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Skin changes with chemotherapy

Minor skin changes or skin irritation can occur during and for some time after chemotherapy. Not all chemotherapy drugs cause skin changes, but it is important to be aware that skin may be more sensitive or easily irritated during treatment.


General skin reactions that can occur with chemotherapy include:

  • redness
  • rash
  • itching
  • dryness
  • acne

The following are different types of changes that can occur in the skin or nails with certain chemotherapy drugs.

Changes in skin colour

Some chemotherapy drugs may cause the skin and veins to become discoloured or darker in colour (called hyperpigmentation). Skin colour changes may be limited to a specific area or more widespread. Colour changes seem to occur more often in dark-skinned people and in areas where the skin is exposed to the sun.

Some drugs that can cause changes in skin colour include:

  • 5-fluorouracil (Adrucil, 5-FU)
  • bleomycin (Blenoxane)
  • busulfan (Busulfex)
  • cyclophosphamide (Cytoxan, Procytox)
  • doxorubicin (Adriamycin)

Changes to fingernails and toenails

Changes to fingernails and toenails are common during chemotherapy. These changes may include:

  • darkening (usually fades a few months after chemotherapy treatment ends)
  • yellowing
  • brittleness
  • cracking
  • lines
  • partial separation of nails from the nail bed

Drugs that can cause nail changes include:

  • docetaxel (Taxotere)
  • paclitaxel (Taxol)
  • bleomycin (Blenoxane)
  • doxorubicin (Adriamycin)
  • cyclophosphamide (Cytoxan, Procytox)
  • 5-fluorouracil (Adrucil, 5-FU)

Sensitivity to the sun

Many chemotherapy drugs can make the skin more sensitive to sunlight (called photosensitivity) while a person is receiving chemotherapy. Photosensitivity can continue for a few months after treatment is finished.

Some drugs that can make the skin sensitive to the effects of the sun include:

  • 5-fluorouracil (Adrucil, 5-FU)
  • methotrexate
  • bleomycin (Blenoxane)
  • doxorubicin (Adriamycin)
  • hydroxyurea (Hydrea)

Hand-foot syndrome

A few chemotherapy drugs can cause pain, swelling, redness, tingling or burning in the hands, feet or both. Some drugs can also make the skin peel on the hands and feet. This is called hand-foot syndrome (palmar-plantar erythrodysesthesia). It occurs because chemotherapy drugs, such as 5-fluorouracil (Adrucil, 5-FU) or capecitabine (Xeloda), concentrate in the palms of the hands and soles of the feet.

Radiation recall

Radiation recall is a skin reaction that can occur when certain chemotherapy drugs are given after radiation therapy. It usually appears in the area of skin where the radiation was given. The skin becomes red and tender. It may also peel or blister like a sunburn. Radiation recall may be treated with corticosteroids to lessen inflammation or chemotherapy may be delayed until the skin heals.

Prevention and management

Nursing staff check the injection site often when chemotherapy drugs are given intravenously (into a vein). Pain, burning or swelling at the injection site while chemotherapy is being given should be reported to the healthcare team.

Tell the healthcare team if skin becomes red, itchy or dry or if it starts to peel during or after treatment.

Many of the skin conditions caused by chemotherapy treatment are not serious and can be treated at home. It is important to care for the skin during chemotherapy treatment.

  • Wash often to lower the risk of skin irritation and infections.
  • Do not squeeze or scratch pimples.
  • Bathe in warm, instead of hot, water. Hot water dries out the skin.
  • Gently pat skin dry rather than rubbing it briskly.
  • Use a moisturizer to soften the skin and help prevent it from becoming dry or cracked.
    • Look for a moisturizer that does not contain alcohol and has high lanolin content. The healthcare team or pharmacist can suggest one.
    • It is best to apply a moisturizer while the skin is still moist.
  • Use cuticle cream instead of tearing or cutting the cuticles.
  • Protect nails by wearing gloves when washing dishes, gardening or doing other household chores.
  • Use an electric shaver rather than a razor to prevent cutting the skin. If the skin is accidentally cut or scraped, clean the area at once with warm water and soap.
  • Avoid perfume or aftershave lotion. These products often contain alcohol, which can dry the skin.
  • The skin may be a little more sensitive to the sun than normal.
    • Protect skin from the sun by wearing a wide-brimmed hat and clothing that covers the arms and legs.
    • Apply sunscreen with a sun protection factor (SPF) of 30 or higher before going outside and limit time outdoors. Zinc oxide can be used to fully block out the sun, but it should be used along with other sun-protection measures.

For more detailed information on specific drugs, go to sources of drug information.


Any steroid hormone that acts as an anti-inflammatory by reducing swelling and lowering the body’s immune response (the immune system’s reaction to the presence of foreign substances).

Corticosteroids are made by the adrenal gland. They can also be produced in the lab.


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