Cancer is a devastating disease, and the process to treat it can result in significant changes to the appearance that can be profoundly emotional. While we know that cancer therapies can result in hair loss, you may not realize just how much the skin can be affected by cancer treatments. We spoke to dermatologists to learn more about how cancer therapies can affect our skin and how to treat any issues that may arise.
What Happens to the Skin During Cancer Treatment?
There are a lot of side effects from cancer therapies, undoubtedly. When it comes to the skin, the kind of therapy that a patient is receiving can result in skin reactions like rashes to more long-term changes like skin firming and sensitivity to light.
Houston dermatologist Jennifer Segal, MD explains that skin changes are common for any type of cancer treatment. “There are myriad skin changes that occur with the medications used in cancer treatment, whether chemotherapy, immune therapy, or hormonal therapy,” Dr. Segal explains. “Sometimes there are specific skin reactions to the medications themselves. In general, however, the skin can become dry, itchy, and generally more sensitive.”
These general symptoms can occur in a lot of cancer treatment types, including chemotherapy.
You can also develop a localized reaction during radiation therapy, which is only in the treatment area. This is called radiation dermatitis, and has its own treatment needs. Radiation therapy damages the DNA of a cancer cell, but that means it also causes damage to our cells. This damage to healthy tissues results in dryness, peeling, and a loss of elasticity.
Additionally, cancer treatments can increase one’s sensitivity to sunlight, putting them at risk of absorbing too much of the sun’s UV rays, which could result in sunburns and even skin cancer. Chemotherapy increases a person’s overall sensitivity to light, but this effect is temporary. Radiation, on the other hand, only increases sensitivity in the areas directly treated, but that change in sensitivity can be permanent.
New York dermatologist Orit Markowitz, MD explains that a person’s skin type is just as important as the kind of treatment they’re receiving. “Similar to any skin issue, it really depends on the skin type,” Dr. Markowitz says. “For example, some people’s skin tends to scar or become firm with trauma.”
Nanuet, NY dermatologist Heidi Waldorf, MD notes radiation dermatitis is also more common in some skin types. “Radiation dermatitis is generally more common on darker or sun damaged skin,” Dr. Waldorf explains.
It’s also possible for your skin type to change altogether.
“Your skin type—dry or oily—may change and someone who used light or no moisturizer, may need heavier amounts,” Dr. Waldorf explains.
When it comes to easing some of these symptoms, protecting the skin barrier can help. “In general, dryness, sensitivity, risk of infection and increased sun-sensitivity are common,” Dr. Waldorf confirms. “You can help maintain the skin barrier by using mild, non-stripping cleansers.”
Gentle Skin Care
Your skin becomes more sensitive overall undergoing cancer therapies, so it is critical to practice a gentler skin care routine to keep your skin barrier strong and avoid causing more irritation.
“Gentle cleansing and nourishing and protecting the skin enhances healing and minimizes irritation,” Dr. Segal explains. “If there are open areas in the setting of radiation, I also like to add EltaMD Silver Gel, which is a wonderful wound care topical that prevents and treats skin infections.”
To avoid any further irritation, Dr. Segal adds that your hair and skin-care products should be fragrance-free. “I always recommend gentle skin care and avoidance of fragrances, which can be irritating in the setting of drier, more sensitive skin,” she says.
You may also need to look for alternatives for some skin care that previously worked for you, like retinoids or peels.
“If you were using a retinoid without problems, you may want to decrease the frequency until you see if you tolerate it during treatment,” Dr. Waldorf explains. “Don’t use at home peels unless approved by your doctor, some chemotherapies change your cell turnover and you can pull off too much and cause a burn-like result.”
Because a lot of cancer therapy is about eliminating bad cells, you may have to stop taking or using cell-protecting ingredients. “Don’t assume that you should use oral or topical antioxidants,” Dr. Waldorf warns. “Because the goal of chemotherapy is to damage the bad cells, your oncologist may not want you to use something that could potentially protect them.”
Sensitivity to Light
“Some cancer therapies can cause increased photosensitivity,” Dr. Waldorf explains. “Sun protection, including sunblock, hats, clothing and seeking shade midday are critical for all exposed skin.”
Chemotherapy and immunotherapies can cause drug-induced photosensitivity, which causes the body to increase its absorption of UV radiation. According to the Cancer Treatment Center of America, this sensitivity is not permanent, and usually wears off a few months after treatment ends.
Radiation therapy, on the other hand, is focused on the area the beam actually passed through. These areas may always be more sensitive to sunlight, even long after the treatment has concluded.
Dr. Waldorf, herself a breast cancer survivor, explains that the loss of hair caused by chemotherapy means expanding your sun protection to newly exposed skin. “Chemotherapy baldness requires special care since that skin may never have been exposed before,” Dr. Waldorf says. “As a second-generation dermatologist, sun protected since birth, I was an anomaly during chemotherapy for breast cancer 15 years ago: My scalp color matched my face,” Dr. Waldorf explains. “Sunscreen and a hat protected that skin when I wasn’t wearing a wig.”
“My recommendations for sunscreen are the same for cancer patients as for healthy folks,” Dr. Waldorf explains. “Choose a sunscreen with an SPF of at least 30 for UVB protection and a physical block, zinc oxide or titanium dioxide, for UVA protection.”
Treating Itchy and Dry Skin
When it comes to treating dry and itchy skin, Dr. Segal explains that cancer patients need to prioritize gentleness. “I always recommend a ‘gentle skin-care regimen to my patients undergoing cancer treatment,” Dr. Segal says. “Fragrances should be avoided since they can cause irritation and itching in more sensitive skin.”
Dr. Segal adds that moisture is critical to maintaining skin health while undergoing cancer treatment. “Patting dry after baths or showers and immediately moisturizing all over with a gentle moisturizer is important for nourishing and maintaining the skin barrier,” Dr. Segal says. “My favorite combination is Avéne Cleansing Oil with the Avéne emollient baume. I also love Cicalfate+ Cream for the face, and Cicalfate+ Spray which relieves itching.”
“There’s no need to purchase cancer-focused products,” Dr. Waldorf explains. “For particularly scaly, dry skin, look for a moisturizer that includes AHA like Amlactin 12%, Neostrata AHA, or CeraVe SA to help exfoliate and moisturize.”
When searching for effective moisturizers, be on the lookout for hydrating ingredients like hyaluronic acid and glycerin. These minimize water loss and can draw water from your environment to moisturize your skin.
Treating Radiation Dermatitis
There are some types of radiation therapy that are external, meaning that the beams have to pass through your skin to get to the cancer cells they’re meant to kill. This is common to treat lung and breast cancers, for example.
With external beam radiation, the skin cells can be harmed as the beam passes through them. According to the Cancer Treatment Center of America the result is often dryness, itchiness, swelling, and redness. There is even a chance of a “moist reaction,” where skin becomes wet, sore, and easily infected.
Because of the range of symptoms, it’s vital to talk through what could happen to your skin and what to do about it with your oncologist.
“Since radiation effects can range from darkness and scale to moist ulcers, its critical to speak with the radiation oncologist treating you before treatment begins and as symptoms arise because they have specific products to reduce and treat those effects,” Dr. Waldorf, who herself is a breast cancer survivor, explains. “Despite being a dermatologist, I followed the skin care instructions of my radiation oncologist.”
Treatments for radiation dermatitis are specific. Often, prescribed corticosteroids and antibiotics will be necessary, so you won’t be able to cure it by following basic dry or itchy skin care products. This can even include some products that are cancer-specific.
“No one should be applying Amlactin to radiation dermatitis,” Dr. Waldorf warns.
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