What methods do you use to prophylactically reduce radiation dermatitis for head and neck irradiation?

My approach has been:

1. Start Remedy (less greasy but less effective) and/or Aquaphor (more greasy but more effective) 3-4x daily at beginning of RT. Try to use Aquaphor at least at night when the greasiness is less bothersome. If patients have some other alcohol-free/non-anti-oxidant product they really like, seems reasonable to let them try that instead. Ensure the patient avoids sun exposure, razor shaving, and other irritants. Keep the area gently clean to avoid cream buildup - Cetaphil is gr...

With the important disclaimer that I am a private practice generalist/not an H&N subspecialist, earlier this year, I started adding mometasone once daily at nighttime to their daily instructed regimen after reading a bit more about its use in H&N (link), and I have been very happy with this regimen. I have them use aquaphor after treatment, and mometasone at night, applied to each side of the neck. I look forward to reading other answers to this helpful question.

Great question and would also be interested in what others are doing.

I trained with recommending the use of an over-the-counter lotion/cream/gel containing aloe vera used twice daily starting the first day of radiation as a preventative, and (anecdotally at least) feel as an attending that it makes a big benefit in H&N patients, and other patients at risk for dermatitis, who use it religiously versus those who do not.

Ideally, I request they find one without a significant alcohol component in ...

I recommend bleach baths prior to each radiation session to everyone starting radiation therapy. There haven’t been human studies yet, but in a mouse model, a 30-minute dilute bleach (0.005%) soak reduced radiation dermatitis. It’s simple and safe, so I recommend it to everyone. If they don’t want to do a full bath prior to each radiation treatment, I tell them to mix a gallon jug of water with a teaspoon of regular bleach (6%). They can use it to soak a white washcloth and apply to the treatmen...