Q: My best friend is undergoing radiation for breast cancer, and trying to figure out how to protect her skin during the treatments. Are there any creams that could help her?
Nearly 8 out of 10 people will experience a significant skin reaction during their radiation treatments for cancer. Called radiation dermatitis, it usually starts as redness and warmth and looks a lot like a rash, with increased sensitivity to touch and a “tight” feeling. As the skin reaction becomes more severe, dryness, itching and peeling occur, leaving tender, red skin, which may ooze clear fluid and become crusty. The chance of experiencing a serious skin reaction increases if the skin receiving radiation has had previous surgery, has another skin surface touching it, if the person smokes or is a diabetic.
The keys to prevention of radiation dermatitis are avoiding irritating the skin, decreasing overall stress, and keeping the skin hydrated. Washing the skin gently using a mild soap and water has been shown to prevent skin reactions compared to just rinsing with water. When advised to treat their skin gently, most patients are advised to use a “mild, non-alkaline soap, preferably unscented”. Which ones are best? There isn’t any consensus about that, or evidence that any particular soap is better than another. Gentle soaps like Dove, Ivory, Neutrogena are fine. Avoiding highly scented soaps such as Coast® or Irish Spring® may help decrease skin irritation, as well as avoiding either hot or very cold water and never scrubbing with a washcloth or, worse, a loofah.
In the past women have been advised to avoid using any antiperspirants containing aluminum because of concerns that aluminum could interfere with the dose of radiation given during treatments. Thankfully, this has been completely disproven; there is no reason to give up wearing deodorant or antiperspirant during treatment unless your underarm develops broken skin.
Keeping treated skin moisturized can help prevent serious radiation-related reactions. Which cream or lotion should you use? Are there any products proven helpful in preventing pain, itching or peeling? Although there are a few small trials with several prescription-only products, the most compelling evidence is a study done in 1999 by a group of French researchers featuring calendula officinalis, an extract from the marigold plant.
The French study compared a calendula ointment manufactuered by Boiron with a prescription-only wound care product containing the active ingredient trolamine (Biafine®). In this well-designed trial of 254 women who were receiving radiation for breast cancer, half of the women in the study were assigned to use trolamine to prevent radiation dermatitis and the other half were assigned to use the calendula. The calendula ointment proved significantly better in preventing skin reactions and in reducing pain associated with radiation dermatitis when compared to Biafine®, but was judged difficult or unpleasant to apply by one third of the participants.
As a pharmacist trained in various types of formulations, the surprising evidence of calendula’s effectiveness and the complaints about applying it intrigued me. Were there other formulations of calendula available that would be more pleasant than the product used in the French study?
Hmm…I decided to get some calendula-containing products and find out for myself. The calendula product from the French study is an ointment made by Boiron, a French homeopathic company. It’s basically a calendula-infused petroleum jelly, and very stiff, greasy, and hard to spread. Another calendula ointment, made by Weleda, spreads well but contains lanolin. Lanolin is wool fat, and can cause skin reactions. The only cream I evaluated was Arbordoun’s Abundantly Herbal Calendula Cream®, which besides calendula, contains other ingredients such as oregon grape. It also contains olive oil instead of petrolatum, which makes it easy to spread, but it takes about 5 minutes to “soak in” after you apply it. It doesn’t leave a film after that, though. Olive oil has been shown to be possibly beneficial in protecting skin from radiation damage.
After trying out several different formulations of calendula, I have an answer. For prevention of radiation dermatitis I recommend the calendula gel made by Boiron, instead of their ointment. It spreads easily, gives a nice cooling effect, and soaks in so quickly that I have to stop myself from applying more of it. It doesn’t leave any sticky or greasy film, either.
Dr. Louise Achey, Doctor of Pharmacy is a 30-year veteran of pharmacology. Please send your questions and comments to www.AskDrLouise.com.
