Side Effect Management - Skin & Nails

Skin and nail changes are a common side effect of cancer treatment that can typically be managed with some advanced preparation and special attention to these areas while going through treatment.

Your oncology team will guide you on what you’re most likely to experience based on the treatment(s) planned.

Keep reading for more information on:

Types of skin and nail changes you might expect
How you can prepare and manage skin and nail changes during cancer treatment
When you should contact your cancer care team for an evaluation

Types of Skin and Nail Problems During Cancer Treatment

Various cancer treatments can cause skin and nail problems for cancer patients, including:

Chemotherapy can cause damage to healthy cells while working to destroy cancer cells. This can include damage your typically fast-growing skin and nail cells.
- Skin may become dry, itchy, or red. It may also peel.
- Some people may develop a rash or sun sensitivity, which can make them extra vulnerable to sunburns.
- Nail changes may include dark, yellow, or cracked nails and/or cuticles that are red and hurt.
- In some cases, people who received radiation therapy prior to chemotherapy may experience skin changes on the part of the body that received radiation therapy. This is called radiation recall.
- Sores can appear on the skin and/or lips that aren’t caused by a cut or injury.
Radiation therapy, primarily external beam therapy such as IMRT or IGRT, can cause side effects similar to a sunburn. Patients may experience dryness, peeling, itching, and changes in color (skin may turn red or darker) of the skin. Skin may look sunburned or tan. It could also appear swollen or puffy.
Biological therapy, which includes immunotherapy, is a type of treatment that uses substances made from living organisms to treat the cancer. Patients may experience pain, swelling, soreness, redness, itchiness, and even a rash at the site of infusion or injection.
Targeted therapy, drugs or other substances that block the growth and spread of cancer by slowing or stopping the cells that form cancer from growing, may cause dry skin, acneiform rash (resembles acne), and nail problems. Certain side effects of some targeted therapies have been linked to patients having more success with their treatment. For example, patients who develop acneiform rash have tended to respond better to targeted therapy drugs than patients who do not develop the rash.

Some skin problems are much more serious and require immediate medical attention. Call your oncologist right away if you notice:

Sudden or severe itching, a rash, or hives that appear while you are receiving chemotherapy or immediately after. These may be signs of an allergic reaction.
Sores that appear without any other cause. Especially if they are painful, wet, and/or appear infected. This is called a moist reaction and may happen in areas where the skin folds, such as areas around your ears, breast, or bottom.
Swelling, redness, or any burning or pain near a surgery or procedure site, an IV, or a port.
Foul smell or drainage around the nail beds. Taxanes can cause nail infections.

Managing Skin and Nail Changes During Cancer Treatment

Below are suggestions on how to protect your skin, prevent infection, and reduce itching while going through cancer treatment. Your cancer care team can give recommendations on what could be most beneficial for you based on the type of treatment you are receiving.

Some steps you could take to manage skin and nail problems during cancer treatment may include:

Protect your skin while going through cancer treatment:

Use lotions, creams, or ointments for dry, itchy, infected, or swollen skin.
Don’t shave as often (or stop altogether) and consider switching to an electric razor, which can be easier on your skin.
Avoid using heating pads, ice packs, or bandages on the area receiving radiation therapy.
When outdoors, wear sunscreen (SPF 30 or higher) and SPF lip balm. If possible, cover up as much skin as you can with loose-fitting clothing and a hat with a wide brim.

Prevent or treat dry, itchy skin caused by cancer treatments:

Avoid skin care products with alcohol or perfume, which can irritate or dry out your skin. This also includes laundry detergent.
Keep showers or baths short and use lukewarm, not hot, water.
Add baking soda, oatmeal (in a cloth or mesh bag), or bath oil to bath water.
Try calamine lotion (Caladryl^®) or witch hazel to soothe itching, but be aware that they can dry the skin.
Avoid scrubbing the skin during bathing and gently pat the skin dry afterwards. Because skin can be extra sensitive during treatment, it is best to hold off on exfoliating with loofahs or products that contain microbeads.
Apply fragrance-free lotion while your skin is still slightly damp.
Keep your home cool (60° to 70° F) and humid. Use a humidifier in the house if you live in a dry climate or you’re using the heater to keep your house warm.
Protect your skin from cold and wind. Be sure to wear a hat and scarf if it’s cold out.
Eat a healthy diet and drink plenty of fluids to help keep your skin moist and healthy.
Apply a cool washcloth or ice to ease the affected area.
Consider acupuncture, which has been known to help some people.
Get enough rest.

Prevent or treat minor nail problems:

Keep your nails clean and cut short.
Avoid wearing tight-fitting shoes so that your toenails aren’t pressed into the front of your shoe.
Skin can split on fingertips easier while going through cancer treatment. Wear gloves while doing activities such as washing the dishes or car, gardening, or cleaning the house.
Avoid biting your nails and using fake nails, wraps, or anything that binds to your nail and may cause damage.
Ask your oncology care team about products that can help your nails.

Use Only Recommended Skin Care Products

When it comes to skin and nail care during cancer, a good rule of thumb is to use sensitive skin products that are listed as fragrance-free, alcohol-free, and hypoallergenic. Because creams and ointments are thicker, they can sometimes provide more relief than lotions. While there are a variety of products that can be used to manage skin and nail side effects during cancer treatment, here are some popular brands to consider:

Aquaphor Advanced Therapy Healing Ointment
Aveeno Skin Relief Fragrance Free Body Wash
Bag Balm Skin Moisturizer
Neutrogena Sheer Zinc Sunscreen SPF 50
Renpure 100% Organic Coconut Oil (use as a moisturizer)
Dove Sensitive Skin Bar (unscented)

If your skin and nails need extra help, your oncologist my prescribe medications to help reduce swelling and provide relief from dryness and itching. These may include topical therapeutic creams or ointments, antihistamines, antibiotics, or pain medications. Talk with your doctor first before taking over-the-counter medicines as they could interfere with your cancer treatment or cause a dangerous reaction.

Remember, it is important to tell your cancer care team if your skin hurts, you’re getting sores or start to see a rash. While certain skin and nail side effects are normal, others are not and can lead to an infection if not properly treated. Your oncology team may have you come into the office for an evaluation so they can recommend the best steps to give you as much relief as possible.

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