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Skin & Nail Changes During Chemotherapy

Chemotherapy drugs are designed to slow down the rapid cell growth of cancer cells by attacking the cells' DNA to prohibit growth. In the process of killing rapidly dividing cells, chemo drugs impact other rapidly growing cells including those in the hair, skin, and nails. Not everyone experiences hair, skin, or nail issues – this varies by person and type of chemo drug. It’s important to be aware of possible chemo side effects and take care of your skin and nails. Some chemo skin reactions are serious and potentially life-threatening. Sudden or severe itching, a rash, or hives during chemo may be signs of an allergic reaction and require immediate medical attention.

Skin Changes

More common problems include dryness, itchiness, rashes, flushing/redness, peeling skin, and hyperpigmentation. A rash resembling acne or measles is a common side effect in patients receiving anticancer medications. Some people may develop sun sensitivity, making it easier to get a sunburn. Receiving radiation therapy before chemo may cause skin to become red, blister, peel, or painful on the part of the body that underwent radiation therapy (called radiation recall). Most skin reactions occur within 2 to 3 weeks of chemotherapy initiation and resolve 10 to 12 weeks after stopping treatment.

Flushing: This temporary redness of the face and neck is caused by dilation of blood capillaries. The following chemo drugs are associated with flushing: asparaginase, bleomycin, carboplatin, carmustine, cisplatin, cyclophosphamide, dacarbazine, diethylstilbestrol, docetaxel, doxorubicin, fluorouracil, lomustine, paclitaxel, plicamycin, procarbazine, and teniposide. Aside from chemo, carcinoid tumors can cause flushing as part of carcinoid syndrome.

Hyperpigmentation: Overall darkening to the skin can occur or it can be localized. This may be connected to phototoxic reaction in which areas of skin exposed to light may change to a golden-brown or slate-grey color. The chemo drugs busulfan, cyclophosphamide, cisplatin, ifosfamide, thiotepa, docetaxel, and etoposide can cause discoloration under medical tape or dressings. Fluorouracil, vinorelbine, and some combination regimens administered intravenously can cause darkening veins up the arm, which eventually fades. In most cases, skin discoloration gradually resolves after chemotherapy is stopped.


Skin Care for Chemo Patients

  • Use only mild soaps, cleansing lotions, and creams

  • Avoid products with alcohol or perfume

  • Take short lukewarm baths or showers, avoiding hot water

  • Pat skin dry with a soft towel, rather than rubbing vigorously

  • If shaving causes irritation, rash, or dryness, avoid until skin is healed

  • Keep home cool and humid

  • Eat a healthy diet and drink plenty of fluids

  • Apply moisturizer on damp skin

  • Be extra careful with sensitive area around eyes and lips

  • Avoid all types of hormone creams (e.g. products containing hydrocortisone)

  • Avoid prolonged sun exposure and use sunblock with an SPF of 15 or higher unless otherwise directed by your doctor



Nail Changes

The most common changes are cosmetic, impacting only the appearance of the nails. These includes dark, yellow, brittle, or cracked nails. Cuticles can also become inflamed and painful. These changes are more likely to occur with the chemo drugs paclitaxel and docetaxel. Multiple lines and indentations may also appear in your nails, reflecting the different cycles of chemotherapy.

Taking care of your nails can help prevent lymphedema, a condition that develops when lymph fluid accumulates in the soft tissues of the arm, causing it to swell. Infection or injury to the same side of the body as the breast cancer surgery can increase the risk of lymphedema. So it is important to prevent injury (e.g. cuts or burns) to nails, fingers, and hands.

Nail Care for Chemo Patients

  • Trim your nails short

  • Wear gloves during household chores (e.g. washing dishes)

  • Avoid professional manicures and pedicures (unless you bring your own tools)

  • Do not trim your cuticles

  • Massage cuticle cream into the cuticle area to prevent dryness, splitting, and hangnails

  • For discoloration, use a dark, water-based nail polish (free of dibutyl phthalate, toluene, and formaldehyde)

  • Use a gentle remover free of acetone, ethylacetate, and other harsh solvents

  • Do not change nail polish frequently

  • Avoid artificial nails such as acrylics or other nail wraps because they can trap infection-causing bacteria

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