Moist desquamation in large-chested women

In my practice in radiation oncology, we see many of the larger-chested women develop moist desquamation under their breasts. We currently treat this with Domeboro solution and air exposure. Are there any better methods for treating this? — Barry A. Cochran

Large-breasted women who receive radiation have an increased chance of developing a significant skin reaction, and cosmesis may not as good as with other patients. Skin recommendations for patients receiving breast radiation include keep the skin dry and clean; use warm water and gentle soap; avoid extreme temperatures while bathing; avoid trauma to the skin and sun or wind exposure; avoid shaving the treatment area with a razor blade; avoid the use of perfumes, cosmetics, aftershave, or deodorants in the treatment area; and only use the recommended creams or lotions after daily treatment.

Some patients may still develop moist desquamation, a sunburnlike reaction with blistering and peeling of the skin. This usually occurs in the fold under the breast or in the fold between the breast and the arm and sometimes in the area where the radiation boost was given. Most patients with a limited area of moist desquamation can continue treatment without interruption. In more severe cases where radiation therapy must be stopped, the skin usually heals enough to allow radiation to be resumed within 5 to 7 days. Skin reactions usually heal completely within a few weeks of completing radiotherapy. Treatments for moist desquamation include Aquaphor (a petroleum-based product), Biafine (a topical emulsion), aloe vera, and hydrocortisone cream. Many institutions also use methods such as three-dimensional planning, modified higher energy radiation beams, the use of custom support bras during treatment, and intensity-modulated radiation therapy (IMRT) to improve the distribution of radiation throughout a large breast. All of these measures reduce the side effects of radiation in women with large or pendulous breasts. — K. Lynne Quinn, RN, MSN, CRNP, AOCNP