Skin & Nail Care During Chemotherapy

hand-foot syndrome

Some chemo drugs, including capecitabine (Xeloda), 5-FU and liposomal doxorubicin, and several targeted drugs can make the palms of the hands and the soles of the feet red, swollen and sore. It usually starts in the first two to six weeks, often as tingling or warmth before anything shows. The medical name, palmar-plantar erythrodysesthesia, is a mouthful, but it helps at the appointment.

Tell your team at the first tingle rather than waiting to see. It is easier to manage early, and if it becomes severe they may adjust your dose or pause treatment for a while.

• Keep hands and feet cool, and skip hot baths, hot tubs and long stretches at the sink.
• Go easy on pressure and rubbing: long walks, tight shoes, gripping tools and chopping.
• Ask your team about a cream with urea in it. Some are sold without a prescription, but ask which one before you buy.
• If your team agrees, a layer of cream under cotton gloves or socks overnight helps hold the moisture in.
• Leave blisters alone, and tell your team if one breaks.
• Peeling can wear your fingerprints smooth for a while, enough that your phone stops recognizing you. Set up a passcode or face unlock as a backup. Fingerprints usually return as the skin recovers, often within weeks to months after treatment ends.

rashes from targeted therapy and immunotherapy

Some newer drugs bring rashes of their own. EGFR inhibitors, used for some colon, lung, and head and neck cancers, cause an acne-like rash in as many as nine in ten of the people who take them. It looks like acne and it is not, so skip drugstore acne products unless your team recommends one.

Don't stop a targeted drug because of a rash without talking to your doctor first. With immunotherapy, call about any rash that is severe, blistering or painful, and straight away if it reaches your eyes or mouth.

sun protection

Avoid prolonged sun exposure and use a broad-spectrum sunscreen with an SPF of 30 or higher unless otherwise directed by your doctor, plus a lip balm with sun protection. Wear a sun hat when going outdoors.

Some chemo drugs make skin burn far more easily than it used to, so the way your skin handled last summer is no guide to this one. A brim of about three inches all the way round shades your face, ears and neck. A hat shades. It does not seal, so wear it with sunscreen rather than instead of it.

If you have lost your hair, remember your scalp. It has spent its whole life under hair and has had no practice at this, so it needs a hat or sunscreen whenever you are outside.

your scalp is skin too

A tender, prickly or burning scalp often turns up around the time hair starts to shed. It has a name, trichodynia, and it usually settles as the shedding does. While it lasts, choose soft natural fibers and nothing tight, and wash with cool water and a mild shampoo.

At night, a sleep cap in cotton or viscose from bamboo stays put on a bare scalp, where satin tends to slide off. There is more on a sore scalp in Help! My Hair Is Falling Out!

if a nail starts to lift

• Keep it short, and cover it with a bandage so the loose edge can't catch on a sweater or a sheet.
• Keep it dry. Wear gloves at the sink and dry it well after a shower.
• Don't pull it off or cut it back yourself. Let your team decide what comes off and when.
• Leave it bare. Polish and gel hide what is happening underneath.
• Your team may suggest a vinegar soak. Ask before you start one.
• Call if there is pus, fluid or a bad smell under it, or the skin around it turns red, swollen or painful.

manicures & pedicures, if your team says polish is okay

For sanitary reasons, it is recommended to avoid professional manicures and pedicures during treatments. Chemo can lower the white blood cells that protect you from infection, so a nick from a shared tool matters more than it used to. You can still pamper yourself at home, the one salon where every tool has only ever touched your hands. Keep the number of products and removals small. Here are a few recommendations for home manicures and pedicures:

• Clean tools after each use.
• Change emery boards regularly.
• Use quality, long-lasting nail polish, and avoid changing it more often than is needed. A long-wear top coat such as OPI Infinite Shine ProStay Gloss helps it last.
• Follow your cancer center's advice on polish remover. Some centers recommend avoiding it during treatment. If yours allows it, use it as seldom as you can and choose a gentle one free of acetone, ethyl acetate, and other harsh solvents.
• Ask about nail strengtheners separately, even if polish is fine. If your team agrees, a professional-quality strengthener is designed for thin, brittle, splitting or soft nails. We like OPI products.
• Wear a priming nail treatment under your nail polish as a barrier between the nails and polish. It also helps your polish last longer.
• Secure your nail polish with a high-quality top coat.

using nail treatments

Dry and brittle nails are a common side effect of chemotherapy. Nail treatments are designed to restore moisture to nails and make them stronger, and they can either be used as a primer underneath nail polish, or worn by themselves.

Check with your care team before you start one.

There are different types of nail treatments on the market to choose from. These are the ones we carry, with what OPI says each is for:

• OPI Natural Nail Strengthener: OPI formulated it to increase strength and decrease discoloration of the nails, and it serves as a protective barrier between the nails and nail polish.
• OPI Nail Envy Original Nail Strengthener: OPI's original strengthener, now made with its Tri-Flex Technology. Older bottles were formulated with hydrolyzed wheat protein and calcium to build and strengthen nails.
• OPI Nail Envy Nail Strengthener + Color: Nail Envy with a sheer tint, in shades such as Pink to Envy. Strength and color come from one bottle, so there is one less layer to take off with remover.
• OPI Repair Mode Bond Building Nail Serum: A 9-free serum for damaged nails. OPI describes it as bond building, strengthening the nail from the inside.

OPI makes all four without formaldehyde today. If a bottle at home is older, check its label, since earlier formulas of some of them used it.