• Avoid tight-fitting clothing and undergarments.
• Use tepid not hot water in the bath and pat the skin dry, don't rub it. You can also use a hair drier at the warm or cool setting to dry skin.
• Avoid extremes in temperature from hot water bottles or ice packs.
• Avoid direct sunlight to the field of treatment.
• Wash areas of irritation with water and cotton balls, NO SOAP or very MILD SOAP.
• It's a good idea to stay away from creams, powders and lotions unless your doctor recommends them.

The last rule listed above, notwithstanding, moisturizing creams with lanolin can help to relieve discomfort for minor skin reactions. For scaling and peeling skin, your doctor might recommend a 1% cortisone cream, which will promote healing. BiafineRE cream, available by prescription, is being studied in clinical trials for effectiveness in preventing or reducing radiation induced skin reactions.

Chemotherapy Treatment

Some drugs (chemotherapy) used to kill cancer cells can also cause troubling, annoying or even painful skin conditions. For instance as many as 75% of patients given docetaxel will experience rashes on the forearms, hands and feet (see Hand-Foot Syndrome below.)

Hand-Foot Syndrome (Palmar-Plantar Erythrodysesthesia) is characterized by a tingling or burning, redness, flaking, bothersome swelling, small blisters, or small sores on the palms of the hands or soles of the feet. 

Cellulitis is a highly treatable bacterial skin infection. Symptoms include localized redness or inflammation, a tight, glossy stretched appearance of the skin, and pain and tenderness. Cellulitis can develop rapidly and usually has clearly defined, sharp borders. You may be able to make out a thin red line leading from the area of redness along a vein toward the heart.

In any patient, but especially a patient with a compromised immune system, cellulitis is a serious infection and requires immediate attention from your doctor. Most chemotherapy agents damage, at least temporarily, your immune system's white blood cells and they are your body's sentries against infection.

Itchy (pruritus) skin can be caused by cancer treatment or the cancer itself. Some tumors release an enzyme that stimulates the sensation of the need to scratch. For instance, lymphoma and leukemia are associated with this condition. To control this problem, your medical team will want to know when the feeling starts, how long it lasts and how intense it is. 

Pruritis is often controlled through one or a combination of several methods: 

• Stay well hydrated - drink at least 2 quarts of liquid daily.
• Use water-soluble skin lubricants not oil based ointments to keep the skin from drying out.
•  Protect the skin from cold and wind.
• The use of COOL wet packs applied for 20 minutes at a time. (Allow the skin to dry completely between uses.)
• Avoid drinking alcoholic beverages.
• Avoid excessive exercise.
• Use cotton thermal blanket in bed and wear light nightclothes.
• Protect your skin by keeping the fingernails cut short; wear cotton gloves especially when asleep; avoid tight cloths and items such as panty hose and jock straps; use mild soaps; use soothing substances in a tepid bath such as soluble cornstarch, oatmeal, soybean powder, or baking soda. 
• Stroke site with an ice cube or ice bag.
• Use a menthol-based cream or lotion.
• Vibrate area of itching.
• Message area of itching.
• Apply steroid or anesthetic lotions prescribed by your doctor.
• Antihistamines, as prescribed by your doctor, may also help.

Some chemotherapy agents can cause blotchy or generalized hyperpigmentation. This darkening of the skin may occur around the joints or under the nails, in the mouth or along the vein used to infuse chemotherapy. Sometimes it's limited just to the site of infusion; sometimes it's more generalized and covers larger areas of the body. Hyperpigmentation often appears 2 to 3 weeks after chemotherapy treatment begins and goes away as new skin cells are generated and replace the dead cells 10 to 12 weeks after treatment is over. Chemotherapy agents associated with temporary hyperpigmentation are melphalan, busulfan, cyclophosphamide, 5-fluorouacil, adriamycin, daunorubicin, bleomycin, and topical BCNU. 

Some chemotherapy drugs can cause your skin to burn very easily in sunlight (photosensitivity.) Avoiding exposure to the sun is the best advise but if that's impossible, wear protective clothing and a wide brimmed hat. Check with your doctor before using sunscreen lotion however.

Thickening of the skin (hyperkeratosis) on the hands, feet, face or areas of trauma has been associated with the chemotherapy agent bleomycin. This condition can be disfiguring but usually reverses when treatment is discontinued.

Chemo/Radiation Combination Therapy

Sometimes a severe skin reaction, called radiation recall, develops when chemotherapy is administered during or soon after radiation treatment. It usually appears on the area of skin in the field of treatment several weeks after the end of the radiotherapy. You may develop red and tender swelling or wet peeling skin. After the skin heals, it may remain discolored. Certain chemotherapy agents are more likely to lead to radiation recall than others such as adriamycin, antinomycin D, methotrexate, bleomycin, cyclophosphamide, 5-fluorouracil, hydroxyurea, and vincristine/vinblastine.


For information about side effects to your nails, click here.

This page was last edited on 06/19/2003
Written by Rachael Myers Lowe, cancerpage.com
Reviewed by Sara Parkerson, RN, MSN, OCN,  and Maureen Wilkie, RN, CCM