Skin care and cancer treatment

Many cancer treatments, including chemotherapy, radiation therapy, immunotherapy, targeted therapy and stem cell transplant, may cause side effects that lead to skin issues, such as a rash, dry or itchy skin, color changes or extreme sensitivity to light. Some skin problems resolve themselves after the patient finishes treatment. Other issues may linger.

Chemo rash

“Chemo rash” simply refers to the various types of rashes that may develop in response to cancer treatment. This may occur not only with chemotherapy, but also targeted therapy, immunotherapy, radiation therapy and bone marrow transplant. It tends to look like acne or measles, and in some cases, it’s a sign that treatment is working.

Chemo skin care

Although a rash is a common side effect of cancer treatment, some changes patients can make to their routines during treatment may allow them to avoid this side effect. Such changes may include:

• Bathe with a mild, low-pH cleanser.
• Wash the skin gently, don’t scrub. Avoid abrasive cloths, sponges and products.
• Use a gentle, unscented moisturizer.
• Avoid fragrances in products that touch the skin, including dishwashing liquid and laundry detergent. Choose gentle, unscented, mild formulations.
• Avoid the sun as much as possible.
• When time in the sun is necessary, wear at least SPF 30 sunscreen, sunglasses, a wide-brimmed hat and loose clothes that cover the skin.

Itchy skin

Some patients experience a persistent itch in response to treatment, including chemotherapy, radiation therapy, targeted therapy and immunotherapy. Severely itchy skin (called pruritis) may cause restlessness and anxiety. Continually scratching may also lead to sores that are vulnerable to infections.

Some patients find relief on their own. Changes to bathing habits, skin care practices and daily routine may help as well.

When bathing:

• Use warm water rather than hot.
• Add baking soda, bath oil or oatmeal in a cloth or mesh bag to the bath.
• Bathe gently with mild, unscented products and a soft cloth.
• Gently pat the skin dry; don’t rub.

After bathing:

• Replace deodorant with baking soda.
• Use only unscented, alcohol-free products on the skin.
• Shave with an electric razor rather than a blade.
• Apply unscented, alcohol-free skin cream two to three times a day, especially when the skin is still damp. Ask the pharmacist or the care team for creams that are safe. They may recommend products with menthol, camphor or pramoxine.

In the patient's day-to-day routine:

• Keep the house well-ventilated and the temperature set to a cool 60° to 70° F to avoid sweating.
• Wear loose-fitting soft clothes that won’t irritate the skin.
• Drink plenty of water and other fluids.
• Get enough sleep. If the itch keeps the patient up at night, ask the care team or a pharmacist about whether taking antihistamines may help.

These steps may help curb the scratching:

• Apply cool, wet packs to the itchy areas. Crush ice into a plastic bag and wrap it in a towel. Leave it on the skin until the ice melts. Repeat as needed.
• Keep fingernails clean and short to reduce damage to the skin if scratching can't be curbed.
• If the patient tends to scratch without noticing, he or she should consider wearing soft gloves.
• Instead of scratching the itch, try rubbing, vibration or pressure to avoid breaking the skin.
• Seek distractions from the itch by reading, watching TV, listening to music or engaging in social activities.
• Take anti-itch medications as directed.

Ask the care team for more tips and advice. The team may also be able to prescribe medications and recommend over-the-counter remedies.

If the patient experiences these other signs and symptoms that may come with treatment-related itch, contact the care team:

• Dry, red, rough, flaky skin
• Yellowing of the skin or the whites of the eyes
• Rash or bumps
• Scratch marks
• Skin sores
• Scratching when the patient doesn't even realize it

Dry skin and cancer

If the patient's treatment plan includes chemotherapy, radiation, targeted therapy or stem cell transplant, he or she may experience very dry skin―with or without an itch.

Extremely dry skin sometimes looks like normal skin, but it may also be red, rough and flaky. The patient may see cracks in his or her skin, and it may bleed slightly in the lines and creases over knuckles and elbows―some common signs of the type of dry skin that cancer treatment may cause.

To soothe severely dry skin, the patient should take the same steps he or she would to relieve itch and prevent chemo rash.

When bathing:

• Use warm water, not hot.
• Don’t scrub or rub too hard.
• Avoid abrasive products, cloths and sponges.
• Add mineral or baby oil to the bath water or put it on after showering when the skin is still damp.
• Pat dry; don’t rub.

After bathing:

• Use an alcohol-free moisturizer twice a day, especially after a bath or shower, when the skin is still damp.
• For extremely dry and cracked skin, use moisturizers with ingredients that help the skin retain water, such as salicylic acid, urea, ammonium or lactic acid.
• Avoid any skin care products that contain alcohol.
• Shave with an electric razor rather than a blade.

In the patient's day-to-day routine:

• Ask the cancer care team how much water or other liquid beverage is safe to drink. If it’s safe to do so, drink two to three quarts each day.
• Avoid heat, especially dry heat.
• Protect the skin from cold and wind.

Ask the cancer care team for any other recommendations they may have to help relieve dry skin.

Skin discoloration

Cancer treatment, tumor growth and sun exposure may cause changes in skin color. Some color changes go away within about six months; others may be last years after treatment.

Potential skin color changes include:

• Yellowing of the skin and whites of the eyes
• Areas of blue or purple skin that look like bruises but have no known cause
• Very pale or bluish skin, lips or nail beds
• Redness

The patient may also experience these skin color changes:

• Dark orange to brown urine
• Swelling in the discolored area
• Itching

As with dry and itchy skin, be gentle with the affected areas. Make sure to:

• Clean the area gently with warm water, gentle soap and a soft cloth.
• Pat the area dry; don’t rub.
• Keep the skin moisturized with products that the care team recommends.
• Wear loose-fitting, soft clothes.
• Apply medications to the skin as directed.
• Protect all areas of the skin from the sun with sunscreen of SPF 30 or higher and by wearing long sleeves, sunglasses and a wide-brimmed hat.
• Protect the discolored area from heat and cold.

Call the cancer care team if the patient experiences:

• Yellowish skin or whites of the eyes
• Urine that stays brown or orange for more than a day
• White or gray stool for two or more bowel movements
• Severe itching
• Bruises that last longer than a week
• New bruises for three consecutive days
• Pink or red patches or rashes on the skin

Skin care after radiation therapy

Like other cancer treatments, radiation therapy may also cause skin-related side effects. It may take a few weeks or longer after treatment starts before the patient experiences them. Skin problems should clear up within a few weeks of the patient's last radiation treatment.

Radiation dermatitis

Radiation dermatitis, the clinical name for the rash some patients develop during radiation treatment, usually appears on the skin in the area where radiation was directed, typically within 90 days of starting treatment. The severity depends on where the patient receives the radiation, the size of the area, how much radiation was administered and for how long. The rash may cause ulcers and red, peeling, dry skin.

Proper skin care during and after radiation therapy may help the patient avoid this side effect or at least prevent symptoms from worsening.

Radiation therapy skin care

Throughout radiation treatment, follow the tips listed below.

In the bath:

• Be gentle with the skin. Use a soft cloth and gentle, low-pH products.
• Don’t scrub, and make sure to leave the marks on the skin left by the radiation oncologist.
• Avoid shaving.
• Apply moisturizer daily as directed by the care team. Don’t put moisturizer on open wounds.

Getting dressed:

• Take care of any radiation-related wounds and sores as directed.
• Don’t put anything sticky, such as surgical tape or adhesive bandages, on the skin.
• Use fragrance-free products.
• Skip antiperspirant and talcum powder. The patient may use non-antiperspirant deodorant as long as it doesn’t irritate his or her skin.
• Wear loose-fitting clothing to avoid irritating the treated area.

Leisure time:

• Cover the treated area with sun-protective clothing.
• Use the sunscreen that the care team recommends.
• Stay in the shade when outdoors.
• Don’t use hot tubs or tanning beds.
• Bundle up when going outside in near-freezing temperatures, but limit overall time outdoors.

At home:

• Don’t put anything hot or cold, such as heating pads or ice packs, on treated skin.
• Protect treated skin when doing chores. For example, if the patient's hands were treated, he or she should wear rubber gloves to wash dishes.

After completing radiation therapy, continue to protect the treated area from the sun. Closely watch the treated skin for changes, such as redness or a rash, and report these symptoms to the care team. Also, make an appointment to see a dermatologist who can monitor the skin for changes, too.

Skin care after chemotherapy

The most common skin-related side effects of chemotherapy, and other treatments, are redness and dryness.

Radiation recall

Rarely, patients who receive chemotherapy immediately following or during radiation therapy may develop a more serious skin-related side effect called radiation recall, a sunburn-like rash that develops on radiated areas after the patient has had chemotherapy.

Radiation recall may cause:

• Redness
• Swelling
• Pain and tenderness
• Blisters and wet sores
• Peeling skin
• Discoloration after the skin heals

In some cases, the rash may be severe enough that patients have to stop chemotherapy until it heals. To treat this skin condition, the care team will likely prescribe medicine to reduce the inflammation so the patient can resume his or her chemotherapy regimen.

The patient can help the healing process by taking these steps:

• Stay out of the sun.
• Use sunscreen when sun exposure can't be avoided.
• Avoid tanning beds.
• Wear loose-fitting clothes to avoid further irritating the skin.
• Use gentle, unscented, alcohol-free products on the skin.

To ease the pain and soothe skin while it heals, try these remedies:

• NSAIDS, such as ibuprofen or naproxen, or corticosteroids to reduce swelling, inflammation and pain
• Steroid creams to reduce swelling and inflammation
• Lotions or gels to moisturize skin and prevent drying and cracking
• Cool compresses on the affected areas

Photosensitivity

Several cancer treatments, including some types of chemotherapy, radiation therapy and stem cell transplant, may make the patient's skin more sensitive to light. After having these treatments, the patient may need additional protection from the sun to prevent sunburn when he or she is outdoors.

Make sure to:

• Wear long sleeves, long pants and a wide-brimmed hat to protect the skin from the sun, especially from 10 am to 4 pm.
• Use a broad-spectrum sunscreen (to protect against both UVA and UVB rays) of at least SPF 15 generously and reapply at least every two hours.