Many cancer treatments, including chemotherapy, radiation therapy, immunotherapy, targeted therapy and stem cell transplant, may cause side effects that lead to skin issues, such as a rash, dry or itchy skin, color changes or extreme sensitivity to light. Some skin problems resolve themselves after you finish treatment. Other issues may linger.
Chemo rash
“Chemo rash” simply refers to the various types of rashes that may develop in response to cancer treatment. In fact, not only chemotherapy, but also targeted therapy, immunotherapy, radiation therapy and bone marrow transplant may cause a rash. It tends to look like acne or measles, and in some cases, it’s a sign that your treatment is working.
Chemo rash prevention
Though a rash is a common side effect of cancer treatment, making some changes to your routine, while you’re in treatment, may help you avoid this side effect, including:
- Bathe with a mild, low-pH cleanser.
- Wash your skin gently, don’t scrub. Avoid abrasive cloths, sponges and products.
- Use a gentle, unscented moisturizer.
- Avoid fragrances in products that touch your skin, including dishwashing liquid and laundry detergent. Choose gentle, unscented, mild formulations.
- Avoid the sun as much as possible.
- When you must spend time in the sun, wear at least SPF 30 sunscreen, sunglasses, a wide-brimmed hat and loose clothes that cover your skin.
Itchy skin
Some patients experience a persistent itch in response to treatment, including chemotherapy, radiation therapy, targeted therapy and immunotherapy. Severely itchy skin may make you restless and anxious. By continually scratching, you may also cause sores that make you vulnerable to infections.
Some patients find relief on their own. Some changes to your bathing habits, skin care practices and daily routine may help.
When bathing:
- Use warm water rather than hot.
- Add baking soda, bath oil or oatmeal in a cloth or mesh bag to your bath.
- Bathe gently with mild, unscented products and a soft cloth.
- Gently pat yourself dry; don’t rub.
After you bathe:
- Replace deodorant with baking soda.
- Use only unscented, alcohol-free products on your skin.
- Shave with an electric razor rather than a blade.
- Apply unscented, alcohol-free skin cream two to three times a day, especially when your skin is still damp. Ask your pharmacist or your care team for creams that are safe. They may recommend products with menthol, camphor or pramoxine.
In your day-to-day routine:
- Keep your home well ventilated and the temperature set to a cool 60° to 70° F to avoid sweating.
- Wear loose-fitting soft clothes that won’t irritate your skin.
- Drink plenty of water and other fluids.
- Get enough sleep. If the itch keeps you up at night, ask your care team or your pharmacist about whether you should take antihistamines.
You can also take these steps to try to curb the scratching:
- Apply cool, wet packs to the itchy areas. Crush ice into a plastic bag and wrap it in a towel. Leave it on your skin until the ice melts. Repeat as needed.
- Keep your nails clean and short to reduce damage to your skin when you can’t help but scratch.
- If you find yourself scratching without noticing, consider wearing soft gloves.
- Instead of scratching the itch, try rubbing, vibration or pressure to avoid breaking the skin.
- Get your mind off the itch by reading, watching TV, listening to music or engaging in social activities.
- Take anti-itch medications as directed.
Ask your care team for more tips and advice. Your doctor may also be able to prescribe medications and recommend over-the-counter remedies.
If you experience these other signs and symptoms that may come with treatment-related itch, contact your care team:
- Dry, red, rough, flaky skin
- Yellowing of your skin or the whites of your eyes
- Rash or bumps
- Scratch marks
- Skin sores
- Scratching when you don’t even realize it
Dry skin
If your treatment plan includes chemotherapy, radiation, targeted therapy or stem cell transplant, you may experience very dry skin―with or without an itch.
Extremely dry skin sometimes looks like normal skin, but it may also be red, rough and flaky. You may see cracks in your skin, and it may bleed slightly in the lines and creases over knuckles and elbows―some common signs of the type of dry skin that cancer treatment may cause.
To soothe severely dry skin, you’d take the same steps you would to relieve itch and prevent chemo rash.
When bathing:
- Use warm water, not hot.
- Don’t scrub or rub too hard.
- Avoid abrasive products, cloths and sponges.
- Add mineral or baby oil to your bath water or put it on after showering when your skin is still damp.
- Pat yourself dry; don’t rub.
After you bathe:
- Use an alcohol-free moisturizer twice a day, especially after a bath or shower, when your skin is still damp.
- For extremely dry and cracked skin, use moisturizers with ingredients that help your skin retain water, such as salicylic acid, urea, ammonium or lactic acid.
- Avoid any skin care products that contain alcohol.
- Shave with an electric razor rather than a blade.
In your day-to-day routine:
- Ask your cancer care team how much water or other liquid beverage is safe to drink. If it’s safe to do so, drink two to three quarts each day.
- Avoid heat, especially dry heat.
- Protect your skin from cold and wind.
Ask your cancer care team for any other recommendations they may have to help you relieve your dry skin.
Skin color changes
Cancer treatment, tumor growth and sun exposure may cause changes in skin color. Some color changes go away within about six months; others may be last years after treatment.
Potential skin color changes include:
- Yellowing of the skin and whites of the eyes
- Areas of blue or purple skin that look like bruises but have no known cause
- Very pale or bluish skin, lips or nail beds
- Redness
You may also experience these skin color changes:
- Dark orange to brown urine
- Swelling in the discolored area
- Itching
As you do with dry and itchy skin, be gentle with the affected areas. Make sure you:
- Clean the area gently with warm water, gentle soap and a soft cloth.
- Pat the area dry; don’t rub.
- Keep your skin moisturized with products that your care team recommends.
- Wear loose-fitting, soft clothes.
- Apply medications to your skin as directed.
- Protect all areas of your skin from the sun with sunscreen of SPF 30 or higher and by wearing long sleeves, sunglasses and a wide-brimmed hat.
- Protect the discolored area from heat and cold.
Call your cancer care team if you experience:
- Yellowish skin or whites of your eyes
- Urine that stays brown or orange for more than a day
- White or gray stool for two or more bowel movements
- Severe itching
- Bruises that last longer than a week
- New bruises for three consecutive days
- Pink or red patches or rashes on your skin
Skin care after radiation therapy
Like other cancer treatments, radiation therapy may also cause skin-related side effects. But it may take a few weeks or longer after treatment starts before you experience them. Any skin problems you experience should clear up within a few weeks of your last radiation treatment.
Radiation dermatitis, the clinical name for the rash some patients develop during radiation treatment, usually appears on the skin in the area where you received radiation, typically within 90 days of starting treatment. The severity depends on where you received the radiation, the size of the area, how much radiation you got and for how long. The rash may cause ulcers and red, peeling, dry skin.
Proper skin care during and after radiation therapy may help you avoid this side effect or at least prevent symptoms from worsening.
Throughout your radiation treatment, follow these tips:
In the bath:
- Be gentle with your skin. Use a soft cloth and gentle, low-pH products.
- Don’t scrub, and make sure to leave the marks on your skin left by the radiation oncologist.
- Avoid shaving.
- Apply moisturizer daily as directed by your care team. Don’t put moisturizer on open wounds.
Getting dressed:
- Take care of any radiation-related wounds and sores as directed.
- Don’t put anything sticky, such as surgical tape or adhesive bandages, on your skin.
- Use fragrance-free products.
- Skip antiperspirant and talcum powder. You may use non-antiperspirant deodorant as long as it doesn’t irritate your skin.
- Wear loose-fitting clothing to avoid irritating the treated area.
Leisure time:
- Cover the treated area with sun-protective clothing.
- Use the sunscreen that your care team recommends.
- Stay in the shade when outdoors.
- Don’t use hot tubs or tanning beds.
- Bundle up when you have to go outside in near-freezing temperatures, but limit your time outdoors.
At home:
- Don’t put anything hot or cold, such as heating pads or ice packs, on your treated skin.
- Protect treated skin when you do chores. For example, if your hands were treated, wear rubber gloves to wash dishes.
After you’ve finished radiation therapy, continue to protect the treated area from the sun. Closely watch your treated skin for changes, such as redness or a rash, and report these symptoms to your care team. Also, make an appointment to see a dermatologist who can monitor your skin for changes, too.
Skin care after chemotherapy
The most common skin-related side effects of chemotherapy, and other treatments, are redness and dryness.
Radiation recall
Rarely, patients who receive chemotherapy immediately following or during radiation therapy may develop a more serious skin-related side effect called radiation recall, a sunburn-like rash that develops on radiated areas after the patient has had chemotherapy.
Radiation recall may cause:
- Redness
- Swelling
- Pain and tenderness
- Blisters and wet sores
- Peeling skin
- Discoloration after the skin heals
In some cases, the rash may be severe enough that patients have to stop chemotherapy until it heals. To treat this skin condition, your care team will likely prescribe medicine to reduce the inflammation so that you can resume your chemotherapy regimen.
You can help the healing process by taking these steps:
- Stay out of the sun.
- Use sunscreen when you can’t avoid the sun.
- Avoid tanning beds.
- Wear loose-fitting clothes to avoid further irritating your skin.
- Use gentle, unscented, alcohol-free products on your skin.
To ease the pain and soothe your skin while it heals, try these remedies:
- NSAIDS, such as ibuprofen or naproxen, or corticosteroids to reduce swelling, inflammation and pain
- Steroid creams to reduce swelling and inflammation
- Lotions or gels to moisturize skin and prevent drying and cracking
- Cool compresses on the affected areas
Photosensitivity
Several cancer treatments, including some types of chemotherapy, radiation therapy and stem cell transplant, may make your skin more sensitive to light. After you’ve had these treatments, you may need additional protection from the sun to prevent sunburn when you are outdoors.
Make sure to:
- Wear long sleeves, long pants and a wide-brimmed hat to protect your skin from the sun, especially from 10 am to 4 pm.
- Use a broad-spectrum sunscreen (to protect against both UVA and UVB rays) of at least SPF 15 generously and reapply at least every two hours.
