Some cancer treatments can cause skin problems. Treatments can also make the skin more sensitive and likely to be irritated. Most skin problems go away once cancer treatment finishes, but you may need to take steps to manage them during treatment. Some skin problems need to be treated right away so they don’t become serious or cause permanent damage.
Cancer treatments that can cause skin problems include:
- biological therapy
- targeted therapy
- radiation therapy
- photodynamic therapy
Tell your healthcare team as soon as you notice skin problems. Many of the effects that cancer treatments have on the skin can be managed at home with proper skin care.
Redness and irritation
During radiation therapy, the skin in the treatment area may look and feel like it is sunburnt. How red and irritated the skin gets depends on the dose of radiation and how sensitive your skin cells are to the radiation.
Treat skin exposed to radiation with extra care. Your healthcare team may be able to suggest ways to manage redness and irritation.
Itching is also called pruritis. It can be caused by:
- certain cancers such as leukemia, lymphoma or myeloma
- kidney, liver or thyroid problems
- allergic reactions to chemotherapy
- dry skin
- skin infections
Itching caused by chemotherapy usually goes away once chemotherapy treatments are finished. If itching is very severe, your healthcare team may lower the dose of chemotherapy or stop it for a time.
You can try the following measures to relieve itching and prevent skin breakdown.
Bathe in cool water using an oatmeal or oil soap. You can also try adding baking soda to bath water to relieve itching. Rinse skin well and pat it dry.
Try not to scratch. You can try massaging, putting pressure on or rubbing the itchy area with a soft cloth instead of scratching. Apply cool, moist compresses to itchy areas. Try to distract yourself with music, imagery or relaxation techniques. Keep your nails short and clean to avoid cuts and infections from scratching.
Avoid extreme cold and heat. Avoid sweating by keeping the room cool and dressing in light layers of clothing. If you do sweat, change into dry clothing as soon as possible.
Change your bed sheets daily. Wash sheets and towels in gentle laundry soap and avoid harsh detergents. Avoid perfumes, cosmetics, starch-based powders and deodorants.
Your healthcare team may suggest medicated creams, gels or ointments, steroid medicines or antihistamines to help soothe the itching.
Dryness, flaking or peeling
When the skin is really dry, it can crack or layers of the skin may peel away, much like it does after a sunburn. The dryness, flaking or peeling should go away after treatment is finished.
You can try different measures to reduce the dryness and prevent skin breakdown. Limit bathing to once a day and take sponge baths rather than full baths or showers. If you do have a bath, add mineral oil or baby oil to bath water to restore oiliness to the skin. Use a gentle soap and warm rather than hot water.
Use a moisturizer daily. Apply the moisturizer when your skin is still a little wet. This will help it hold in some of the moisture. Avoid perfumes and lotions that contain alcohol, which can dry the skin.
Drink plenty of fluids. Avoid extreme heat, cold and wind, which can chafe the skin. Try to stay cool to avoid sweating and losing more moisture from the skin.
Radiation therapy can cause the skin to peel, especially in skin folds such as the buttocks, under the breasts and behind the ears. It can also easily peel in areas where the skin is thin, such as on the neck. When this happens, the skin can become wet due to oozing of body fluid from the open area. Sores or ulcers could develop, which can lead to infection.
Once radiation treatment is finished, skin cells will grow back. Moist reaction should go away 2–3 weeks after treatment.
During treatment, try to keep your skin as dry as possible and free from infection until it heals.
Skin in the radiation treatment area can become swollen and puffy. This is the body’s normal reaction to the damage to the cells of the skin and the tissues under it. The body sends extra healthy cells and fluids to the area to try to heal it. Swollen skin will go away after radiation treatment is finished.
Some chemotherapy drugs, especially targeted therapy drugs, will cause a mild rash. The chance of developing a rash is higher if you receive monoclonal antibodies than if you receive tyrosine kinase inhibitors. It will usually go away on its own without treatment or stopping chemotherapy.
The rash usually occurs within 1–2 weeks of starting targeted therapy. It usually starts on the face. The skin looks red and feels warm, like a sunburn. Around the fourth week of treatment, the skin usually crusts and becomes very dry and red. After that, tender pimples and pus bumps appear. The rash can itch, burn, sting or feel very tender when touched. This rash looks like acne, but it isn’t acne and shouldn’t be treated like acne. This rash is also not a sign of a drug allergy.
During targeted therapy, the rash may get better, stay the same or get worse for a short time. It usually goes away about a month after treatment is finished.
Your healthcare team will suggest ways to help you manage a rash caused by targeted therapy. Topical antibiotics that help relieve inflammation are usually given to treat rashes that look like pimples (pustular, or papular, rashes). Cortisone cream is usually given to treat blotchy, or macular, rashes. If how the rash looks bothers you, ask your healthcare team about using camouflage makeup that can provide good coverage without aggravating the rash.
You can also take steps to protect your skin and avoid getting a rash. Drink plenty of water to keep your skin hydrated. Avoid exposing your skin to the sun. Use a broad-spectrum sunscreen that contains zinc oxide or titanium dioxide on exposed skin when you go outside. Bathe with cool or lukewarm, rather than hot, water and use mild soaps. Use water-based, non-alcohol-based skin products such as facial cleaners. This will help lessen dryness. Use emollient creams that contain 5%–10% urea. Avoid lotions and creams that contain irritants such as alcohol, perfume or dyes.
Darker skin and veins
When some chemotherapy drugs are given into a vein, or intravenously, they can cause the skin and veins to become discoloured or darker. These skin colour changes can be widespread or limited to a specific area such as the tongue, nails or mucous membranes.
Some targeted therapy drugs can cause the skin and hair to turn a yellowish colour. In some cases, the hair may turn darker.
Experts aren’t sure why some chemotherapy drugs affect the colour of skin, veins or hair. There are no ways to treat or prevent these changes. They will gradually fade over time after treatment is finished.
Changes to fingernails and toenails
Changes to fingernails and toenails are common during chemotherapy. These changes include:
- brittleness and cracking
- lines across the nail
- partial separation of nail from the nail bed
Darkening will occur evenly across the nail if chemotherapy is given continuously. It will occur in bands if chemotherapy is given in cycles.
Targeted therapy can cause the skin in the folds along the sides of the fingernails and toenails to become swollen and red with cracks or open sores. These changes commonly occur in the big toes and thumbs. The cracks or sores look a lot like an infected ingrown nail and can be very painful.
Certain types of targeted therapies can also cause a condition called subungual splinter hemorrhage. Black or red lines that look like splinters appear under the nail. It is thought that bleeding in the nail bed creates these lines.
Your healthcare team can suggest ways to manage changes to fingernails and toenails. Ask them about using over-the-counter nail-strengthening products. They will also tell you how to care for cracks in the skin around the nails with padding, cushioning or a liquid bandage.
You can protect your nails by wearing gloves when doing household chores or gardening. Avoid nail polish remover that contains alcohol. Keep your nails short to avoid breaking and chipping. Use a moisturizer around the cuticles to prevent tearing and bleeding. You can also try using lip balm to moisturize your cuticles.
Sensitivity to the sun
Some chemotherapy drugs may make the skin more sensitive to sunlight. This is called photosensitivity. It looks much like sunburn and can occur after being in the sun for a very short amount of time.
Photosensitivity can continue for a few months after treatment is finished so sun protection is important during this time.
Changes in and around the eyes
Some chemotherapy drugs can cause a burning feeling in the eyes and make them dry or red. The eyelids can become tender, swollen or inflamed. Crusts may form in the eye lashes. In some cases, the eyelids may turn inward or outward. These changes to the eyelids or long periods of dryness can damage the cornea of the eye.
Your healthcare team can suggest ways to manage changes in and around the eyes, to ease the pain and prevent further injury or infection.
Hand-foot syndrome is also known as palmar-plantar erythrodysesthesia (PPE). It is a rare side effect of some chemotherapy drugs that affects the soles of the feet and palms of the hands. Some targeted therapies can cause a condition similar to hand-foot syndrome called acral erythema.
Symptoms of hand-foot syndrome include:
- pain or burning
- tingling or numbness
- peeling of the skin
If you have these symptoms, your doctor may need to lower the dose of chemotherapy or targeted therapy. Treatments may have to be stopped altogether if symptoms are severe. Once symptoms have improved, treatment can start again, but the healthcare team may lower the dose.
You can help manage the symptoms of hand-foot syndrome by avoiding high temperatures and hot baths on the day you receive therapy and for 5 days afterward. Try to reduce friction and pressure on your hands and feet. For example, you can use gel inserts in shoes for added cushioning and wear slippers instead of shoes. Apply lotions liberally to hands and feet.
Tell your healthcare team if you have symptoms of hand-foot syndrome. They can suggest pain medicines to help relieve the symptoms. Early treatment can keep them from getting worse.
Radiation recall is a skin reaction that can occur when certain chemotherapy drugs, such as doxorubicin (Adriamycin), are given after radiation therapy treatment is finished. It usually appears in the area of skin where the radiation was given. The skin becomes red and tender, and it may peel or blister like a sunburn.
Radiation recall can happen shortly after, a few months after or a year or more after radiation treatments.
Sometimes chemotherapy drugs can escape from the vein and leak into the surrounding tissues. This is called extravasation. Some drugs can be very irritating if they get into the tissues around the vein. These drugs are called vesicants. They can cause the following symptoms at the injection site:
In some cases, extravasation can cause severe damage to the skin and surrounding soft tissue.
Extravasation usually occurs when the drug is given into a vein (intravenously or by IV). Tell your healthcare team right away if you have pain, burning or swelling around the IV site. They will stop the chemotherapy and clean the area around the IV site to prevent further tissue damage. The healthcare team will tell you how to care for the wound. They will also regularly check the area to make sure it is healing.