Q&A

On Cancer: Caring for Your Skin during and after Cancer Treatment

By Christina Pernambuco-Holsten, MA  |  Monday, August 19, 2013
Pictured: Mario Lacouture Dermatologist Mario Lacouture

As the body’s first line of defense against sunlight, chemicals, and infectious germs, the skin is also one of the areas of the body most commonly affected by treatments for cancer.

The good news is that skin reactions are usually temporary and treatments are available to help patients cope with these side effects. Unfortunately, many patients do not receive the medical attention they need to address them. 

“We have made incredible progress in developing better cancer treatments, but in doing so a real gap in many patients’ skin health has emerged,” says Mario E. Lacouture, a Memorial Sloan Kettering dermatologist who specializes in treating skin conditions that result from cancer treatment.

In an interview, Dr. Lacouture describes some of the most common dermatologic side effects of anticancer medications, radiation therapy, and surgery, and offers suggestions for lessening their impact.

What should patients receiving medications such as chemotherapy or targeted therapy keep in mind in terms of dermatologic side effects?

Skin reactions are not unusual among cancer patients. Whether you experience one will depend in part on the type and dose of medications you receive and whether radiation therapy is part of your treatment. 

Usually your doctor will be able to tell you before treatment begins whether the medication you are receiving may cause skin reactions. In fact, for some medications, a rash is considered a sign that the therapy is working.

Early intervention is key to preventing side effects from worsening. Once you begin treatment, write down any skin reactions you notice and bring them to the attention of your healthcare team.

Dry and itchy skin is common, as are changes to the nails. 

Rash – which may look like acne or measles in appearance – is the dermatologic side effect we see most often in patients receiving anticancer medications. Taking photos of the affected area to bring to your next appointment can be helpful to your doctor, as rashes tend to change in appearance.

Is it OK to use cosmetics to cover up rashes caused by anticancer medications?

It is perfectly fine to use cosmetics on rashes. But keep in mind that anything that comes in contact with the skin may cause irritation.

When you first begin applying cosmetics, I recommend trying only one product at a time. Some people find they have developed new allergies, even to products they used regularly in the past.

If you have an acne-like rash, do not to use acne medications as that may cause even more irritation.

Do you have suggestions for patients who are experiencing dry, itchy skin?

Many cancer treatments can cause or worsen dry skin because they slow down the skin’s ability to renew itself.

Look for creams and ointments, which are generally more effective than lotions at retaining moisture, and select products that are fragrance free. These should be applied at least twice a day, preferably within 15 minutes after showering or bathing. Try not to stay in the shower too long, use lukewarm or warm water instead of hot, and avoid scrubs or loofahs, which can strip away natural oils and contain many bacteria after repeated use. 

If your skin is itchy, be sure to tell your healthcare team so they can help you select the best treatment. It is important to use fragrance-free soaps, creams, and detergents. And avoid scratching, even though it may be difficult. Look for over-the-counter creams that contain anti-itch substances such as menthol, camphor, or pramoxine, or consider taking an oral antihistamine.

How can patients manage changes to their nails?

Nail changes occur more often in patients receiving targeted therapies and certain chemotherapy drugs such as paclitaxel and docetaxel. These changes are typically cosmetic, meaning the texture or color of the nails is affected, but some patients do experience pain and discomfort in their nails. While prevention is difficult, there are simple steps you can take to manage nail changes.

Keep your nails trimmed and wear gloves when working with your hands. During chemotherapy, avoid manicures and pedicures, and do not trim your cuticles. If you experience discoloration, consider using a dark, water-based nail polish free of harsh chemicals, particularly dibutyl phthalate, toluene, and formaldehyde. Because nail polish remover can be damaging I don’t recommend changing polishes too frequently.  

Once you have completed chemotherapy, you can resume manicures and pedicures and use a nail strengthener or a natural supplement, such as biotin.

For patients who have had surgery, what are some signs that a scar may not be healing properly?

If you have scars that do not seem to be healing, or have increased in size, tell your surgeon right away. Other signs of a problematic scar include itchiness, dryness, and tightness.

Dry or itchy scars may be treated with corticosteroid creams. Patients with scarring that restricts movement in the joints or limbs can often benefit from physical therapy

Keloids [extra growths of scar tissue that may be lumpy or rigid in appearance] are another concern. A plastic surgeon or dermatologist can perform a procedure called scar revision or laser treatment to remove excess tissue and make the scar less noticeable.

What should patients receiving radiation be aware of?

External-beam radiation is the type of radiation therapy that most often causes dermatologic side effects. These may include swelling, itching, pain, or inflammation.

Take care with the affected area. Wash with warm water and mild soap. When using a towel, pat the area dry instead of rubbing it and wear loose-fitting cotton clothes. In many cases, skin problems connected to radiation therapy can be prevented with corticosteroid creams, or lessened with oral antibiotics if an infection has already developed, when used from the beginning of or during radiation treatment.

Do you have any general advice for patients who have already completed treatment?

If you are a cancer patient or survivor and don’t already have a dermatologist caring for your skin, now is the time to find one. It’s a good idea to bring your medical records to your first appointment, so your dermatologist knows the specifics of your treatment. And keep the other members of your care team informed of any treatments your dermatologist recommends.

Being safe in the sun is the most important general piece of advice I can give. Most anticancer medications and radiation therapy increase your sensitivity to the sun, and studies have shown that skin cancer rates are greater in survivors. In most cases, good skin care and early intervention are all that is needed to achieve the best possible skin health.

To learn more about dermatologic health during and after treatment, speak to your doctor or nurse, or you can call our Dermatology Service at 212-610-0079.

Comments

Hello
I have metastatic bone cancer which resulted in a fractured femur. This occurred most recently in May of 2012 and previously Feb 2011.
I was on a dose dense schedule of Gemzar but within the last three months have had a schedule reduction. Recently I have lines of blotches around my fractured hip, it looks like bruises but it is not. Is this from my treatment?

Dear Cori, unfortunately, we are not able to answer personal medical questions on our blog. We recommend that you check with your medical oncologist or dermatologist to discuss whether this is a side effect of your treatment. Thank you for your comment.

thanks.

I developed lymphadema after hysterectomy, in my left leg, I periodically get a rash and very dry skin on my feet, which in turn leaves cracks which led to cellulitis 3x in the last year that required hospitalization. What treatment would you recommend for the itchy rash, leg swelling, and dry skin to prevent this happening in the future.

Dear Maureen, unfortunately, we are not able to answer personal medical questions on our blog. We recommend that you check with your surgeon and/or dermatologist to discuss the best treatment for you specific to your symptoms and medical history. You can also call our Dermatology Service at 212-610-0079. Thank you for your comment.
.

I am a survivor of pharyngeal cancer. I live in Puerto Rico. I receive 40 radiotherapy. My esophagus was received radiation although the tumor was not in it. Seven years have passed and I only can swallow a special drink, because it is like a "spaguetti". The surgeon ha stried has dilatatine
me in 2007, 208 and 2013, but he explains me that it is so rigid, that he do not insist and only dilator # 1 is used. I want to know if you can do a new esophagus, plastic, or helping with mother cells. Only my Faith in Jesus help me, because is terrible seeing food, announces, family special feasts, and I have to contain my tears not to make my family suffer.

Norma, we are unable to answer specific medical questions on the blog but if you are interested in making an appointment at Memorial Sloan Kettering, contact our International Center at 1-212-639-4900 or go to http://www.mskcc.org/cancer-care/international-patients. Thank you for your comment.

I do not live in the states. I live in Puerto Rico. I depend on my Social Security monthly payment . But if if it a solution or surgery or whatever to my situation of a replacement of my radiated esophagus, I will move any institutions or churches help to have an esophagus to be happy, to have the opportunity to join my family eating all in the table as we do seven years ago.

I've had numerous surgeries, [about 18+] from ovarian cancer, an active adrenal tumor, and then bone cancer. The stylist who cuts my hair [hadn't seen her for over a year due to treatment] actually asked if I had surgery recently with anesthesia because she said the texture and color of my hair was different. In her opinion, she told me the after effects of anesthesia was very damaging to hair. Is this true? [I also noticed my hair looked and felt different, but never connected the two as the culprit]. And if so, is there a remedy?

Dear Deborah,
Thank you for your comment. We reached out to Dr. Lacouture, and this is what he said: "The physical and emotional stress from surgeries can lead to a temporary thinning or loss of hair known has 'telogen effluvium.' This condition is temporary in the great majority of cases, and hair should grow normally within a few months. However, there is no evidence that anesthesia itself will affect hair growth or texture. If you are having hair issues, a consultation with a dermatologist is advisable, as there may be other causes of hair thinning."

Greetings!
My brother's skin has become ultra-sensitive due to seven years of chemotherapy. Would you kindly recommend a cream or gel that would facilitate shaving. Thank you for all consideration. Best wishes.

Rosanna, unfortunately we have not yet heard back from Dr. Lacouture. We cannot offer personal medical advice on our blog, but we do recommend that your brother make an appointment with a dermatologist. If he is a patient of Memorial Sloan Kettering, he may want to call his doctor's office to schedule an appointment with Dr. Lacouture.

I just made a new friend and she recently completed chemotherapy for breast cancer. I make home made soaps and I am planning on making an Olive Oil soap for her since I am told it is the most gentle. No fragrance obviously. I would also like to make her a body butter to help combat her dry skin. Obviously I won't be using fragrance in that either and only the highest quality butters and oils. Is there anything I should know that will make sure this product will be safe for her and not an irritant? I plan to use Coco, Mango, Kokum and Shea butters, Coconut Oil, Jojoba Oil and Vitamin E. Should any of those be avoided for her particular situation? Thank you in advance.

Diane, many apologies for the delay. We did hear back from Dr. Lactouture about ingredients in soap. Here's what he had to say:

"The most common irritants and allergens in soaps are:
Fragrances
Sodium Lauryl Sulfate
Balsam of Peru
Coconut Diethanolamide
Paraben

That said, any product can cause irritation or allergy, so if any skin irritation is observed, please consult with a dermatologist (www.aad.org)."

I have explain so many article of this site in which some of them were very interesting and inspiring.This article has good title with good description.

Patients taking Tarceva experience the acne form rash mentioned in your article. What topical ointments are recommended to decrease the outbreak of this rash? And which moisturizers would be recommended for the face for this acne form rash?

Thanks for your question, Kim. We forwarded your comment to Dr. Lacouture, and we'll let you know what he says.

Kim, we just heard back from Dr. Lacouture. He recommends topical corticosteroids and antibiotics, as well as fragrance-free moisturizers.

I have finished 5 months of chemotherapy and 6 weeks of radiation for triple negative breast cancer. I have noticed that every time I get extremely hot, my skin itches all over. Is this a side effect of the chemo or radiation?

Dear Chevella, we are sorry to hear about your diagnosis. Unfortunately, we cannot answer personal medical questions like this on our blog. We would encourage you to consult with your oncologist. If you would like to make an appointment with one of our specialists, please call our Physician Referral Service at 800-525-2225. Thank you for your comment.

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