Macmillan, M.S., Wells, M., MacBride, S., Raab, G.M., Munro, A., & MacDougall, H. (2007). Randomized comparison of dry dressings versus hydrogel in management of radiation induced moist desquamation. International Journal of Radiation Oncology, Biology, Physics, 68, 864–872.

To evaluate the effect of a hydrogel or dry dressing on the time to healing of moist desquamation after radiation therapy

Participants were randomly assigned to either dry dressing or no dressing (Tricotex) or hydrogel (intrasite) dispenser at the beginning of radiation therapy. Patients received the same instruction of skin care and were provided with simple soap. Patients were instructed to use their dressing from the onset of moist desquamation, if it occurred.

• The study sample (N = 100) was comprised of male (n = 30) and female (n = 70) patients with breast (n = 10), head and neck (n =30), or anorectal cancer (n = 60) who developed moist desquamation.
• Most patients were aged less than 50 years in the hydrogel (55%) and dry dressing (50%) groups.
• Patients with breast cancer had a tangential field separation of greater than 22 cm.
• Patients were excluded if they had a previous skin reaction to chemotherapy.

The study took place at multiple sites in Scotland.

The study used a randomized controlled trial design.

• Patient perception was measured completing daily diary cards that detailed the degree to which they experience pain, itching, burning, and sleep disturbances.
• Participants rated the appearance of their skin reaction using a desquamation scale that allowed them to score whether their skin was dry or scaly, broken, or weeping in small or large patches.
• Researchers used a modified Radiation Therapy Oncology Group and European Organisation for Research and Treatment of Cancer (RTOG/EORTC) scale weekly until the skin was healed.

• Moist desquamation occurred in 48% of all radiation therapy patients and reviewed mean time was 32 days, with a range of 16–50 days.
• The reaction occurred in 47% of patients before the end of treatment and 39% during the final week. In 38%, the reaction occurred after the end of treatment.
• Moist desquamation was confirmed earlier to those randomized to hydrogel dressings.
• Desquamation scores improved more in patients not assigned to hydrogel dressings.
• Skin reactions healed much more slowly in those assigned to hydrogel dressings (p = 0.03)
• In anorectal cancer cases researcher and patient scores showed they experienced more severe reactions than the other groups and both reactions were significantly worse for those who used hydrogel than those who were assigned to the dry dressing.
• Although variables such as body mass index and smoking, concurrent chemotherapy, bolus use, and total radiation dose were predictive of development of moist desquamation, these variables did not influence demonstrated time to healing.

The study does not support the routine use of hydrogel in the care of patients with moist desquamation and suggests that the healing times are prolonged, without any improvement in patient comfort.

• Hydrogel dressing was more costly than the dry dressing.
• Modified RTOG/EORTC scale was not an established measure and precludes comparison to other studies.
• Patient self-rating scales were not fully described.
• The sample size for head and neck and breast cancer cases was small.
• Although 100 cases were reviewed, only 48% actually would have used the assigned treatment.
• The control group combined dry or no dressing.