by Dr. C.H. Weaver M.D. 5/2022
Chemotherapy can be effective treatment for cancer but may also cause physical side effects that may be uncomfortable and affect your appearance. These side effects, however, are manageable.
Both chemotherapy and radiation therapy can cause dry skin. Management of dry skin includes using moisturizer, avoiding things that make the symptoms worse, and protecting your skin until it returns to normal.
Newer treatments are more likely to be responsible for causing more severe reactions to skin. Specifically, drugs
- Doxil® cause Hand/Foot Syndrome
- EGFR Inhibitors such as Erbitux® and Tarceva™, cause acneiform rash.
While these types of skin reactions can be mild to severe some are painful enough for a patient to lessen or stop treatment for a period of time. Management of these side effects, therefore, becomes imperative so that treatment can continue on schedule.
Radiation therapy, depending on different variables, can cause what’s known as radiation dermatitis, which will also vary in severity from person to person. Reactions vary from redness (mild), to flaking and itching (moderate), to peeling, seeping and pain (severe)—and all are characteristics of radiation dermatitis, depending upon strength and duration of treatment.
For lack of a better description for their condition many patients complain of overall dry skin while undergoing chemotherapy or radiation therapy.
Dry skin is really an understatement for what many people truly experience. Intense hydration of the skin is crucial for maximum maintenance of healthy skin while undergoing all treatment, and it is important to choose products that will best achieve this.
Many oncologists do not deal directly with these side effects and so don’t know what to offer in terms of a solution. It is usually left to the oncology nurse to answer patients’ questions and to offer solutions. Sometimes, oncologists will refer patients to a dermatologist, but they are not necessarily equipped to handle the skin care issues that accompany cancer treatments either. For that reason, it can be helpful to seek out skin care products developed specifically for cancer patients and their needs.
What is dry skin?
Dry skin is a lack or shortage of moisture in the skin, causing it to appear rough and scaly. It may feel tight and possibly itchy.
What causes dry skin?
There are many causes of dry skin, but for cancer patients, treatment is often a cause. Your skin cells are constantly renewing themselves by dividing rapidly in the deep layers and sloughing off the old cells at the surface. Both chemotherapy and radiation can disrupt this process, resulting in dry skin and other skin reactions.
Chemotherapy involves the use of drugs to destroy cancer cells. Chemotherapy works by destroying cells that grow rapidly, a characteristic of cancer cells. Unfortunately, chemotherapy also affects normal cells that grow rapidly, such as skin cells.
Radiation may also cause your skin to be dry and flaky. Skin reactions that are caused by radiation usually occur 2 to 3 weeks after radiation therapy begins and can take 4 to 6 weeks to heal.
Other factors that contribute to dry skin include:
- Extreme weather conditions
- Perfumed products
How can dry skin be managed?
Try the following tips for managing dry skin:
- Avoid long, hot showers and baths.
- Use only gentle, fragrance-free soaps and laundry detergents.
- For moisturizers, use creams or ointments instead of lotions; the thicker consistency may more effectively prevent dehydration.
- Apply moisturizers often, especially after showering or washing hands.
- If your skin is extremely dry and flaky, ask your doctor about ammonium lactate cream (prescription or over the counter).
- Be sure to use sunscreen (at least 30 SPF) when outdoors and reapply often.
- If your skin itches, ask your doctor about steroids or anesthetic medications (over-the-counter hydrocortisone creams may be too weak).
- If you plan to go swimming, ask your doctor first. Hot tubs should be avoided.
- Watch for signs of skin infection such as inflammation, open wounds, and discharge. See your doctor if this occurs.
- Drink plenty of fluids to keep your body well hydrated. Becoming dehydrated will cause your skin to dry out.
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- Use lotions, creams or oils frequently. These products prevent water loss by placing an oily substance over the skin to keep water in or by attracting water to the outer skin layer from the inner skin layer.
- Use products that are mild and do not have perfume. The chemicals that are responsible for fragrances may further irritate your skin.
Things to avoid:
- Any allergen; skin reactions are very common when you are exposed to something you are allergic to
- Perfumed skin products; perfumes can be allergens and the chemicals may further irritate your skin
- Friction or rubbing on your skin; dry yourself after bathing by patting instead of rubbing with a rough towel
- Long hot baths with bubble bath; try a cool bath and apply bath oil when you are finished
- Extreme weather such as hot/dry or cold/windy; these will make your dry skin worse
- Wear soft, non-binding clothes.
- Wash clothes in mild detergent.
- Wear gloves to protect your hands.
Possible effects of chemotherapy on the nails include nails becoming dry and brittle, developing lines and ridges, and darkening. Changes to the nails will go away, but it may take several months to do so. Chemotherapy drugs known as taxanes are often associated with nail problems. Taxanes, which are frequently used to treat breast, prostate, and lung cancer, include Taxol® (paclitaxel) and Taxotere® (docetaxel).
You may be able to protect your nails by wearing special cooling gloves and socks during the infusion of chemotherapy. Watch for signs of nail inflammation, especially open wounds and discharge; this could be a sign of infection. See your doctor if you suspect an infection.
Common Problems, Helpful Solutions
Problem: Overall Dryness/Excessive Rubbing
“I’m tired and sore from my treatments and I find it extremely painful to rub lotion on my skin…”
Tip: Look for lightweight lotions that are easy to slather on quickly while your skin is still damp from bathing. Damp skin will help transport the lotion more quickly across the skin surface and will help maintain moisture levels on skin that is already hydrated from bathing.
Problem: Severely Cracking Hands/Feet
“My hands and feet are so dry they are cracked and splitting and it’s painful…”
Tip: Find an unscented cream or lotion (preferably a heavier cream) that has basic moisturizing properties and is less oily. The real challenge is finding one that will help protect your skin, while not too oily. Ingredients with plant oils and especially glycerin are good choices.
Problem: Many Scents Are Intolerable
“I can hardly stand the smell of anything – even scents I usually enjoy are now nauseating…”
Tip: Avoid heavily perfumed products. While scent is a very personal choice, lavender is the most widely tolerated of those with soothing properties for many people. Sweet scents such as vanilla are often tough to tolerate during treatment. Scents to start your day and help invigorate tend toward light citrus or lavender.
Problem: Acneiform Rash
“My face has broken out in a terrible rash that looks like acne, but the dryness and itching are intolerable…”
Tip: While the rash appears like acne (thus the name acneiform rash), it is nothing like acne and shouldn’t be treated as acne at all. Drying potions will not help, and may possibly cause further irritation. Look for very light, hydrating face products that don’t contain Beta or Alpha Hydroxy acids, alcohol or mineral oil.
Problem: Cleanliness/Need for Extra Hygiene While on Treatment
“I find that I now need to bathe even more frequently but am very concerned about drying my skin out even more…”
Tip: This is a catch-22, as extra bathing can also cause extra dryness. It is important to use cleansers that are very mild. Choose very mild soaps and skin washes that have emollient properties.
Problem: Hair Loss/Dry Scalp/What to Use
“Due to treatment I’ve experienced hair loss and my scalp is very dry and itchy when I use shampoo…”
Tip: Use a super mild body wash that has emollients or moisturizers, such as glycerin. Keep scalp moisturized but use products that absorb well into the skin.