When preparing for cancer treatment, patients often focus on managing side effects like fatigue and nausea, however, chemotherapy, radiation, and other cancer therapies can also significantly impact skin health. According to Dr. Sam Awan of U.S. Dermatology Partners McKinney, “Cancer treatments commonly disrupt the skin barrier, leading to increased dryness, itching, rashes, and delayed wound healing. These changes can raise the risk of infection and discomfort if not properly addressed. Working with a dermatologist during treatment can help patients protect their skin, manage side effects, and support healing throughout the course of care.”
In this blog, Dr. Awan explains the impact of chemotherapy, immunotherapy, and radiation on skin and outlines dermatologic treatments and daily skincare routines to keep skin healthy and minimize complications during cancer treatment.
Why Cancer Treatments Affect the Skin
Cancer treatments like chemotherapy, immunotherapy radiation profoundly affect skin health. While everyone has a unique response to treatments, some of the common ways that cancer treatments impact skin include:
- Damaged skin barrier – the outer layer of skin is essential to moisture retention and protecting skin from irritants, allergens, bacteria, and other environmental aggressors. Cancer treatments reduce the production of lipids that make up a significant portion of the skin’s barrier. These treatments may also damage the outer layers of skin. Barrier damage leads to increased skin dryness and sensitivity.
- Diminished skin cell turnover – healthy skin is constantly shed and replaced. Cancer and treatments for these conditions take a toll on overall health, including slowing the removal of damaged skin cells and the production of new, healthy cells. This can cause thinning skin, increased skin peeling and flaking, delayed healing, and increased skin reactivity.
- Increased inflammation – cancer treatments increase inflammatory signals to skin, leading to redness, sensitivity, itching, and rashes. Sensitive skin during cancer treatment is common, but there are skincare steps that reduce the effects of these conditions. Immunotherapy in particular works to fight off the cancer by activating a person’s immune system; these medications are extremely effective at battling cancer, but the activation of the immune system can lead to new skin rashes developing. Over the last 10 years, dermatologists and oncologists have worked together to study the pattern of these rashes.
“Twenty years ago, when targeted cancer therapies first emerged, we started seeing predictable rashes from these therapies in our cancer patients – and we realized that many of these rashes can be treated through simple interventions,” says Dr. Awan, a dermatologist in McKinney who specializes in treating cancer patients. “Now we have an entire field of oncodermatology – where dermatologists work to treat these skin side effects so cancer patients can stay on their cancer treatments as long as possible.”
Common Skin and Nail Side Effects During Cancer Therapy
While people respond differently to cancer treatments, some of the most common skin and nail side effects that occur during treatment include:
- Dryness, flaking, and peeling skin.
- Rough patches.
- Dull or ashen skin appearance.
- Cracking skin, which most often occurs on the lips, hands, and feet.
- More noticeable appearance of fine lines and wrinkles.
- Skin irritation, sensitivity, and rashes, including radiation dermatitis.
- Itching (pruritus) which can occur without or without a rash.
- Sun sensitivity that leads to faster or more severe sunburn, hyperpigmentation, or rashes after exposure.
- Warmth, tenderness or burning.
- Brittle or cracking nails.
- Nail darkening or discoloration.
- Ridges in nails.
- Lifting of nails from the nail bed.
Gentle Skincare Treatment During Treatment: The Do’s
According to Dr. Awan, “The best thing you can do for your skin before and during targeted therapy, chemotherapy, and immunotherapy is to develop a dedicated, daily skincare plan with your dermatologist. During cancer treatments, skin is vulnerable to a range of issues, so it’s important to maintain skin health and hydration throughout.” Skincare routines during cancer therapy should focus on calming skin irritation and inflammation, hydrating skin, and strengthening the protective barrier. A dermatologist can provide personalized skincare recommendations, but some basic chemo skincare tips include:
- Less is more – look for cleansers and other products that are free of fragrance, dyes, and other harsh ingredients. Products designed for sensitive skin are usually best. Even individuals with oily or acne-prone skin will likely see reduced oil production during chemotherapy, so avoid using harsh or abrasive cleansers and serums.
- Take care when cleansing – use a gentle cleanser once or twice a day. Use lukewarm or cool water and gently massage cleanser onto skin with hands. Then, rinse away all soap and pat skin dry.
- Keep skin hydrated – apply a thick, cream-based moisturizer in the evening to heal and soothe skin. In the morning, use the same cream moisturizer or a lighter moisturizing lotion if skin has excess oil. Look for skin barrier boosting ingredients like ceramides and petrolatum, soothing colloidal oatmeal, and long-term moisture boosting hyaluronic acid. Hydration is key to alleviating chemotherapy symptoms like skin dryness and itch. Urea is another excellent moisturizing ingredient that Dr. Awan commonly recommends to cancer patients, explaining, “I’ve found urea based moisturizers to be especially effective for the hands and feet.”
- Protect skin from sun damage – during chemotherapy and radiation, skin may be more susceptible to sun damage. It’s essential to minimize sun exposure, especially during peak hours between 10 am and 4 pm. Apply a broad-spectrum SPF 30+ sunscreen every day and reapply at least every two hours.
- Adjust your bathing routine – a nice hot shower or bath may feel great, but it can strip moisture and oils from skin, increasing dryness and irritation. Take shorter showers with lukewarm rather than hot water. Pat skin dry after bathing and apply a moisturizer right away to lock in hydration.
- Practice good nail hygiene – keep fingernails and toenails short and clean. Trim nails straight across and avoid damaging cuticles. Keep hands hydrated by applying moisturizer several times a day, especially after washing hands. Wear gloves to protect hands when cleaning, gardening, or washing dishes.
- Protect the hands and feet from trauma and friction – “Many targeted cancer therapies can cause hand and foot rashes that are induced by friction,” says Dr. Awan. “So it’s especially important for patients to moisturize regularly, wear gloves and socks to protect the skin barrier, and avoid unnecessary trauma or friction, especially in the first few months in therapy.”
Skincare Don’ts During Cancer Therapy
While it’s important to know how to care for your skin during cancer treatment, it’s also important to know what skincare products and steps should be avoided. Below, Dr. Awan outlines skincare don’ts during chemotherapy and radiation:
- Avoid harsh ingredients – don’t use scrubs and harsh exfoliant skincare products or tools like loofahs or brushes. These can damage skin’s already fragile protective barrier.
- Don’t use heavily fragranced products – lotions, soaps, laundry detergents, and other products that have fragrance can be irritating to skin.
- Skip alcohol-based products – toners and astringents with rubbing alcohol as an active ingredient are very drying, and they may be painful when applied to already damaged or irritated skin.
- Reduce shower time – don’t take long showers or baths as the heat increases skin redness, itch, and moisture loss.
- Minimize friction – jewelry, bags, belts, rough clothing fabrics, and other items that repeatedly rub against skin cause irritation. Take note of any irregular skin patches related to friction and remove the item causing concern.
- Don’t self-treat – rashes and wounds may get worse if treated with the wrong product. Consult your dermatologist or oncologist for product and treatment recommendations, especially for severe rashes.
As a simple example, Dr. Awan says, “EGFR inhibitors are a type of cancer medication that can cause a rash that looks like acne. So a common tendency is for patients to reach for over the counter acne washes and products with harsh ingredients, like benzoyl peroxide. While these are fine for patients with teenage acne, for EGFR-induced rashes, these harsh ingredients can damage the skin barrier and make itching worse. So it’s important to develop a personalized skincare routine with your dermatologist.”
Caring for Skin During Radiation Therapy
Dr. Awan says, “Radiation presents unique skin health concerns, specifically radiation dermatitis, a common skin condition that develops for those receiving radiation therapy. Radiation damages skin in the treated area. This leads to increased inflammation and difficulty healing damaged skin. Symptoms of radiation dermatitis develop gradually, but it’s important that patients let their oncologists and dermatologists know right away if they notice skin irritation at the treatment site. Radiation dermatitis is best managed when identified and treated early.” Radiation dermatitis requires gentle, consistent skincare to minimize symptoms. Specifically, Dr. Awan recommends:
- Prevent sun exposure on areas of skin treated with radiation.
- Don’t use hot or cold packs on radiation-treated skin unless approved by a physician.
- Don’t use adhesive bandages or medical tapes in the area.
- Wear loose-fitting clothing made from skin-friendly materials.
- Use skincare products approved by your oncology team to gently cleanse and moisturize the treated area.
- Avoid rubbing or using abrasive applicators when caring for skin.
- Use topical ointments and medications as prescribed.
- Report serious symptoms like blistering, sores, increasing pain, oozing, fever, or chills right away.
When to See a Dermatologist Urgently
While skin changes are common during chemotherapy and radiation, certain symptoms require prompt evaluation by a dermatologist care during chemotherapy, including:
- Rapidly spreading rashes.
- Painful skin changes.
- Signs of infection like warmth, swelling, redness, or pus.
- Peeling or areas of skin breakdown.
- Sores that aren’t healing, including inside the mouth
- Intense itch that isn’t alleviated with moisturizers.
- Nail changes like pain, oozing, or detachment.
How Dermatologists Help During Cancer Treatment
Cancer treatment often requires a multidisciplinary care team to address both systemic and treatment-related side effects. Dermatologists play an important role in managing skin changes caused by cancer therapy , helping reduce discomfort, prevent complications, and support skin healing throughout treatment. Seeing a dermatologist during cancer treatment can offer:
- Accurate diagnosis of skin reactions – some rashes and other skin reactions are not related to cancer treatments. It’s important to have an accurate diagnosis from a dermatologist to ensure treatments are effective and symptom relief is fast.
- Provide appropriate, targeted treatment – dermatologists tailor therapies to specific chemotherapy- or radiation-related skin conditions, minimizing unnecessary medications and reducing the risk of irritation or treatment interactions.
- Develop a coordinated care plan – Dermatologists work within a patient’s existing treatment regimen and healthcare team to create individualized skincare plans that account for skin type, symptom severity, and cancer-related therapies.
Manage Side Effects & Maintain Comfort
In conclusion, Dr. Awan says, “To minimize skin side effects of cancer therapy and maintain comfort throughout cancer treatments, it’s important to practice consistent, gentle skincare every day. Keep skin hydrated by moisturizing after showers and before bed. Minimize unnecessary trauma to the skin and protect your hands during simple daily activity like washing dishes. Skin side effects may be common for those undergoing cancer treatments, but patients should not have to endure ongoing pain or discomfort as part of their care. Dermatologists can help alleviate skin symptoms of cancer treatment, so you are comfortable and skin stays healthy.”
Schedule a Dermatology Consultation
If you notice negative side effects of cancer treatment reflected in your skin health, don’t hesitate to reach out to a dermatologist, like Dr. Awan, who specializes in a wide range of skin conditions and is dedicated to building lasting relationships with patients. To schedule an appointment with a U.S. Dermatology Partners location near you, take a few moments to complete our online scheduling request form. Once we hear from you, a dermatology team member will be in touch to finalize the details of your upcoming visit.
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