Skin and Nail Changes During Cancer Treatment

Cancer treatments can cause various skin and nail changes. Talk with your healthcare team to find out whether these changes may occur with your treatment.

Radiotherapycan cause dry, itchy skin that becomes red or dark. It may look sunburned or tanned and may be swollen or raised.

Chemotherapy drugs act on cell division (mitosis), so they most adversely affect rapidly multiplying cells. Skin and nail cells are among our fastest-multiplying cells, so chemotherapy affects them. It can cause dry, itchy, red and/or flaky skin. Some people develop redness or sun sensitivity leading to sunburn. Nail changes include redness, darker or lighter discoloration, and yellow or cracked nails. Chemotherapy-related nail and skin changes generally return to normal within 3-6 months.

People who previously received radiation and are now receiving chemotherapy may develop redness, raised areas or crusting in the irradiated skin; this is called radiation recall.

Targeted Drugs and Immunotherapies Can Cause Itching

New-generation chemotherapy drugs directed at molecular targets, also called smart pills and mostly taken as tablets, and immunotherapies can cause dry skin, rashes and nail problems.

- Related Topic: What Are Immunotherapy Drug Side Effects, and How Are They Treated?

The following skin problems are more serious and require urgent medical attention:

• Sudden or severe itching, rash or hives during chemotherapy. These may indicate a serious allergic reaction.
• Sudden pain, redness, moisture, infection and/or sores in the treatment area. This is called a moist reaction and may occur where skin folds, such as around the ears, breasts or buttocks.

Your doctor or oncology nurse will discuss possible skin and nail changes and advise how to treat or prevent them.

Ways to Treat Skin and Nail Changes

Depending on your treatment, the following steps are recommended to protect your skin, prevent infection and reduce itching:

• Use Only Recommended Skin Products
  Use soaps that feel gentle on your skin. We do not recommend antibacterial soaps. Ask your nurse to recommend specific lotions and creams, and when and how often to use them. Ask which skin products to avoid. For example, you may be advised against powders or antiperspirants before radiation treatment.
• Protect Your Skin
  Ask about lotions or antibiotics for dry, itchy, infected or swollen skin. Do not use heating pads, ice packs or bandages on irradiated areas. If your skin hurts, shave less often with an electric razor or stop shaving. Use sunscreen and lip moisturizer, or wear a loose long-sleeved shirt, trousers and a wide-brimmed hat outdoors.
• Avoid Scratching Your Skin
  Particularly while taking certain chemotherapy drugs, such as bleomycin, avoid scratching because the marks may be permanent. Your doctor will investigate the itching's cause. There are also steps you can take to feel better. Avoid products containing alcohol or perfume that may dry or irritate skin. Do not shower with very hot water. Apply moisturizing lotion after showering while skin remains slightly damp. Keep your home cool and humid. A healthy diet and plenty of fluids help keep your skin moist and healthy. Applying a cold cloth or ice to the affected area may also help. Acupuncture also helps some people.
• Prevent or Treat Minor Nail Problems
  Keep nails clean and trimmed short. Wear gloves when washing dishes, gardening or cleaning the house. Discuss products that may help your nails with your nurse.

Tell your doctor or nurse if skin in the treatment area hurts. You may have a moist reaction, often where skin folds behind the ears or under the breasts. Without appropriate treatment, this can cause infection. Ask how to care for these areas.

Talking with Your Oncology Team About Skin and Nail Changes

Prepare for your visit by listing questions. Consider adding these:

• Which symptoms should I mention?
• What steps can I take to feel better?
• Which soaps and lotions should I choose? Which products can help keep my nails healthy?
• Which skin and nail products should I avoid?
• When will these problems go away?