Table 5 Summary of management recommendations outlined in the (national) guidelines reviewed

General management/prevention

To ensure good hygiene the skins should be washed daily, preferably with lukewarm water and gently drying of the treatment area

MASCC (2013); Rosenthal et al. [3]; Iacovelli et al. [6]; Russi et al. [54]; Kumar et al. [72]; McQuestion et al. [73]; Spasic et al. [77]; Bolderston et al. [81]; Chan et al. [94];

DE; NL; UK; Gutierrez et al. [55]; Chan et al. [95]

Butcher et al. [96]

BE; DK; FR; IT; ONS; Siddiqui et al. [69]; Radvansky et al. [88]

The use of deodorant is allowed unless the skin is broken

MASCC (2013); MASCC(2023); Salvestrini et al. [26] (breast cancer only); Chan et al. [95]

DE; NL; ONS; UK; McQuestion et al. [73]; Spasic et al. [77];

Butcher et al. [96]

BE; IT; Ramseier et al. [76];

Skin irritation due to friction and abrasion in the treatment area should be avoided through the wearing of loose fitting (preferably cotton, linen, or silk) clothing, avoidance of excessive rubbing, trauma, jewellery or adhesives

UK

BE; DE; FR; IT; NL; MASCC (2013); Iacovelli et al. [6]; Russi et al. [54]; Ramseier et al. [76]; Siddiqui et al. [69]; Spasic et al. [77]; Abreu et al. [97]

Sun exposure in the treated area should be avoided. Protect the (irradiated) skin from exposure to the sun by covering the skin. After treatment a high SPF (SPF50) or sunblock is recommended

BE; FR; IT; NL; ONS; UK, Iacovelli et al. [6]; Russi et al. [54]; Ramseier et al. [76]; Spasic et al. [77]; Radvansky et al. [88] Abreu et al. [97];

Apply moisturizing cream/lotion to hydrate the irradiated skin. Application of cream/lotion directly/shortly before treatment is acceptable

BE; Bruch et al. [98]

DE; DK; IT; MX; UK; Gutierrez et al. [55]; Naylor et al. [86]; Bolderston et al. [81];

Management of Grade 1 RID

Continue general management/prevention

BE; FR; IT; NL; UK; Gutierrez et al. [55]

Apply moisturizing cream/lotion to hydrate the irradiated skin. Application of cream/lotion directly/shortly before treatment is acceptable

BE; DE; DK; IT; MX; NL; UK; Bolderston et al. [81];

The continued use of corticoid creams or topical steroid can be considered (but only when the skin is not broken)

DE; ISNCC; MASCC (2013); ONS; Rosenthal et al. [3]; Siddiqui et al. [69]; Chan et al. [95]

Spasic et al. [77]; Bolderston et al. [81]; Naylor et al. [86]; Abreu et al. [97]

BE; NL; DK; FR; MX; Gutierrez et al. [55]; Ramseier et al. [76];

Management of Grade 2 RID

Continue general management/prevention

BE; FR; NL; UK; Gutierrez et al.; [55]

Treat areas with intact skin same policy as grade 1

BE; DK; NL

Option 1: Apply self-adhesive soft silicone dressings on the irradiated skin

MASCC (2023)

ISNCC; Iacovelli et al. [6]

BE; DK; FR; IT; NL; Ramseier et al. [76]; Spasic et al. [77]

Option 2: Continue using moisturizing cream or use hydrogel in combination with soft absorbent dressings on areas of open skin (and fix in position with bandages)

NL

BE; DK; FR; IT; UK; MX

The continued use of corticoid creams or topical steroid can be considered (but only when the skin is not broken)

DE; ISNCC; MASCC (2013); ONS; Rosenthal et al. [3]; Siddiqui et al. [69]; Chan et al. [95]

Gutierrez et al. [55]; Spasic et al. [77]; Bolderston et al. [81]; Naylor et al. [86]; Abreu et al. [97]

BE; DK; NL; MX; UK; Ramseier et al. [76];

Prevent and be aware of infections, infections should be overseen by a clinician

DK; IT; UK; NL; Gutierrez et al. [55]

At any sign of infection: the use of topical antiseptics and/or antibiotics is advised

NL

DK; IT; MASCC (2013); Russi et al. [54]; Gutierrez et al. [55]; Radvansky et al. [88]; Spasic et al. [77]

Ensure adequate analgesia is prescribed for the patient if required

DK; NL; UK; Gutierrez et al. [55]

Management of Grade 3 RID

Ensure good hygiene care by daily or twice daily cleansing

BE; FR; IT; NL

Apply soft silicone or other appropriate dressings on broken skin, fixate with soft bandages

MASCC (2023)

NL; UK; Naylor et al. [86]

BE; DE; DK; FR; IT; Russi et al. [54]; Ramseier et al. [76]; Spasic et al. [77]; Radvansky et al. [88]

Manage exudates with absorbent dressings

FR; IT; NL; ONS; Russi et al. [54]

Prevent and be aware of infections, should be overseen by a clinician

DK; IT; NL; UK

At any sign of infection: use of topical antiseptics and/or antibiotics is advised

NL

BE; IT; MASCC (2013); Russi et al. [54]; Gutierrez et al. [55]; Spasic et al. [77]; Radvansky et al. [88]

Ensure adequate analgesia is prescribed for the patient if needed

DK; NL; UK; Gutierrez et al., [55]