Skin and nail changes and cancer treatment

Chemotherapy, and other types of cancer treatments, may cause changes to the skin and nails. Most of the time, the effects are more a nuisance than a cause for concern. However, some skin and nail changes caused by certain types of cancer treatments may be more serious.

Nail changes with chemotherapy or other cancer treatment

Patients undergoing chemotherapy or other cancer treatments may notice the following nail changes.

• Streaks or grooves in the nails
• Nails may lift or break more easily
• The cuticles may become swollen, red and painful
• Nail infections may occur more often

Skin changes after chemotherapy or other cancer treatment

Following are some of the skin changes patients may notice following chemotherapy, radiation or other cancer treatments.

Changes to skin color: Cancer treatment or tumor growth may lead to changes to skin color around certain areas of the body. For example, patients may develop bruises that don’t have a clear cause or purple areas on the skin. Patients may also notice redness or paleness of the skin, lips and nail beds.

Burning and painful skin: If chemotherapy given through a vein leaks onto the skin, it may burn and feel painful. If left untreated, it may lead to an open wound. Alert the care team immediately if pain or burning occurs while receiving chemotherapy, so treatment may be adjusted.

Dry, itchy skin: If the patient has leukemia, lymphoma or multiple myeloma, he or she may notice dry or itchy skin. It’s also common to have dry and itchy skin with bone marrow transplants, chemotherapy, radiation therapy and targeted therapy. Itchy skin may be referred to as pruritus.

Graft-versus-host disease (GVHD): This may occur after a bone marrow or stem cell transplant if the donated cells attack tissues in the body as foreign invaders. GVHD may affect various organs, including the skin, causing blisters, a rash and thickening.

Hand-foot syndrome: Redness, pain, swelling and tingling in the hands and/or feet are part of hand-foot syndrome. The redness may resemble a sunburn. Hand-foot syndrome may affect the patient's ability to walk or engage in normal activities. Targeted therapy as well as several other treatments are associated with hand-foot syndrome.

Malignant wounds: Cancer that breaks the skin may cause a malignant wound. These types of wounds may be painful and become infected. They also may leak blood or fluid. Breast cancer and skin cancer have a greater association with malignant wounds.

Peeling skin: Radiation therapy may cause the patient's skin to peel, itch or feel painful. The peeling skin usually starts a week or two after treatment and improves shortly after the end.

Pressure ulcers: Excessive, persistent pressure on a certain area of the body may lead to pressure ulcers, also called bed sores. Some areas where pressure ulcers commonly form include the heels of the feet or the tailbone.

Rashes: It’s possible to develop a rash as a side effect of certain treatments, including chemotherapy, immunotherapy and radiation therapy. A sudden or severe rash also may develop if the patient has an allergic reaction to chemotherapy. (Hives or a burning sensation also indicate an allergic reaction.)

Sensitivity to light (photosensitivity): Certain types of chemotherapy, radiation therapy and stem cell transplants make the skin more prone to sunburns and more sensitive to light.

8 tips to manage skin and nail changes associated with cancer treatments

Tell the cancer care team about any of the following:

• Blistering, painful rash while on immunotherapy
• Rash near the eyes or the mouth
• Suspected malignant wound
• Bruises that remain for more than a week
• Pink or red patches or rash-like areas
• Severe itching

Ask the care team about products to use for dry skin. A moisturizing cream with salicylic acid, urea, ammonium or lactic acid may help dry, cracked skin. Avoid overly hot baths or showers, which may dry out the skin.

Practice sun safety. When outside, use sunscreen that has a sun protection factor (SPF) of 30 or higher, and wear a long-sleeved shirt, pants and wide-brimmed hat. Limit exposure to the sun when it is at its strongest, between 10 a.m. and 4 p.m. Reapply sunscreen every two hours or when swimming or sweating.

Try to stop the itch of itchy skin. Don’t use skin products with fragrances. Look for over-the-counter creams with camphor, menthol or pramoxine. Ask the care team about possibly using oral antihistamines to help treat itching.

Take care of the nails. To protect and soothe the nails during cancer treatment, consider taking these steps.

• Apply cream or oils to keep the area around the nails soft.
• If a nail infection is suspected, soak the nails at night for 15 minutes using a solution that is equal parts white vinegar and water.
• Keep the nails short and avoid manicures and pedicures while undergoing cancer treatment.
• Trim the nails regularly.
• Use gloves while cleaning or doing yard work.

Place an air or water pad on top of the mattress to help treat and avoid pressure ulcers. See a doctor if pressure ulcers develop, so they may be treated before they worsen.

Keep the skin clean and dry. This is to help avoid infection, especially following radiation therapy. The patient's skin may peel or become wet due to radiation therapy, leaving it prone to a skin infection. This more commonly happens in areas such as the ears, breast or buttocks. Ask the care team for pointers on cleaning the skin or using special dressings.

Manage discomfort from a rash. To help soothe a rash, consider:

• Patting the skin dry instead of rubbing it
• Exposing the rash to air as much as possible—don’t cover it
• Wearing loose-fitting, cotton clothing
• Bathing or showering in warm, not hot, water
• Not shaving over a rash

Inform the care team if a rash develops. There are over-the-counter treatments and prescription corticosteroid creams to help manage it.