Skin, Nails & Hair
Standard chemotherapy, as well as Targeted therapies can affect hair, skin and nails. While these changes can be disheartening they are generally mild to moderate in severity and can be managed.
Hair Loss
Hair Loss also known as alopecia, is a common side effect of chemotherapy and can lead to the loss and/or thinning of the hair on your head, the underarms, body hair (including pubic hair), eyebrows, and eyelashes. The degree of hair loss is dependent upon the specific drugs you receive and generally occurs 2-3 weeks after your first treatment. The good news is that hair loss is temporary and generally starts growing back 3-6 weeks after your last cycle of chemotherapy. While it is not possible to prevent hair loss there are several things that you can do to prepare yourself for hair loss.
- Use mild shampoos and soft hairbrushes.
- If you use a hair dryer use it on low heat.
- Avoid dyes or permanents during this time.
- Cutting hair short prior to start of treatment may make the loss of your hair easier to manage.
- If you are planning on using a wig during treatment it is best to shop for this before you lose your hair.
- Besides wigs, you can try hats, scarves or turbans.
- If you prefer to leave your head uncovered, be sure to use sunscreen with an SPF of at least 30 on your scalp.
Dry Skin
Skin cells are rapidly growing cells and are susceptible to chemotherapy, targeted and radiation therapies. In addition, other factors can contribute to dry skin: perfumed products, allergies, extreme weather changes and dehydration. Tips for managing dry skin include:
- Moisturize skin frequently. Products with lanolin are particularly good. Avoid harsh products that are heavily perfumed. If you are receiving a targeted agent like Nexavar, Sutent or Tarceva, keeping your skin moist is vital. We will provide you with a more detailed “to do” list prior to beginning of your therapy.
- Keep your skin hydrated by drinking plenty of fluids.
- Avoid friction or rubbing on your skin.
- Avoid bubble baths. Most bubble baths contain chemicals that can be irritating to the skin and increase dryness.
- Wear soft, nonbinding clothes.
- Take quick showers, not long hot baths. Exposure to hot water can irritate skin.
Acne-Like Rashes
Acne-Like Rashes: Also known as folliculitis, acne-like rashes is a common side effect in patients receiving certain Targeted Therapies such as Cetuximab or Eriotinib. The rash begins as a reddening of the face and is followed by small bumps and pustules on the face and trunk of the body. Tips for decreasing the severity of this side effect include.
- Limit sun exposure. Wear sunscreen of at least 30 SPF when planning to be out in the sun for more than 20 minutes or cover all exposed skin with clothing, gloves, hats, etc.
- Maintain good hygiene. Keep skin clean and dry it well after washing. Apply a moisturizer within 15 minutes of bathing or showering to any dry areas; use moisturizer every time you wash your hands. Use hypoallergenic moisturizers that do not have perfumes such as Vaseline, Eucerin, Avenno or Vanicream.
- Use mild soaps and rinse skin thoroughly.
- Keep nails short to avoid scratching rash.
Follow the Skin Care Guide we will provide before initiating targeted therapy. Talk with your physician or nurse regarding what over the counter skin products are best for you.
You may require treatment with topical and oral antibiotics or steroids. If rash is severe, we might need to delay your treatment and/or reduce the medication dose.
Changes in skin color
Hyperpigmentation or darkening of the skin and fingernails is associated with very specific drugs. The palms of the hands and fingernails are most frequently affected. However, in the case of drugs such as docetaxel and paclitaxel it can occur along the vein line of the vein used to administer the chemotherapy. Hyperpigmentation can occur at any time during treatment and may be expected to slowly disappear after completion of therapy. Topical bleaching agents such as hydroquinone can decrease melanin production and assist in clearing areas of pigmentation. Check with your physician before using any of these products.
Sun Sensitivity
Sun Sensitivity, also known as photosensitivity is associated with certain chemotherapy drugs. Minimal sun exposure can cause sunburn when you are on these drugs. If you have had previous radiation or areas of sunburn you may experience a recall reaction. This is a redness of the skin in areas previously sunburned or exposed to radiation. The primary intervention for sun sensitivity is prevention.
- Avoid direct sunlight especially during the peak hours when the suns rays are strongest.
- Wear long-sleeve shirts, pants and hats with a wide brim if you are planning to be out in the sun for more than 15 minutes.
- Use sunscreen with a SPF of 30 or higher on any exposed skin prior to going out into the sun.
- Keeps lips protected with the use of a lip balm with SPF or zinc oxide.
Nail Changes
Nail Changes: changes in finger or toenails can occur through direct toxicity of chemotherapy to the nail plate. Changes may present as grooves in the nail plate, separation of the nail plate from the nail bed, loss of the entire nail, thickening or thinning of the nails and hyperpigmentation of the nail plate. Nail changes are associated with very specific drugs. At this time there is no known way to prevent these changes from occurring, but nails will continue to grow and after completion of therapy will be replaced by normal nails.
- Looks at your nails daily and let your physician or nurse know if you notice changes in your nails.
- Avoid nail-strengthening products
- Wear gloves when performing housework or working in the garden to protect nails.
- Keep hands clean and dry.
- Notify your physician or nurse if you have any changes in your nails, especially redness, pain or changes around the cuticles of your nails or the skin around your nails.
Hand and Foot Syndrome
Hand and Foot Syndrome is a side effect associated with a limited number of chemotherapy drugs, but can occur in up to 40% of persons receiving targeted therapies such as Sorafenib or Sunitinib. It affects the palms of the hands and the soles of the feet and begins as a painful reddening of the skin. There may or may not be blisters. The usual course is a shedding of the outer layers of skin followed by re-growth.
It is important to let us know as soon as you notice any changes in your hands/feet. Early intervention may prevent worsening of the problem. Perform a daily assessment of your hands and feet and let your physician or nurse know if you notice any signs presented below:
Redness and drying of the palms of the hands and soles of the feet
Thickening of the skin on the palms of the hands and soles of the feet
Appearance of blisters on the hands and soles of the feet
Sensations of numbness, tingling, pain or burning
Swelling in the hands and feet
Dry, cracked skin.
Listed below are some of the strategies you can take to decrease discomfort of this side effect. If your hand and foot syndrome is severe your cancer treatment may have to be delayed or the dose reduced.
Use Epsom salts and warm water and soak hands and feet. Dry them thoroughly and apply cream or lotion.
Use creams or lotions that contain urea. Apply at least twice a day. At night prior to sleep apply a generous amount and cover your feet with socks to protect your linens. Some of the products available for use are Dr. Scholls Callus Exfoliating ointment, Udderly Smooth, Dermal Therapy and Kerasal.
If you have a buildup of hard skin and calluses on your feet prior to starting therapy, get a pedicure. This may actually help prevent the development of some symptoms of hand and foot syndrome.
Use cotton socks or gel inserts. This will help reduce pressure on affected areas.
Consider wearing soft shoes or tennis shoes.
Avoid long periods of standing or walking.
May require pain management.
Injection site reactions
An injection site reaction is inflammation in or damage to the tissue surrounding where a drug was injected. Intravenous medications are classified in three categories: non-irritating drugs, irritants and vesicants (drugs which can cause tissue damage). Injection site reactions are classified as either infiltration (non-irritating drug), flare reactions (irritant drug) or extravasations (vesicant drug).
Infiltration
Infiltration of an IV site occurs when non-vesicant agents leaks into the tissue surrounding the site. This can occur for a variety of reasons:
- Small fragile veins.
- Long term use of steroids or a history of diabetes which can damage veins and make them susceptible to infiltration.
- History of vascular or circulatory problems.
- Treatment with medications that have a high ph or a high osmolarity (concentration of medication to the fluid it is mixed in).
Signs of infiltration include: pain, swelling, redness, coolness or heat at the site of the IV and the surrounding tissue. Infiltrations can occur quickly so it is important to alert your nurse to any discomfort noticed while receiving any medications or fluids by IV.
Treatment of infiltration can depend on the type of fluid that has infiltrated but most often consists of warm compresses to the affected area several times a day with concurrent elevation of the hand and arm. Most infiltrations resolve within several days and usually have no lasting effects. However, depending upon the medication, an infiltration can be severe.
Flair Reaction
A flare reaction is a local reaction and is generally caused by drugs that are considered irritants. Flare reactions may present as tenderness, warmth, redness or pain along the vein or at the site of the injection. Some persons may also experience itching. Flare reactions can occur immediately or may be delayed up to 12 hours after receiving the drug. Although Flare reactions are traditionally short lived and may be treated by the application of ice to the affected area, it is still important that you notify your physician or nurse if you notice signs of a flare reaction after leaving the clinic.
Extravasation
Extravasation is a rare complication of treatment and is associated with very specific drugs. Extravasation means that drug which has a propensity for tissue damage got outside of the blood vessel into the surrounding area. Signs of extravasation include redness/pain/burning at the IV site, swelling just above the site of the IV or around a central catheter or changes in the flow of your IV.
There are multiple factors that put a person at risk for this complication:
Small fragile veins.
History of vascular or circulatory disease.
History of diabetes.
Previous treatment with medications that effect vascular integrity.
History of long term use of steroids.
History of multiple IVs.
Prior to the start of your therapy your nurse will perform a vein assessment. If you are receiving medications that could cause extravasation, the physician or nurse will discuss placement of central venous catheter (port) with you.