Skin reactions usually fall into this category. Late responding reactions are those that are manifested months to years after radiation therapy is completed. Late changes can follow acute changes. It should be stressed to the patient that with megavoltage equipment and modern techniques, permanent skin changes usually are minimal. Erythema and Folliculitis Erythema should be categorized as mild, moderate, or severe.
Mild erythema constitutes the first appearance of pink to the skin.
Progression to a red hue is considered moderate erythema. In severe erythema, the skin is deep and dusky red. Pruritus and dryness often accompany erythema, and are irritating to patients. When erythema becomes moderate or severe, the patient should be instructed to rinse with water only. The gel should not be applied before treatment as it could have a bolus effect on the skin enhancing a reaction.