If you’re reading this, it means that you or someone you care about may be navigating a cancer diagnosis and the twisty path that follows. Having lost my mother too early to cancer, I’d like to start by saying that cancer sucks, and that I’m sending you a huge wave of warmth, courage, and support right now. As a medical doctor and a skin expert, I thought it might be helpful to summarize some of the most common skin issues that can arise during cancer treatment, and offer some ways to support your skin before, during, and after treatment. One of the reasons I created so many unscented, gentle products in our line was because I wanted to provide some beautiful options for taking care of your skin during a difficult time. I hope this article helps, and please reach out to us at help@osmiaskincare.com if you have any questions after reading!
What are the most common skin changes during cancer treatment?
Skin reactions during cancer treatment are extremely common. Radiation-induced skin reactions may be more common than chemotherapy-induced skin reactions, which makes sense since the radiation treatment is happening directly through the skin, but problems can happen with either form of treatment. Having both radiation and chemotherapy together can increase both the likelihood and the severity of skin reactions, as some chemotherapy medications can make your skin more sensitive to radiation damage. Hair loss, which you probably don’t think of as a “skin change,” is the one of the most common and distressing skin reactions to chemotherapy.
What skin problems happen during chemotherapy?
As mentioned above, hair loss is a very common side effect that is usually reversible after the treatment is over. Some forms of chemotherapy and immunotherapy can cause non-specific skin symptoms like dry skin, increased sensitivity and reactivity, rashes, itching, and burning. Some medications can cause pigmentation changes in the skin, making your skin or nails either lighter or darker. Some chemotherapy drugs can also make you more sensitive to UV rays, making it much easier to get a sunburn during treatment. Be sure to use a mineral sunscreen to protect your skin, during treatment and beyond.
Another chemotherapy reaction is called Hand Foot Syndrome, or PPE (Palmar-Plantar Erythrodysesthesia). This can happen with certain drugs like cytarabine, doxorubicin, and 5-FU, and occurs on the palms and soles about 2-6 weeks after treatment. Symptoms include tingling, pain, redness, swelling, peeling, and blistering, and may require patients to wear special gloves or footwear, or reduce activities that place too much strain on the skin of the hands and feet, like excessive walking or lifting weights.
What skin problems happen during radiation treatment?
During radiation treatment, people often experience what is called acute radiation dermatitis. The symptoms are often dependent on the dose, with the most severe symptoms like ulceration occurring in patients who receive the highest doses. At lower doses, acute radiation dermatitis presents as redness, pain, and hair loss at the site of radiation. Patients can also experience itching, scaling, and pigmentation changes. Symptoms can begin a few hours, days, or weeks after treatment, and damaged skin usually start to heal after about two weeks. Dermatitis can sometimes be worse if someone is also receiving certain types of chemotherapy, or if someone is receiving multiple doses of radiation without sufficient time to heal in between treatments. If your skin gets to the point where it is super angry, raw, and moist, you need to talk to your care team to make sure you’re doing all you can to prevent infection; you may need special wound dressings or prescription creams or gels.
Another phenomenon, called radiation recall, occurs when an area of the skin previously treated with radiation becomes inflamed after treatment with certain chemotherapy drugs. Most radiation recall happens when the chemotherapy is administered within two months of radiation, but it’s possible for it to occur after a longer period of time as well.
Chronic radiation dermatitis is the big bad wolf of radiation-induced skin changes, because it’s less likely to repair itself, and more likely to result in permanent skin changes like fibrosis, hypopigmentation, and atrophy. It can even lead to a secondary skin cancer, especially if the dose was high or the patient’s radiation treatment happened at a young age.
What percent of people have skin rashes during radiation treatment?
Unfortunately, up to 85-95% of people have some form of radiation dermatitis. Considering that up to 70% of people with cancer end up needing radiation, and the fact that about two million people a year in the US get diagnosed with cancer, we’re looking at almost 1.2 million people in the US each year who could be dealing with a skin rash during cancer treatment. That’s a lot of unhappy skin. :(
A few factors that increase your chances of radiation dermatitis include female sex, advanced age, chronic sun exposure, smoking, and other systemic illnesses like diabetes and chronic stress. And, of course, the higher the dose of radiation, the greater the chance of having a more serious skin reaction.
How can I prepare my skin for cancer treatment?
There is no magic pill here, but there a few things you can do to support your skin before you start treatment to minimize your chances of skin problems, or reduce their severity if it does happen. The most important thing you can do is have healthy skin going into treatment. Daily washing with a gentle soap and water is a great way to prepare for treatment, as well as using an unscented body oil or body mousse on wet skin to fortify your skin’s barrier function in preparation for treatment. Additionally, paying great attention to your nutrition and hydration prior to treatment can help prepare not only your skin, but your entire system for treatment.
Another thing to note is that if you have a history of eczema, it can get much worse during cancer treatment. It’s a good idea to try to get your eczema under good control before your treatment begins, which you may be able to do with a few simple changes.
Talk with your healthcare provider to ask if the use of a steroid cream or ointment could be helpful prior to treatment. While it’s wise to use steroids sparingly given the chance of rebound dermatitis, there is some evidence to show that pre-treatment with a topical steroid can help reduce the severity of radiation dermatitis.
How do you treat skin rashes during cancer treatment?
In a word, gently!
I generally recommend using simple, unscented products (not even essential oils), and avoiding ingredients like sodium lauryl/laureth sulfate and synthetic fragrance, both of which can make your skin more susceptible to irritation. Take a look at your laundry detergent, shampoo, toothpaste, and hand soap to make sure they’re free of those two ingredients as well. Osmia’s Unscented Skincare Collection is a great place to start, and our Cancer Care Package is a really nourishing group of products to help keep skin happy during treatment.
In case you’re thinking about slathering your skin in diaper cream after radiation treatment, which would be a reasonable thing to think, don’t do it! It turns out that creams or treatments with metals like zinc and aluminum can actually increase the dose of radiation to the surface of the skin, which could make the dermatitis worse. Opt for a balm that does not contain any metallic ingredients instead. Another thing that could make your rash worse is using powders to dry the irritated areas, so keep the areas clean and dry, but don't use powder to try to dry it out more.
How else can I support my skin during cancer treatment?
Other than the products you’re using on your skin and in your home, here are a few simple things than can be helpful:
- Wear loose fitting, soft clothing
- Avoid super hot showers or baths
- Do not exfoliate or shave any irritated or sensitive skin
- Wear hats, sunglasses, protective clothing, and sunscreen when outdoors
- Continue to pay attention to nutrition and hydration the best you can during treatment to nourish your skin from the inside
Can I use essential oils on my skin during cancer treatment?
It depends on how your skin is doing. Don’t ever use undiluted essentials on your skin, and if your skin is upset, avoid them entirely. If you want a little aromatherapy along the way and your skin is doing well, you can use a properly-formulated face wash, serum, body oil, or hand cream with a low dose of essential oils. If you experience any irritation, go back to using unscented products until you’re a few months out from your last treatment.
I hope this information helps you or a loved one take great care of your skin during cancer treatment. Cancer sucks, but skincare during cancer treatment doesn’t have to. Again, please email us if we can help!
Resources:
Acute and Chronic Cutaneous Reactions to Ionizing Radiation Therapy