Skin and nail changes from cancer treatment

Some cancer treatments may affect your skin and nails. Their condition and appearance may change, depending on the drug or treatment you are having. Tell your doctor or nurse about any skin changes.

Your cancer team may give you advice on looking after your skin. They may tell you if there are products you should use or avoid. It is very important to follow their advice.

Some chemotherapy drugs make your skin dry and more sensitive to sunlight. Certain drugs may make the palms of your hands or the soles of your feet red and sore (palmar-plantar syndrome). Your specialist can give you advice and may reduce the dose of the drug.

Radiotherapy can affect the skin colour in the treated area or cause broken veins to appear later. Your skin may become red, sore or itchy. If you have dark skin, it may become darker. The person giving you your radiotherapy will tell you how to care for your skin during and after your treatment. It is important to follow their advice.

Hormonal therapy drugs can affect your skin, nails and hair. But the effects are usually mild. Hormonal therapies may cause dry skin and rashes. Rarely, they may also cause spots.

Some people have medicines called steroids as part of their treatment. Steroids can make your skin more likely to get spots and redden.

Chemotherapy, targeted and immunotherapies, hormonal therapies or steroids can cause rashes, dry skin or spots that look like acne. If you are having immunotherapy treatment and you get a rash, tell your doctor straight away. Targeted therapies and immunotherapies can also make your skin itchy and more sensitive.

Tips for dry skin

If you have dry skin, these tips may help:

• Wash with lukewarm water using mild, unperfumed, soap-free cleansers. Soap will make your skin drier.
• Use unperfumed bath and shower products. If your skin feels sensitive, or if you are having a targeted therapy drug, avoid products containing colouring.
• Avoid having long, hot showers or baths which will make your skin drier. Pat your skin dry instead of rubbing it. Use a clean, soft towel.
• Moisturise your skin regularly. This will keep it supple and less likely to become dry and itchy. Apply lotions, creams or ointments soon after you have washed.
• Keep your nails short to protect your skin from scratches.
• If you have dry or sore lips, use a lip balm. Choose one made from moisturising ingredients such as petroleum jelly (Vaseline®), shea butter or glycerine. Avoid petroleum jelly if you are having radiotherapy to the head or neck, or if you are using oxygen.

Try these tips for cleansing your face:

• Use a gentle cleanser that does not remove the moisture from your skin. Creamy cleansers could be a good option. Put the cleanser on carefully and avoid your eyes.
• Remove cleansers with a damp cotton wool pad or a clean, damp flannel. This will leave your skin feeling soft and clean.
• If you use a toner, avoid products containing alcohol, which dry your skin.

Using moisturiser

If you have dry skin, use a moisturiser at least twice a day on your face and body. You may need a richer moisturiser than you usually use. Do not use products containing sodium lauryl sulphate (SLS), especially if you have eczema. This can irritate the skin.

Moisturisers containing oatmeal can be soothing for dry or sore skin. Try tying a muslin bag filled with oatmeal over your bath tap and letting the water run through. This can be a good way to soothe and soften your skin in the bath.

If your skin is very dry, it can become itchy. Try using an emollient or moisturising cream that contains oatmeal, menthol or 10% urea. This may help relieve the itchiness. Ask your cancer nurse specialist or oncology team for advice. They may prescribe you something to reduce itching.

If you are having radiotherapy or targeted therapies, the staff at the hospital will talk to you about caring for your skin. Check with them first before using any skin products.

Tips for oily skin

If your skin is oily, try the following tips:

• Use a good cleanser and a light, oil-free moisturiser to keep your skin in good condition.
• A wash-off cleanser can be a good option. Gently work the cleanser into your skin, before washing it off.
• Use a soft flannel or muslin cloth to remove all traces of the cleanser and help your skin feel cleaner.
• Do not overwork your skin. Avoid exfoliating or harsh products that strip the skin of moisture.

If you are having chemotherapy, your skin may become less oily during treatment.

Rashes or spots

If you develop a rash, always get it checked by your specialist doctor or nurse straight away. They will know the cause and be able to give you advice.

Some targeted therapies can cause a rash or spots that look like acne. But this is not caused by acne. Do not use anti-acne products, as they make the problem worse. Your cancer nurse specialist or doctor can give you treatment that will help.

Your specialist may prescribe creams or drugs to help if you develop itchy skin or a rash. Always tell your specialist doctor or nurse if you get a rash.

Taking care in the sun

Certain drugs and treatments can make your skin more sensitive to sunlight. Here are some tips to protect your skin if you are out in the sun:

• Wear loose clothes made of cotton or natural fibres to cover up.
• Wear a wide-brimmed hat to protect your face and neck.
• Stay out of the sun during the hottest part of the day. This is usually between 11am and 3pm.
• Apply a suncream with a sun protection factor (SPF) of at least 30. Choose one that protects skin against UVA and UVB rays with at least 4 or 5 stars.
• Wear sunglasses to protect your eyes from the sun.

Remember, the best way to protect your skin is to cover up and to stay out of strong sunlight.

Changes in your skin tone

As your treatment goes on, you may notice changes in your skin tone or in the brightness of your complexion. The following tips may help:

Using foundation

• If you wear foundation, you may need to change from your usual shade.
• Choosing a foundation with a dewy finish (moist looking) will brighten your complexion naturally.
• Choose a base colour that is not visible at your jawline. Even a sheer or light foundation will help to even out your skin tone.
• Tinted moisturiser can work well if you are not used to wearing a lot of make-up, or prefer not to.

Applying a bronzer

• Use a make-up brush to apply bronzer lightly to your forehead, cheekbones and down the middle of your nose. This adds a natural wash of colour to the face.
• Start by adding a small amount and gently build this up. Finish by buffing really well into the skin so there are no obvious lines.

You could ask a Boots Macmillan Beauty Advisor about other make-up options to improve your skin tone.

Using a concealer

You can use a concealer under and over foundation, or on its own. It can hide blemishes or dark circles under your eyes. It is helpful if you need a quick cover-up.

Managing flushed skin

A green-tinted primer can help tone down rosy skin and even out the colour on your cheeks, nose and chin. But try to use these products sparingly. When you put on the primer, pat it gently on to your skin. Rubbing your skin can make the redness worse.

If you have flushed skin, try a medium-coverage foundation with sun protection. Make sure the foundation matches the areas of your face that are less red. Pat the foundation over the primer to avoid disturbing it.

You could ask a Boots Macmillan Beauty Advisor about using concealer or toning down flushed skin.

Keeping your make-up routine clean

Cancer treatments can make you more at risk of getting an infection. Keep your make-up routine as clean as possible with the following tips:

• Wash your hands before applying creams or make-up.
• Do not share towels or flannels with other people.
• Check expiry dates on make-up.
• Do not share make-up brushes, sponges or any other applicators with anyone else.
• If you use mascara avoid pumping the wand into the tube. This reduces the risk of introducing bacteria.
• Take eye make-up off using a new cotton pad for each eye to avoid spreading any possible infection.
• Clean your make-up brushes or sponges regularly, or use disposable sponges.
• Put the tops or lids back on any tubes or jars when you have finished using them.

Cancer treatment can affect your nails. They may grow more slowly or break more easily. You might notice ridges or white or dark lines across your nails. Sometimes nails can become loose or fall out. When treatment finishes, any changes usually disappear as the nails grow out.

There are things you can do to look after your nails:

• Moisturise your nails and cuticles regularly.
• Keep your nails clipped short.
• Wear gloves to protect your nails when you are doing things in the house or garden.
• Keep your hands and nails clean to help avoid infection, but avoid bathing in very hot water.
• Do not use false nails, gels or other acrylics during this treatment, as they may increase the risk of infection.
• It is fine to wear nail varnish, but try to use a water-based polish. Avoid using harsh chemicals, such as acetone, when taking off the polish.
• If your toenails are affected, wear well-fitted shoes to cushion them.

Tell your doctor or nurse if you notice changes to your nails. They can give you advice or arrange for you to see a podiatrist for foot care advice if needed.