Know about skin reactions and what to do about them.

Though modern oncological therapies have low systemic toxicity because of their high specificity, cutaneous side effects are common and may negatively affect a patient's quality of life.

One inch of your skin has approximately 19 million skin cells, 60,000 melanocytes (cells that make melanin or skin pigment) and numerous Langerhans cells ( immune or protective cells). Skin cells are specialized cells that are constantly dividing. Unfortunately, this property of rapid renewal makes these cells particularly sensitive to the damaging side effects of chemotherapy.

This includes damage to the protective function of the skin barrier, disruption of the native function of skin cells as well as of immune cells that penetrate the skin, and loss of protection against environmental insults. These side effects can be temporary or last a long time significantly affecting your quality of life.

Not all chemotherapies have skin side-effects, and this depends on the type and duration of each treatment.

Many cancer treatments, including chemotherapy, radiation therapy, immunotherapy,

targeted therapy and stem cell transplant may cause skin changes such as a rash, dry or itchy skin, color changes or extreme sensitivity to light. Some skin problems resolve themselves after treatment is finished while other issues may linger. Some skin issues may need special care or medication as well as close follow up. Skin changes related to cancer treatment can show up in several ways:

• Itchy skin
• Pimple-like bumps on face, neck, and chest that look like acne or measles
• Sore, tight sensation on face, neck, scalp, and chest
• Cracks along the skin
• Changes in hair texture and curling of the eyelashes and eyebrows
• Dry, flaky skin on face, neck, and scalp
• Infection of the skin around the nail
• Brittle nails, nails that become loose in the nail bed
• Sores in and around the nose and mouth

While different cancer treatments may affect the skin differently ( even from patient to patient), when it comes to chemotherapy, there are some specific reactions on the skin to look out for.

A common issue that arises is called ‘chemo rash’, a misleading term. Many of the skin issues or rashes related to treatment are lumped together as “chemo rash” but the fact is, not only chemotherapy, but also targeted therapy, immunotherapy, radiation therapy and bone marrow transplant may cause a rash. Skin rashes may show up any time throughout cancer treatment but are most common in the first two or three weeks following the start of a new treatment cycle and can appear in several different forms. Chemo rash specifically may appear on the face, scalp, neck, back and chest, but can also show up on the arms and legs, abdomen and buttocks. 

The common ways that chemo rash shows up is as an itchy rash or dry skin:

Itchy Rash: You might hear your cancer care team refer to itching as pruritus. Constant, repeated and rough scratching may cause sores or your skin to break that makes you susceptible to infections. Some meaningful changes to your bathing habits, skin care practices and daily routine may help. These include:

• Apply cool, wet packs to the itchy areas. Repeat as needed.
• A humidifier in the room may help.
• Adding colloidal oatmeal to your bath water can help to relieve dryness and itching. Colloidal oatmeal solution contains finely ground oatmeal that forms a protective barrier on the surface of the skin, which helps to seal in moisture.
• Keep your nails clean and short to reduce damaging your skin when you can’t help but scratch.
• If you find yourself scratching without noticing, consider wearing soft gloves.
• Instead of scratching the itch, try rubbing, vibration or pressure to avoid breaking the skin.
• Adding a good moisturizer can help with itching. A good moisturizer will contain humectants and emollients. Humectants draw water into the skin, while emollients form a protective film over the skin’s surface, which helps lock in moisture which helps with itching..
• Activities such as reading, watching TV, listening to music or engaging in social activities can help you get your mind off the itch.
• Take anti-itch medications as directed if the itching is not manageable. Your cancer care team can prescribe medications.

Dry Skin: This is also called xerosis by your cancer care team. Dry skin may or may not be accompanied by an itch. Extremely dry skin sometimes looks like normal skin, or it may be red,rough and flaky. It can cause cracks in the skin, and cause bleeding in the lines and creases over knuckles and elbows. In many ways, taking care of dry skin is similar to what you would do with very itchy skin. These include:

• Products marked “lotion” instead of “cream” contain less oil. Water-based lotions may irritate your skin instead of healing your skin or soothing symptoms. Use skin creams or moisturizers that don’t contain alcohol or fragrances as a rule. Apply 2 to 3 times a day, especially after a bath when the skin is damp. Do not apply on open wounds.
• Bathe in warm or lukewarm water instead of hot.
• Add baking soda, colloidal oatmeal (in a cloth or mesh bag), or bath oil to your bath water.
• Wash your skin gently using a mild, unscented soap and a soft washcloth.
• When drying off, try not to rub your skin. Instead, gently pat your skin dry.
• Avoid using scented or alcohol-based products on the skin such as powders, after- shaves, or perfumes, especially those that contain isopropyl alcohol, benzyl alcohol or sulfates.
• Pause shaving or waxing until your skin is healed. Use an electric razor rather than a blade to avoid cuts and irritation if you must shave.
• Wash sheets and towels in gentle, hypoallergenic laundry soap such as those made for babies.
• Use protection from the sun (sunscreen) with an SPF of at least 30.
• If you have thinning hair, apply sunscreen to your scalp as well.
• Water containing chlorine can make some rashes worse, so don't go swimming if you have a rash.
• Cornstarch-based powders may clump in moist areas and cause irritation so be aware.
• Keep your room cool (60° to 70° F) and well ventilated to avoid sweating.
• Wear loose-fitting clothes made of soft fabric to avoid irritating your skin.
• Drink plenty of water or rehydration solutions.
• Ask about medications such as antihistamines if itching keeps you awake.
• If your itching is severe, your cancer care team may order prescription drugs to help relieve the itching.

It's important that you watch out for changes to your skin post chemo and if you have an underlying skin condition, discuss it with your doctor before chemotherapy starts.