Both chemotherapy and radiation therapy can cause skin changes or problems when the cells in the upper layer of the skin are damaged or destroyed. With radiation, these changes are usually confined to the site of radiation treatment; with chemotherapy, they may be local or generalized. Many of them are temporary and will disappear on their own soon after treatment is finished.
Chemotherapy reactions include:
- Red patches (erythema) or hives (urticaria) at the site of the chemotherapy injections or on other parts of the body. Depending on the drug used, the red patches may appear over pressure points such as the elbows, knees, fingertips, and shoulder blades, or on the face, or in a general, overall pattern. The hives may develop along the vein used for administering the chemotherapeutic drug or may be generalized. These two reactions generally disappear within several hours.
- Darkening of the skin. This may occur in the nail beds (sometimes in bands), inside the mouth, on the gums or teeth, as lines along the trunk, or along the veins used for chemotherapy administration, or it may be generalized. It usually occurs two to three weeks after chemotherapy and continues for ten to twelve weeks after completion of treatment.
- Sensitivity to sun and light. Photosensitivity is a common reaction that causes some people to suffer an acute sunburn after just a short exposure to the sun. They should be careful to avoid exposure as much as possible, to wear protective clothing such as a wide-brimmed hat and a long-sleeved cotton shirt, and to use an effective sun screening agent (one that has a sun protection factor of 15 or more). Effective sun screens include Coppertone Super Shade Sunblocking Lotion, Total Eclipse Sunscreen Lotion, Elizabeth Arden Suncare Sun Blocking , Cream, Clinique 19SPF Sun Block, and Estee Lauder Sun Cover a Cream.The hypersensitivity will disappear once treatment has stopped.
These are the most common skin reactions to chemotherapy. There are others, including a thickening of the skin known as hyperkeratosis, an acne-like reaction, and skin ulcerations that may occur with only one drug or a group of related drugs. In any case, patients should check with the oncologist before treatment begins so that they will know what to expect.
“Radiation recall” is a reaction that can occur when chemotherapy is given after radiation therapy. It may occur several weeks or even months after radiation therapy has ended, and involves only the skin that has been previously irradiated. The usual symptoms of radiation recall are patches of redness and shedding or peeling of the skin, but there may also be blisters and wet, oozing areas of skin that peel. After the skin reaction heals, the skin will be permanently darkened.
While it is present, the patient should:
- Gently cleanse the skin at the site of the reaction. The skin should be washed by patting it gently with a soft cloth, using a mild soap like Dove or Aveeno and tepid water; rinsing and then gently patting it dry with a soft towel.
- Gently apply creams or lotions containing Vitamins A, D, and E to the site to alleviate the dry skin if inflammation and peeling are present.
- Use a cream or aerosol spray containing cortisone, prescribed by the physician, if necessary for itching, but refrain from rubbing, scratching, or massaging the skin.
- If the reaction is more intense, cleanse the area with half-strength hydrogen peroxide and saline solution. Mix the solution immediately before use for maximum effectiveness and apply with an irrigating syringe to avoid friction. Rinse the area with saline solution or water, gently pat dry, and expose the area to air as often as possible. If the drainage is copious, use a non adhesive absorbent dressing (gauze) and change it as soon as it becomes damp.
- Follow the same precautions necessary for irradiated skin (see below).
- Radiation therapy also causes changes in the skin that are generally confined to the area under the focus of the radiation beam. The degree or intensity of the skin reaction will be greater in persons receiving a large daily dose of radiation, in those with fair, thin skin, and in those who are not receiving adequate protein in their diet. Because of the texture or location, certain areas of skin are more sensitive to the effects of radiation therapy. These include:
- Skin surfaces subject to friction and moisture: the skin under the breasts, between the buttocks, under the arms, and the groin and vulva.
- Smooth, thin skin such as that on the face and perineum.
- Skin with a poor blood supply: back of the hand, top and sole of the foot, midline of the back.
- Skin that has been injured by surgery or accidents, or that is inflamed or infected.
The effect of radiation therapy on the skin begins seven to ten days after it is initiated and is progressive in nature.
The four stages of reaction are:
- Inflammation of the skin in the treatment field, the color ranging from pink to red, and slight swelling. The reaction is similar to a first-degree sunburn and damage to the cells is minimal. With this and the next stage, there may be some pigmentation resembling a suntan. It may be patchy and interspersed with patches of thin, silvery white skin.
- Inflammation and dry desquamation (peeling), like that after a sunburn. The skin becomes dry and scaly due to the destruction of the oil glands in the treatment field.
- Inflammation, swelling, and oozing. Blisters form and the skin resembles a second-degree sunburn. Although the damage is reversible, radiation therapy is usually discontinued until the skin heals. Other reactions may include patches of thin, white or silvery skin that heal poorly, leathery skin with little elasticity, and fibrosis or atrophy of the lymph nodes.
- Telangiectasis. These small, reddish areas of the skin are caused by enlargement of blood capillaries. Although the condition is permanent, it may become less noticeable over time.
- Loss of hair in the treatment field. With high doses of radiation, the loss may be permanent and the activity of the oil and sweat glands in the area may be suppressed.
Because the skin in the treatment field is especially vulnerable to injury and infection, patients should take special precautions during and for a month or so after radiation therapy treatment.
These precautions include:
- With mild reactions, gently cleanse the skin with water or, if necessary, with a mild soap such as Dove or Aveeno and a soft cloth. Skin should be gently patted dry with a soft towel.
- If more serious reactions are present, follow the precautions previously listed under radiation recall.
- Avoid wearing rough fabrics such as wool or corduroy, or tight-fitting clothes. Nothing should leave a mark when removed—no elastic on underwear or tight straps or belts. Cotton is the most comfortable fabric; nylon and other synthetics do not permit perspiration to evaporate. If possible, expose the skin in the treatment field to air.
- Wash underclothes or any clothes that will come in contact with the treatment area with a mild detergent, such as Ivory Snow.
- Avoid shaving or using cosmetics, perfumes, or deodorants on the skin in the treatment field.
- Avoid exposing the skin to wind or any source of heat (including hot water bottles, heating pads, and sun lamps) or cold (ice bags, cold weather).
- Refrain from swimming in salt water or chlorinated pools.
- Be especially careful to protect the skin from exposure to the sun, even after radiation therapy is completed. The affected area can be covered with sun-blocking lotions—those with a sun protection factor (SPF) rating of 15 or more. Scarves and broad-brimmed hats provide fashionable shade on sunny days. Lightweight cover-ups should be used at the beach.
- Shave only with an electric razor and, if possible, avoid shaving the affected site.
- Do not use medications, deodorants, perfumes, powders, and cosmetics on the skin in the treatment area. bandages should also be avoided.