Symptoms and Treatment Goals

Symptoms and treatment goals

Each hospital has a different way of managing radiation dermatitis, based on the state of the skin.

To measure and describe the spectrum of radiation dermatitis, a number of different systems have been developed by various organizations over the years, including the National Cancer Institute (NCI), the Radiation Therapy Oncology Group (RTOG), the World Health Organization (WHO) and the European Organization for Research and Treatment of Cancer (EORTC). One of the world most used scale is the one created by the RTOG. The scale is rated from zero to four. Zero stands for normal skin and four is when there is ulceration.

The following table shows you the RTOG scale and the effects on the skin cells.


No visible change to skin.


Appearance of a faint or dull redness (erythema).  A mild tightness of the skin and itching may occur.


Appearance of a bright redness (erythema)/ dry desquamation of the skin. The skin feels sore, itchy and tight.

RTOG 2.5

The skin develops patched areas of moist desquamation. They may produce a yellow/pale green exudate. Sensation of soreness.


What was patchy moist desquamation turns into a confluent moist desquamation. The color of the wound fluid (exudate) is still yellow/pale green. Sensation of soreness.


Ulceration, bleeding, necrosis (rarely seen).

The RTOG scale (Radiation Therapy Oncology Group) provides a standardized description of radiation-induced side effects. Interventions are usually matched to the skin reaction based on assessment of the skin and the RTOG score.


Different treatments that may be used in your radiation center according to the evolution of the radiation dermatitis


Images courtesy of The Princess Royal Radiotherapy Review Team, St James’s Institute of Oncology, The Leeds Teaching Hospitals NHS Trust. Taken from the publication “Managing Radiotherapy Induced Skin Reactions, a Toolkit for Healthcare Professionals”.