Caring for Your Skin during and after Cancer Treatment

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Caring for Your Skin during and after Cancer Treatment

Dermatologist Mario Lacouture leads an interdisciplinary effort to minimize the effects of cancer treatment on your skin, hair, nails, and eyes.

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Memorial Sloan Kettering skin care expert Mario Lacouture describes a variety of treatments for skin infections, inflammation, discoloration, and scars.
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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.

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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.

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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.

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How can patients manage changes to their nails?

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Memorial Sloan Kettering skin care expert Mario Lacouture discusses the effects of cancer treatment on nails.
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 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.

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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.

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What should patients receiving radiation be aware of?

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Memorial Sloan Kettering dermatologist Mario Lacouture discusses the impact of radiation therapy on skin.
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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.

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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.

 

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Comments

I am currently undergoing chemo for breast cancer, 4 AC and 4 Taxol. I began experiencing side effects after my second dose dense Taxol treatment. Some side effects were expected, pins and needles/burning sensation in hands and feet, however some were not. Specifically, certain parts of my body have become sensitive to products and touch. Recently I took a warm bath and then put on Cetaphil cream to combat increasingly dry skin due to treatment. I had used Cetaphil in the past but this time however I experienced a stinging/burning sensation on my back/torso. I have since discontinued use of the cream but the stinging/burning sensations on my torso etc. appear when applying any product, including Vaseline. I also feel stinging/burning when I apply underarm deodorant, upon being touched/rubbed on my back or even laying down. My skin is becoming even drier and more uncomfortable because I am not able to moisturize properly. What can I do to alleviate this condition?

Dear Dee, we’re sorry to hear you’re experiencing these side effects. We recommend you discuss your concerns with your oncologist or a dermatologist. Thank you for your comment and best wishes to you.

I have a light-medium olive complexion and am experiencing lots of new brown or liver spots on my face since beginning A+C therapy for breast cancer (have not begun the 4 cycles of Taxol - that's next). I am wondering whether, once I have completed all my treatments, surgery etc. and wait a bit of time thereafter (few months), there are there dermatological treatments such as topicals and/or IPL or other laser that can be used and are effective in reducing and fading these spots? Is using something like laser treatments contraindicated in a cancer survivor? Are these chemo-related (I assume) spots in some way different from usual brown spots due to aging and sun exposure?

Dear Susan, we’re sorry to hear that you’re experiencing these side effects. We recommend that you discuss your concerns with your medical oncologist, or ask for a referral to a dermatologist who has experience in working with cancer patients. Thank you for your comment, and best wishes to you.

I am a breast cancer survivor of -almost 8 years. I had no chemo but had surgery and follow up radiation. I have avoided extreme temperature changes and sun exposure but this year already I had exposure at the lake with grandkids and the next day had a red prickly itchy rash all ove areas that had been exposed. Lasted about a week of
Misery. Had the opportunity to spend a week at b ache now and spent an hour in pool early one morning and sat for maybe 30 minutes and next day , yesterday my itchy prickly rats has begun again .. Warning was at least a year. , this was 8 years ago , Do I have this to contend with forever.?

Dear Wyolene, we’re sorry to hear that you’re experiencing these problems. We recommend that you discuss this with your doctor. Thank you for your comment, and best wishes to you.

I've had NHL 3x. While taking Treanda/Rituxin with my last go round I began breaking out in blisters. Only on skin that is exposed, only when I'm outside and only when I'm sweating. I have had biopsies and seen 6 different doctors with no diagnosis other than contact dermatitis. According to my allergy tests I am not allergic to anything. These spots start out as a small raised spot (similar to a mosquito bite) and then begin to itch unlike anything I've ever felt. Finally they blister. Not small blisters. Some actually get as big as a nickel. The only thing that gets rid of them is steroids.

Dear Cindy, we’re sorry to hear that you’ve experienced this. We recommend that you ask your doctor for a referral to a dermatologist. Thank you for your comment, and best wishes to you.

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