violet also has created controversy regarding its use on radiation-induced moist wounds. In vitro, crystal violet was cytotoxic at low concentrations to HeLa cells and fibroblasts. For those reasons, gentian violet is not recommended for practice.

Reference: medscape.com/viewarticle/75...

What i generally recommend in my current clinical practice is based on the Supportive Care Guidelines Group.

medscape.com/viewarticle/75...

The safest options would be :

1. Calendula Cream

2. Mometasone Furoate (Available as Lotion / Cream / Gel) under various brand names like Wincort, Topcort, Momate, Dermanex, Cortimom, Gecort, etc

The latter is a Medium potent steroid cream and should be used under supervison of a qualified doctor only, and should not be used long term.

The evidence for the latter comes from a recent clinical trial published few months back

redjournal.org/article/S036...

Let me assure you that this moist desquamation will heal over the next few weeks and you should be alright up and ready for your job next year.

Hang on there, you are already doing sensible things, loose clothing, wash area - Johnson baby soap or herbal soap like medimix or Khadi soap are pretty gentle & safe , pat dry with clean towel, maintain good hygiene, etc.

Congrats that you are finishing your Radiation before X mas, and hopefully you ll be having a toast this Xmas and New year.

All the best

Dr Rohit Malde MD, DNB, FRCR (UK)

Consultant Clinical & Radiation Oncologist

BNH HCG Cancer Centre- Dr Balabhai Nanavati Hospital

Vile Parle, Mumbai (W)

[greenbear in reply to roxboxfox]

Thanks so much for the calendula cream suggestion.

My radiation dermatitis has totally cleared up within 7 days.

[greenbear]

Thanks Dr. Rohit. You are a warehouse of information. Strange how opinions differ. My radiation oncologist

has asked me not to wash the area with soap while radiation is going on. In fact they have marked the area with sketch pen and get quite flustered when the markings are erased when I wash the area with water and dry with towel. Mometasone fureate cream does not suit me. It was recommended by a doctor for rashes on my face. I don't know if it was because it was used on facial skin. Shall try calendula cream.

If gentian violet is detrimental, how is that radiation oncologists attached to corporate hospitals are not aware of this? Its depressing. Thankfully you are there on this forum.

Thanks for your guidance and good wishes.

[PK53]

Hi Greenbear

I finished my radiation yesterday. I had 21 cycles and last 5 cycles are booster. I was using Aveeno fragrant free moisturizer all along. So my Radiation Oncologist asked me to continue the same. After the first week when discolouration and irritation started she asked me to do saline soak ( 4 cups of water boiled with two tablespoon salt) for irritation healing and for skin she prescribed Proshield Plus which is a Dimethicone Ointment. I was told not to apply this two hours before the treatment means I can apply any other time . So I did saline soak two or three times a day and applied pro shield to keep my skin intact. After the booster the area around my breast got imflammated so I have some sort of pain and discomfort however my skin stayed intact.

My naturopathy oncologist prescribed Calendula Salve (note it is not cream rather Salve). However it has olive oil as one of the ingredient So my radiation oncologist suggested I can use this after my radiation is over. Calendula salve is very good for skin irritation and inflammation. Now I going to continue to apply saline soak for a week and apply Proshield and then switch to Calendula I believe it is going to heal me faster as it is all natural. During radiation I also soaked my skin with water boiled with calendula herbs ( we get dried herbs in the herbal store) and it helped me with irritation and itchiness.

Hope you get better soon

Regards

PK

[greenbear]

Thanks for the useful tips pk. Already started saline soaks