Skin and Nail Changes

Did you know that cancer treatments can cause changes to your skin? Sometimes these changes are simply cosmetic, but other times they may require attention from your care team.

To better understand skin changes that happen during cancer treatment and how best to address these side effects, we spoke with Anisha Patel, M.D. Here’s what she had to say.

What types of cancer treatments cause skin changes?

All cancer treatments have side effects, but patients are sometimes surprised by the skin changes they see when receiving chemotherapy and immunotherapy. Since these therapies are used to treat a variety of cancers— and we’re constantly expanding and improving their use through clinical trials — skin changes are common.

What are common skin changes during cancer treatment?

The most common things we see are rashes and dry skin, which may be accompanied by itchiness or burning of the skin.

Chemotherapy and immunotherapy can also change the color, or pigment, of the skin, but it’s less common. You may not even notice. Depending on the therapy, you may see lightening or darkening of skin, hair and nails.

A less common side effect that we see with newer treatments is the development of new growths, such as moles, warts and raised areas of the skin.

It’s important to know that the type of skin side effect you may experience depends on your medical history and the type of treatment you’re receiving, so talk with your doctor about what you should expect.

Why do these skin changes happen?

Chemotherapy and immunotherapy fight cancer by targeting specific molecules in tumors. Those same molecules are also in our skin, hair and nails, so patients can experience side effects in those areas during cancer treatment.

Are these skin changes permanent?

Typically, changes to your skin related to chemotherapy and immunotherapy aren’t permanent. When you stop treatment, we’ll see your skin return to its previous state.

Also, these changes aren’t necessarily negative. Research has shown that certain rashes correlate with having a better tumor response to the treatment. So in some cases, when a patient gets a rash, despite it being uncomfortable and possibly itchy, it can be an indicator of a good overall treatment outcome.

What can I do to cope with skin changes during cancer treatment?

Unfortunately, you can’t avoid treatment-related skin changes entirely, but there are steps you can take to help reduce the discomfort. Before beginning cancer therapy, we suggest you start moisturizing your skin regularly. Also, if you have a history of eczema, psoriasis or skin cancer, see a dermatologist to address those concerns before beginning treatment so that they aren’t amplified during chemotherapy or immunotherapy.

Also, some types of chemotherapy and immunotherapy can make you more sensitive to the sun, so we commonly see sunburns. In order to prevent that, practice sun safety by limiting your time in the sun and wearing sunscreen with SPF 30 or higher, as well as sun-protective clothing, whenever your skin is exposed.

Lastly, try wearing comfortable shoes. We’ve seen a few therapies where patients experience an associated rash in areas that are under pressure such as the balls of the feet or with bunions. If your shoes are too tight and rub your feet, you’re at a higher risk of experiencing this rash.

Are any of these changes dangerous?

New growths related to cancer treatment can be concerning. Most are benign (non-cancerous), but others are malignant forms of skin cancer. It’s possible to develop skin cancer that’s caused by your cancer treatment, even if you’ve already received treatment for another type of skin cancer.

We advise our patients to conduct a monthly skin self-exam to catch these growths quickly. Let your oncologist know if something seems suspicious so that you can get a referral to a specialized dermatologist. If you’ve had a history of skin cancer or are at increased risk, make sure you see a dermatologist regularly during your cancer treatment. If you’re a patient at MD Anderson, you can ask your doctor to refer you to one of our dermatologists.

Is there anything else you’d like patients to know?

Don’t be alarmed if you experience skin changes during treatment. Helping patients cope with these changes is a big part of what MD Anderson’s dermatology team does. We may not always be able to make the change go away immediately, but we can help provide relief. Our goal is to make sure you’re as comfortable as possible so that you can continue on the best course of treatment for the cancer you’re facing.

Request an appointment at MD Anderson online or by calling 1-877-632-6789

Masking, social distancing and hand washing remain important routines that prevent COVID-19 infection even if you’ve been vaccinated. But they can take a toll on your skin.

You can take precautions to protect yourself during the COVID-19 pandemic and still keep your skin and hair healthy. We talked to Susan Chon, M.D., about skin care, and issues to look for  during this time.

Take care of your face – and your mask

Masks are essential to stopping the spread of COVID-19. But they can be hard on your skin, especially if you job requires you to wear one all day.

“Sweat, dirt and oil gets pushed onto and into the skin. This causes inflammation and acne, or maskne,” says Chon. “And if you already have a skin condition like eczema or rosacea, wearing a mask can cause a flareup.”

Chon says there are several ways to protect your skin while maintaining your mask habit.

1. Choose a comfortable mask. There are some situations, such as when you’re at MD Anderson, when you may need to wear a medical-grade face mask for added protection. But when you’re out in the community, it can help to mix things up and wear a mask with two or more layers of washable, breathable fabric, which can give your skin a break while still ensuring adequate protection against the coronavirus.

“Two-ply, soft cotton masks are good because they are a lot less irritating, very breathable and washable,” Chon says. “You can wash off the oil, grime or makeup that accumulates during the day.”

2. Avoid makeup. “You don’t really need it under your mask. It just makes another layer that can irritate your skin and cause problems,” Chon explains.

3. Choose the right skin care regimen. A really good, mild skin care regimen is important. Chon says there are a lot of good, non-stripping cleansers, noting: “Acne products can be irritating and make the problem worse.”

4. Protect your ears. “Everyone’s face is different, but masks are one-size-fits-all. Some people who are bigger, I see the mask cutting into the back of their ear,” Chon says. Search for a face mask strap adjuster that can attach to the mask straps at the back of the head, so the mask does not touch your ears.

5. Manage stress. “Stress absolutely causes acne. It’s hormonal, but it’s also very stress-related,” says Chon. In addition to skin problems, stress can cause a condition called reactive alopecia, or hair loss.

“This year I’ve seen patients who I’ve known for years who have never had hair issues,” Chon says. “They’re showing their stress in patchy alopecia. It’s very mild, but noticeable to them.”

Managing stress starts with a mindset of being kind to yourself and moving your body. Simply taking a walk can improve your circulation, rest your mind and your eyes. It can even boost your productivity.

“Walking is health care. You don’t have to go out and run a marathon, but do something to move your body,” says Chon.

You can also try one of the many free apps that provide guided meditation, yoga, stretching or some moderate cardiovascular exercise. All of these activities can relieve stress.

“Try to find something that you feel comfortable with and that you feel good about,” says Chon.  “You have to sleep well. You have to eat well. And you have to move.”

Be kind to your hands

Keeping your hands clean plays an important role in slowing the spread of COVID-19. But exposing your hands to soap or hand sanitizer several times a day can be hard on your skin.

Here’s what Chon recommends when caring for your hands.

1.  Choose soap and water over hand sanitizer when you can. The alcohol in hand sanitizer strips the skin of protective oils. That can cause drying, cracks and even small fissures. “It is better to wash your hands with soap and water. It’s a little gentler and it’s very effective,” Chon says. You don’t need a heavy-duty soap with detergent. Regular hand soaps are fine.

2. Rinse well. Thoroughly rinse off all traces of soap. Don’t forget to take off your rings, rinse the rings and the area underneath.

3. Moisturize. “Keep moisturizer by the sink so you don’t forget,” Chon says.

Give your eyes a break

Too much computer time can take a real toll on your eyes.

When people look at a computer, they tend to not blink fully, so they don’t put the pressure on their eyelids that releases the oil that lubricates their eyes. That can result in dry eyes and even vision changes over time.

The best thing you can do for your eyes is take a break. Every 20 minutes or so, look away from the screen and blink. Change your focus, look away. And don’t skip your routine eye exams.

“Taking care of your eyes is really important,” says Chon. “Your eye doctor can help with dry eyes, making sure your vision is OK and your prescription is up-to-date.”

No matter what the problem, Chon says it’s important to seek care.

“If you have questions, talk to a specialist. Your doctor can speak to your specific circumstances,” says Chon.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.