Skin problems

Some cancer treatments can cause skin problems, for example, red or itchy skin. Most skin problems go away once cancer treatment finishes, but you may need to manage them during treatment. Some skin problems need to be treated right away so that they don't become serious or cause permanent damage.

Cancer treatments that can cause skin problems include:

• radiation therapy
• chemotherapy
• targeted therapy
• immunotherapy
• 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.

During radiation therapy, your skin in the treatment area may look and feel like it is sunburned. How red and irritated the skin gets depends on many factors, but also on the dose of radiation and how sensitive your skin cells are to the radiation.

Treat skin exposed to radiation with extra care. Use mild soaps and wash your skin gently. Ask your healthcare team which skin care products you can use.

Itching is also called pruritis. Causes of itching include:

• certain cancers such as leukemia, lymphoma and myeloma
• kidney, liver or thyroid problems
• drug reactions
• dry skin
• rash
• skin infections
• hives

Hives can also be a sign of an allergic reaction, so it's important that you speak with your healthcare team about them right away.

Itching caused by chemotherapy or immunotherapy usually goes away once your treatments are finished. If itching is severe, your healthcare team may lower the dose of the drug or stop it for a time.

If you develop severe, constant itching, you may not be able to sleep very well and feel jumpy or restless. If you scratch your skin too much, it can make it sore and more easily infected.

Try the following ways to relieve itching and prevent skin breakdown:

• Bathe in cool water.
• Apply moisturizer many times a day to the affected area.
• Try not to scratch. Try to distract yourself with music, imagery or relaxation techniques.
• Keep your nails short and clean to avoid cuts and infections from scratching.
• Apply cool, moist compresses to itchy areas.
• 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.
• Wash sheets and towels in gentle laundry soap.
• Avoid perfumes, cosmetics, deodorants and starch-based powders.

Your healthcare team may suggest medicated creams, gels or ointments, corticosteroids or antihistamines to help soothe the itching.

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 ways to reduce the dryness and prevent skin breakdown:

• Don't pick or scratch at the area on your skin.
• When showering, use a gentle soap and warm water rather than hot water.
• Use a moisturizer frequently. Apply the moisturizer when your skin is still a little wet. This will help it hold in some of the moisture.
• 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.
• Wear loose-fitting clothing that doesn't rub on the skin.

Your healthcare team may suggest that you:

• Use a special barrier cream. Barrier creams are a type of thick skin cream that protects and holds moisture in your skin.
• Use saline soaks on the area. This means using a cloth that is dampened with salt (saline) water on the area that is dry or sore. Your healthcare team will give you instructions on how to make saline water at home.

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. The moist reaction should go away 2 to 3 weeks after treatment.

During treatment, try to keep your skin as dry as possible and free from infection until it heals. Your healthcare team may suggest using saline soaks every day to help avoid infection in an area that is oozing fluid.

Skin in the radiation treatment area can become swollen, or 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. The swelling will go away after radiation treatment is finished.

Some anticancer drugs, especially targeted therapy and immunotherapy drugs, can cause a mild rash. The chance of developing a rash is higher if you are taking targeted therapy that includes monoclonal antibodies or immunotherapy that includes checkpoint inhibitors drugs.

The rash usually happens within 1 to 2 weeks of starting treatment. It usually starts on your 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, and you may get tender pimples and pus bumps. The rash can itch, burn, sting or feel very tender when touched. This rash may look like acne, but it needs to be treated differently.

During treatment, the rash may get better, stay the same or get worse for a short time. It usually goes away about a month after you have finished treatment.

Your healthcare team will suggest ways to help you manage a rash caused by targeted therapy or immunotherapy drugs. Topical therapy uses a cream or gel to put drugs directly on the skin. 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 makeup that can cover the rash without making it worse.

You can also take steps to protect your skin and avoid getting a rash:

• Avoid being out in the sun. When you do go outside, use a broad-spectrum sunscreen that has zinc oxide or titanium dioxide.
• Bathe with cool or lukewarm water rather than hot water. Use mild soaps.
• Use skin products such as facial cleaners that are water based and do not have alcohol. This will help lessen dryness. Use moisturizing creams that have 5% to 10% urea. Avoid lotions and creams that have irritants such as alcohol, perfume or dye.

When some chemotherapy drugs are given into a vein (intravenously), they can cause your skin and veins to become discoloured or darker. These skin colour changes can be widespread or only in certain areas 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 hair may turn darker or become curlier.

We don't know 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 are common during chemotherapy. These changes include:

• yellowing
• brittleness and cracking
• lines across the nail
• partial separation of nail from the nail bed
• darkening

Darkening will happen evenly across the nail if chemotherapy is given continuously. It will happen 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 happen in the big toes and thumbs. The cracks and 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.

Your healthcare team can suggest ways to manage changes to your fingernails and toenails. They may suggest that you use ice baths for your hands and feet. 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 or a liquid bandage.

These tips can help you protect your nails:

• Wear gloves when you are doing household chores or gardening.
• Don't use nail polish remover that has alcohol.
• Keep your nails short to avoid breaking and chipping.
• Use a moisturizer around the cuticles to prevent tearing and bleeding. Also try using lip balm to moisturize your cuticles.

Some chemotherapy drugs may make the skin more sensitive to sunlight. This is called photosensitivity. It looks like a sunburn and can happen after being in the sun even for a very short time.

Photosensitivity can continue for a few months after treatment is finished so it is important to protect yourself from the sun during this time.

During radiation therapy you should cover your skin in the treatment area to stop it from being exposed to the sun. After treatment has finished you should use a sunscreen of SPF 30 or higher, as the skin that had radiation therapy may still burn easily.

Some chemotherapy drugs can cause different problems to your eyes, including:

• a burning feeling in the eyes
• dry or red eyes
• tearing
• tender or swollen eyelids
• crusting
• eyelids that turn inward or outward
• changes to vision
• cataracts
• sensitivity to light
• changes to eye colour

Radiation therapy can also cause eye problems, especially treatments that are close to the eyes.

Tell your healthcare team if you are having problems with your eyes. Many eye problems caused by treatment can be helped by changing the dose of the drug or by stopping treatment for a while.

Find out more about vision changes.

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
• swelling
• redness
• tingling or numbness
• blistering
• peeling of the skin

If you have these symptoms, your healthcare team may need to lower the dose of chemotherapy or targeted therapy. Treatments may have to be stopped altogether if symptoms are severe. When your symptoms improve, treatment can start again, but your healthcare team may lower the dose.

These tips can help you manage the symptoms of hand-foot syndrome:

• Avoid high temperatures and hot baths on the day you receive therapy and for 5 days afterward.
• Reduce any 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.
• Use lots of skin care lotion on your 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 happen when some chemotherapy drugs are given after radiation therapy treatment is finished. Several different chemotherapy drugs, such as doxorubicin or paclitaxel, are known to cause radiation recall.

Radiation recall 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 you have finished radiation treatments.

Tell your healthcare team if you have symptoms of radiation recall. They may stop the chemotherapy treatment until your skin heals. You may be given creams or medicines to help decrease the swelling and pain.

These tips can help you manage radiation recall:

• Keep your skin moist by using skin lotions or gels. Check with your healthcare team about which ones to use.
• Use gentle soaps to wash your skin.
• Don't use lotions that have perfume or alcohol.
• Use a cool compress on the area to help with pain.

Sometimes chemotherapy drugs 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:

• redness
• swelling
• pain
• burning
• stinging

In some cases, extravasation can cause severe damage to the skin and surrounding soft tissue.

Extravasation usually happens when the drug is given into a vein. Tell your healthcare team right away if you start feeling pain, burning or swelling around the intravenous (IV) site when you are getting the drug. 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.

Stevens-Johnson syndrome and toxic epidermal necrolysis are very rare but serious skin reactions to medicines, including chemotherapy, targeted therapy and immunotherapy drugs.

These syndromes usually start with flu-like symptoms, including a high fever, headaches, joint pain, cough and malaise. Other symptoms start to appear in a few days, including:

• red or purplish rash that starts to spread
• large blisters that burst, leaving painful, raw areas on the skin
• swelling of the face and lips
• inflamed and sore eyes (conjunctivitis)
• blisters and ulcers on the mucous membranes of the body, including the mouth, throat, eyelids and genitals

Other symptoms will depend on which part of the body has developed the rash and blisters:

• Mouth and throat sores can cause problems with breathing and swallowing.
• Eye symptoms can lead to pain, discharge and vision loss.
• Genital symptoms include pain and difficulty urinating (peeing).
• Gastrointestinal symptoms include diarrhea or black or tarry stools (poop).

The difference between Stevens-Johnson syndrome and toxic epidermal necrolysis is the amount of the body affected by the symptoms. Stevens-Johnson syndrome affects less skin area. But both of these conditions are a medical emergency that can be life-threatening because of the death of the skin tissues.

Your healthcare team will admit you to hospital for treatment, and the drug causing the symptoms will be stopped. You may receive treatments like those used for burns, pain control and prevention of infection.