Skin Care During Cancer Treatment

Every medical treatment involves a surgical procedure or use of chemical agents as drugs or X-rays for radiation treatment for cancer. As human body gets exposed to these agents or a surgical procedure, some of them may cause

Not everyone faces the same side-effects from cancer treatment modes like surgery, chemotherapy or radiation. The severity of the side-effects also differs from person to person. The most common side-effects reported by patients include appetite changes, nausea, vomiting, hair loss, fatigue, anemia, constipation, diarrhea, changes in colour of skin and mood changes, among others. In this post, we focus on skin problems that might crop up during chemotherapy and radiotherapy and how to deal with them. 

Skin is the largest organ in our body. It acts as a barrier to external harm in the form of bacteria and other microorganisms, irritants like dust, chemicals, radiation and temperature. Therefore, skin care is not just about aesthetics but is integral to our health and wellbeing. 

While skin care is essential for everyone, it can be particularly important for those undergoing treatment for cancer. This is because the different chemo drugs or the radiation treatment or the combination of radiation and chemotherapy used for treatment can adversely affect the skin. 

How Chemo Can Affect Your Skin 

The most common skin reactions to some chemotherapy drugs  involve dryness, darkening of the skin and rashes. Some patients may also experience acne and itching in the first two weeks of treatment. Certain drugs used in chemotherapy may cause your skin to be sensitive to sunlight, resulting in sunburn even after minimal sun exposure. 

Light skin may turn red and dark skin may turn even darker, or gray. Allergies may develop, with sudden and severe itchiness, causing a rash to appear. Sometimes, by the third or fourth session of chemotherapy, folliculitis may develop, however, this is a rare event. Folliculitis refers to an infection in the hair follicles on the skin.  

The reasons for such varied and severe skin problems during chemo can be several. 

• To begin with, treatment is aimed at destroying cancer cells. But in the process, it also damages some healthy cells. Chemo may cause a reduction in the secretion of sebum from glands in the skin. Sebum keeps the skin and hair moist. With reduced secretion, the skin tends to get dry and aggravated dryness leads to a plethora of other symptoms as mentioned above.  
• Certain drugs used in chemotherapy cause blood capillaries to dilate, leading to a sudden redness in the face and neck. This is commonly referred to as flushing. 
• Some drugs cause hyperpigmentation of the skin. Hyperpigmentation is a condition where certain or all portions of the skin get darker and uneven in colour. 
• Chemo may also cause skin to become photosensitive, which means that the harmful effects of the sun through UV rays are magnified as the skin becomes more sensitive to these. 
• Bone marrow transplant or any other organ transplants require suppression of the body’s immune system. This could mean the skin becomes susceptible to more infections than usual. 
• Drug allergies may also lead to redness and itching of the skin.

How Radiotherapy Can Affect Your Skin

Radiotherapy is known to cause redness of skin, leading to spread and flaking. In some cases, peeling skin and skin ulcers may also appear. If you have dark skin, it might get darker. Radiation is delivered locally to the specified site, so skin changes occur only in the area receiving the radiation. You might also notice redness on the skin at the other side of your body to the treatment area. 

 This also depends on the skin health of the patient before treatment. Studies suggest that genetics may also play a role in the severity of the skin reactions. Groups at higher risk of developing skin reactions include people above the age of 60 years, those receiving concurrent chemotherapy, malnourished patients, patients with poor skin strength, or those suffering from diabetes and renal failure. 

While it is difficult to predict how severe your skin reaction to radiation is going to be, it is generally observed that the severity depends on the dosage of radiation administered, the duration of the treatment and the area of skin under treatment. Certain areas like the neck, head, breast, vulva or near the anus are prone to more severe skin reactions than other areas of the body.  

Grades of Radiation Dermatitis

Radiation dermatitis refers to the side-effect of external beam ionizing radiation on the skin. It may also be referred to as radiation burn or radiation skin damage. Depending on the grade of damage, the treatment for radiation dermatitis will vary.

Grade 1:

You may notice faint redness on your skin and the skin might begin to peel as well. There might be mild tightness of skin and itching. 

Prevention: 

• Avoid all petroleum products or baby powder in the affected area.
• Wear loose fitting clothes made of breathable fabrics.
• Avoid using adhesive tapes on the area. 
• Do not subject the area to extreme hot or cold temperatures, example: use of heating pads, or ice packs, hot showers etc

Treatment:

Your doctor might prescribe a paracetamol or aspirin depending on need. You may also be asked to apply an aqueous cream twice or more, daily. Avoid sun exposure to area being treated.

Grade 2:

There will be swelling of the skin, along with moderate redness. You might also notice that your skin is thinning on the skin folds. 

Prevention:

• You may be asked to use room temperature saline compress multiple times a day. 
• Hydrogels may also help prevent the area from dryness. 
• To prevent infection, your doctor might prescribe anti-bacterial and anti-fungal ointments depending on clinical assessment.
• Always practice hand hygiene before applying any ointment to the area.  

Treatment:

You may be asked to take pain medications for relief. Apart from an aqueous cream, you may also be recommended some steroid-based cream, as long as there is no broken skin. Do not use any ointment or medicine without physician advise.

Grade 3:

You will see that your skin is thinning and not just on the skin folds. The swelling will also be severe. You might notice yellow or pale green secretions from your skin, along with soreness. The superficial layer of skin might get off sometimes.

Prevention: 

• Hydrocolloid or silicon dressing will need to be used, as appropriate. 
• Regular follow-up and checking for infection on wounds will be required. 

Treatment:

Your doctor might have to dress the affected areas to help the skin recover. He/She might prescribe a local antibiotic ointment or aqueous gel for relief. 

Grade 4:

You will experience deep skin ulcers and spontaneous bleeding from the skin. Your oncologists will need to decide on further courses of action.

Prevention First

The best way to tackle all of the above skin-related issues is to start your skincare regime even before you start with treatment. 

Begin by identifying all the products in your bathroom that are alcohol-based or fragrant. This includes soaps, bath gels, handwash, shaving creams, after-shave lotions, deodorants and perfumes. Replace these with products that are alcohol-free, fragrance-free and if possible, soap-free. Alcohol can cause dryness and it would be best to replace these products while your skin is still healthy so that you know which ones work best for you. 

During Treatment

Here are some ideas to build your own personalized skincare routine to minimize the damage to your skin during chemo.

• At night, try to sleep straight on your back, using the support of a pillow to slightly raise your head. This should prevent puffiness of the face and around the eyes in the morning. 
• Bathe in lukewarm or cool water, avoiding hot showers. Do not stay more than five minutes in the bath. A long or hot bath can dry the skin further. 
• Restrict your bath to one or two per day. Use a mild, soap-free cleaning agent for your body.
• After your bath, pat your skin dry using a soft towel. Avoid rubbing your skin lest you irritate it. 
• If you are getting treated on face and neck region, avoid shaving or, if you cannot avoid it completely, shave less often than you used to.  Trimming is a good option.
• Within 15 minutes of your bath, apply a moisturizer. Pick one that is a cream or an ointment as these are thicker than lotions. The thicker the moisturiser, the longer it is likely to last. 
• Use hand cream after washing your hands during the day. 
• Choose loose fitting clothes that do not rub against your skin but allow for the passage of air. 
• If you are stepping out in the sun, choose to cover up with long sleeves. Use a sunscreen lotion that is 30 SPF and protects against both UVA and UVB. Consider using a wide-brimmed hat to protect yourself from direct sunlight. 
• Consider wearing loose-fitted clothing, made of comfortable fabrics like cotton, to prevent any skin irritation that might result from wearing tight clothes or synthetic fabrics. 
• Creams with ammonium lactate are also sold over the counter at medical shops. These can be used for excessively dry or flaky skin. 
• Your doctor can prescribe steroid-based creams to soothe your skin. 
• Drink 8 -10 glasses of water to keep your skin hydrated, unless your doctor has advised you to reduce water consumption. 

Open Sores:

If you have undergone radiation already, you might find that the concerned area reacts further to the drugs of chemotherapy. Blisters or sores may develop and need to be observed to prevent infection from developing. Open sores should be cleaned and covered with a bandage.

Laundry:

Use a mild detergent for your clothes to avoid aggravating your skin condition. Avoid anything that includes fragrance and anything that contains dyes. Use cotton clothing if possible, but ensure that you are suitably dressed for the weather. 

Nails:

You may notice discoloration or malformation of nails. Trim your nails to keep them clean. Wear gloves in cold weather or when during manual work like cleaning or gardening. Do not use nail polishes or artificial nails till the nails grow back normally. If you notice any infections in the nail bed, consult your doctor for antibiotic treatment. 

Make-up:

You may feel the need to use make-up to cover up any discoloration of skin, rashes etc. To avoid infection, it is best you buy new make-up products to be used during chemo, and discard them afterwards, replacing them with fresh products. 

Silicon based primers will help you get an even texture to your skin before you apply make-up. A cream-based concealer will hide any discoloration or redness. 

Avoid any products that have alcohol in them. Pick creams instead of powder-based products. If you need a powder make-up, pick mineral powders. Choose a tinted lip balm over matte lipsticks that might dry out your lips. Pick a lip balm that is also a sunscreen. 

Wellness is Skin-deep

Skin care is not just about hygiene but also about confidence and wellbeing. Treating your skin well can be a way to pamper yourself and lift your spirits daily. Spend the time to take care of your skin, so that you look good externally, while your body recovers internally.