Dr Jonathan Smith imparts invaluable advice on how to care for your skin, hair and nails during and after chemotherapy…
No diagnosis strikes such fear in us as that of the “big C”. Fortunately, however, with the development of new chemotherapeutic agents, checkpoint inhibitors and other therapeutic modalities, the diagnosis of cancer is no longer a death sentence, whereby patients can now enjoy a good quality of life and an increased life expectancy. Due to the effects on the skin from the cancer and its treatment, attention needs to be focussed on good skincare to optimise the skin’s health and appearance.
Cancer cells grow and multiply at a much faster rate than healthy cells.
While chemotherapeutic drugs stop cancer cells from growing and multiplying, it also affects healthy cells – especially those which normally grow and multiply faster (such as those in skin and hair). The result is dry, dull, sensitive, irritated skin and considerable hair loss. The complexion can also change and look grey, yellow, or hyperpigmented, while cuticles become brittle and fissure, with the nails stopping to grow.
In addition to these general effects, specific therapeutic agents cause specific adverse reactions, like redness and hypersensitivity of the hands and feet, and discolouration of the nails with lifting off the nail bed. However, there are other issues go beyond pure cosmetic concerns, such as an increased risk of infection, as the skin and immune system are compromised.
The best solution to these issues is to change your skincare routine to simple, moisturising products for sensitive skin. All rules that apply to sensitive skin are true for those going through cancer therapy. Products that are gentle, hydrating and hypo-allergenic are ideal, while products with fragrances, alcohol, preservatives and essential oils should be avoided as these can cause irritant and even allergic reactions.
Furthermore, exfoliating products that remove the build-up of dead skin cells should also be avoided, so stop using scrubs, alpha-hydroxy acids (e.g. glycolic acid), salicylic acid and retinoids (Vitamin A products).
Skin contact with harsh household cleansers (dishwashing products, oven cleaners, surface cleansers, washing powders etc.) should be avoided by using cotton-lined protective gloves. *Soaps should be mild, moisturising or ‘soapless’, and maintain the skin pH of 5,5 (Sebamed pH 5,5) – which is critical for optimal skin barrier function.
As overly hot water dries the skin and reactivates skin problems, the water used for washing should be at a temperature of between 32 °C and 34 °C. Meanwhile, washing powders for clothes should also be mild (those used for babies’ clothes) and well rinsed out. Fortunately, fabric softeners are generally not an issue.
Be sun savvy
As always (yet even more than usual), sun protection is essential, as many cancer treatments and other medications given during cancer treatment can cause photosensitivity (increased risk of sunburn or an allergic reaction to the sun).
In addition to the daily use of a medically-proven effective sunscreen product, sun-avoidance (especially in the middle four hours of the day), and the wearing of a wide-brimmed hat, long sleeves and even sun-protective gloves is recommended.
Hypo-allergenic physical/mineral (containing zinc oxide and/or titanium dioxide) sunscreens are the most effective and best tolerated by cancer patients.
Fingers and toes
Hand, foot and nail care is especially important in those with cancer, as these areas are common sources of infection. The nails should be trimmed short so that they do not snag on anything. Gloves should be worn to limit contact with irritant and allergenic chemicals, and the regular use of a barrier cream* is advised.
When it comes to moisturising the skin, the following guidelines apply:
- Choose creams and ointments rather than lotions;
- Choose fragrance-free products;
- In general, choose products with fewer ingredients;
- Choose synthetic-free and non-cancer-causing products;
- Avoid using products you do not need;
- Just because a product is labelled ‘organic’ or ‘natural’, does not mean that it is safe.
Skin cancer care
Patients with skin cancer (basal cell carcinoma (rodent ulcer), squamous cell carcinoma and malignant melanoma) need to be especially wary of light exposure (ultraviolet, visible and infra-red). Broad-spectrum sunscreens* containing enzymes that help repair damaged DNA, and anti-oxidants that protect against free radicals are recommended.
These patients also need to look out for solar keratoses – scab-like crusts that recur when scratched off – which are precursors to skin cancer. Any new moles that look different from the rest (ugly duckling sign), or any change in an existing mole (especially irregularity of the edge, colour or surface) should be assessed by a dermatologist.
Take home message
When problems arise, consulting with a skin care professional experienced with the side-effects of cancer treatment and skin reactions is best. All treatment is contingent upon a patient’s specific cancer treatment protocol, skin type, age and personal expectations. Dermatologists and dermatology physician assistants are best trained to help cancer patients choose the best skincare products according to their treatment protocol, state of treatment, current health and even their budget.
Note:* Ask your dermatologist for more information or advice on what skincare product ranges are best suited for your needs www.dermatology.co.za
Written by Dr Jonathan Michael Smith
MB ChB (UCT) MMed (Derm) (US) President of the Dermatology Society of SA.
Having practised since 1986 in Tyger Valley and Wynberg, Dr Jonathan Smith has an interest in all aspects of dermatology, with a special interest in aesthetics, dermatological surgery, vitiligo and psoriasis.
He has lectured at the Aesthetic Medicine Congress and published several papers in dermatological journals. Notably, Dr Smith has served on the executive committee of the Dermatology Society of SA for the past 16 years and is the current treasurer.
A2 Disclaimer: This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice.
This article was written by Dr Jonathan Smith and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine Sep 2019 Edition (Issue 31).
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