Cancer is a devastating disease, and the process to treat it can result in significant changes to the appearance that can be profoundly emotional. While we know that cancer therapies can result in hair loss, you may not realize just how much the skin can be affected by cancer treatments. We spoke to dermatologists to learn more about how cancer therapies can affect our skin and how to treat any issues that may arise.
Featured Experts
- Jennifer Segal, MD is a board-certified dermatologist based in Houston
- Orit Markowitz, MD is a board-certified dermatologist based in New York
- Heidi Waldorf, MD is a board-certified dermatologist based in Nanuet, NY
What Happens to the Skin During Cancer Treatment?
There are a lot of side effects from cancer therapies, undoubtedly. When it comes to the skin, the kind of therapy that a patient is receiving can result in skin reactions like rashes to more long-term changes like skin firming and sensitivity to light.
Houston dermatologist Jennifer Segal, MD explains that skin changes are common for any type of cancer treatment. “There are myriad skin changes that occur with the medications used in cancer treatment, whether chemotherapy, immune therapy, or hormonal therapy,” Dr. Segal explains. “Sometimes there are specific skin reactions to the medications themselves. In general, however, the skin can become dry, itchy, and generally more sensitive.”
These general symptoms can occur in a lot of cancer treatment types, including chemotherapy. You can also develop a localized reaction during radiation therapy, which is only in the treatment area. This is called radiation dermatitis, and has its own treatment needs. Radiation therapy damages the DNA of a cancer cell, but that means it also causes damage to our cells. This damage to healthy tissues results in dryness, peeling, and a loss of elasticity.
Additionally, cancer treatments can increase one’s sensitivity to sunlight, putting them at risk of absorbing too much of the sun’s UV rays, which could result in sunburns and even skin cancer. Chemotherapy increases a person’s overall sensitivity to light, but this effect is temporary. Radiation, on the other hand, only increases sensitivity in the areas directly treated, but that change in sensitivity can be permanent.
New York dermatologist Orit Markowitz, MD explains that a person’s skin type is just as important as the kind of treatment they’re receiving. “Similar to any skin issue, it really depends on the skin type,” Dr. Markowitz says. “For example, some people’s skin tends to scar or become firm with trauma.”
Nanuet, NY dermatologist Heidi Waldorf, MD notes radiation dermatitis is also more common in some skin types. “Radiation dermatitis is generally more common on darker or sun damaged skin,” Dr. Waldorf explains.
It’s also possible for your skin type to change altogether. “Your skin type—dry or oily—may change and someone who used light or no moisturizer, may need heavier amounts,” Dr. Waldorf explains.
When it comes to easing some of these symptoms, protecting the skin barrier can help. “In general, dryness, sensitivity, risk of infection and increased sun-sensitivity are common,” Dr. Waldorf confirms. “You can help maintain the skin barrier by using mild, non-stripping cleansers.”
Gentle Skin Care
Your skin becomes more sensitive overall undergoing cancer therapies, so it is critical to practice a gentler skin-care routine to keep your skin barrier strong and avoid causing more irritation.
“Gentle cleansing, nourishing and protecting the skin enhances healing and minimizes irritation,” Dr. Segal explains. “If there are open areas in the setting of radiation, I also like to add EltaMD Silver Gel, which is a wonderful wound care topical that prevents and treats skin infections.”
To avoid any further irritation, Dr. Segal adds that your hair and skin-care products should be fragrance-free. “I always recommend gentle skin care and avoidance of fragrances, which can be irritating in the setting of drier, more sensitive skin,” she says.
You may also need to look for alternatives for some skin care that previously worked for you, like retinoids or peels.
“If you were using a retinoid without problems, you may want to decrease the frequency until you see if you tolerate it during treatment,” Dr. Waldorf explains. “Don’t use at-home peels unless approved by your doctor; some chemotherapies change your cell turnover and you can pull off too much and cause a burn-like result.”
Because a lot of cancer therapy is about eliminating bad cells, you may have to stop taking or using cell-protecting ingredients. “Don’t assume that you should use oral or topical antioxidants,” Dr. Waldorf warns. “Because the goal of chemotherapy is to damage the bad cells, your oncologist may not want you to use something that could potentially protect them.”
Sensitivity to Light
“Some cancer therapies can cause increased photosensitivity,” Dr. Waldorf explains. “Sun protection, including sunblock, hats, clothing and seeking shade midday are critical for all exposed skin.”
Chemotherapy and immunotherapies can cause drug-induced photosensitivity, which causes the body to increase its absorption of UV radiation. According to the Cancer Treatment Center of America, this sensitivity is not permanent, and usually wears off a few months after treatment ends.
Radiation therapy, on the other hand, is focused on the area the beam actually passed through. These areas may always be more sensitive to sunlight, even long after the treatment has concluded.
Dr. Waldorf, herself a breast-cancer survivor, explains that the loss of hair caused by chemotherapy means expanding your sun protection to newly exposed skin. “Chemotherapy baldness requires special care since that skin may never have been exposed before,” Dr. Waldorf says. “As a second-generation dermatologist, sun-protected since birth, I was an anomaly during chemotherapy for breast cancer 15 years ago: My scalp color matched my face,” Dr. Waldorf explains. “Sunscreen and a hat protected that skin when I wasn’t wearing a wig.”
“My recommendations for sunscreen are the same for cancer patients as for healthy folks,” Dr. Waldorf explains. “Choose a sunscreen with an SPF of at least 30 for UVB protection and a physical block, zinc oxide or titanium dioxide, for UVA protection.”
Treating Itchy and Dry Skin
When it comes to treating dry and itchy skin, Dr. Segal explains that cancer patients need to prioritize gentleness. “I always recommend a ‘gentle skin-care regimen to my patients undergoing cancer treatment,” Dr. Segal says. “Fragrances should be avoided since they can cause irritation and itching in more sensitive skin.”
Dr. Segal adds that moisture is critical to maintaining skin health while undergoing cancer treatment. “Patting dry after baths or showers and immediately moisturizing all over with a gentle moisturizer is important for nourishing and maintaining the skin barrier,” Dr. Segal says. “My favorite combination is Avéne Cleansing Oil with the Avéne emollient baume. I also love Cicalfate+ Cream for the face, and Cicalfate+ Spray which relieves itching.”
“There’s no need to purchase cancer-focused products,” Dr. Waldorf explains. “For particularly scaly, dry skin, look for a moisturizer that includes AHA like Amlactin 12%, Neostrata AHA, or CeraVe SA to help exfoliate and moisturize.”
When searching for effective moisturizers, be on the lookout for hydrating ingredients like hyaluronic acid and glycerin. These minimize water loss and can draw water from your environment to moisturize your skin.
Treating Radiation Dermatitis
There are some types of radiation therapy that are external, meaning that the beams have to pass through your skin to get to the cancer cells they’re meant to kill. This is common to treat lung and breast cancers, for example. With external beam radiation, the skin cells can be harmed as the beam passes through them. According to the Cancer Treatment Center of America, the result is often dryness, itchiness, swelling and redness. There is even a chance of a “moist reaction,” where skin becomes wet, sore, and easily infected.
Because of the range of symptoms, it’s vital to talk through what could happen to your skin and what to do about it with your oncologist.
“Since radiation effects can range from darkness and scale to moist ulcers, it’s critical to speak with the radiation oncologist treating you before treatment begins and as symptoms arise because they have specific products to reduce and treat those effects,” Dr. Waldorf explains. “Despite being a dermatologist, I followed the skin-care instructions of my radiation oncologist.”
Treatments for radiation dermatitis are specific. Often, prescribed corticosteroids and antibiotics will be necessary, so you won’t be able to cure it by following basic dry or itchy skin-care products. This can even include some products that are cancer-specific. “No one should be applying Amlactin to radiation dermatitis,” Dr. Waldorf warns.
Dermatologist-Recommended Skin Care for Cancer Patients
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Avène XeraCalm A.D Lipid-Replenishing Cleansing Oil ($34)
Suitable for even the fragile skin of a newborn, this gentle cleanser is careful to seal in moisture and protect the skin barrier. The formula is dye and fragrance free for the most sensitive of skin, and even helps reduce itching.
This product is gentle enough to be used during flare ups, and helps calm irritated skin while boosting hydration.
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ISDIN Eryfotona Actinica Ultralight Emulsion Mineral Broad Spectrum SPF 50+ ($70)
Designed for sun-damaged skin, this mineral sunscreen protects against broad spectrum UVA/UVB rays while repairing damage caused by the sun. The secret is Photolyase, a plankton extract that can reverse damage to cells and prevent future sun damage.
The formula is lightweight and smooth, making it a great base for any makeup. It also absorbs easily into the skin, so it won’t leave you looking ghostly after application. Dr. Waldorf also recommends their powder sunblock formula.
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Dove Sensitive Beauty Bar ($14 for 8 pack)
This beauty bar is a tried-and-true gentle cleanser that prevents the tight, dry effect other soaps can have. It’s formulated to be 1/4 moisturizing cream, making this affordable stable perfect for extra-dry skin.
Dermatologist-recommended and hypoallergenic, this beauty bar is fragrance-free and provides effective cleansing without stripping the skin of its nutrients.
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CeraVe SA Cream for Rough & Bumpy Skin ($26)
Containing the gentle exfoliating power of salicylic acid, this moisturizer is perfect for softening rough, dry skin. Perfect for sensitive skin, this moisturizer delivers exfoliation without the abrasive damage physical exfoliators can cause.
The combination of gentle exfoliation and powerful moisture is topped off by niacinamide to calm irritation.
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ColoreScience Powder Formula Sunforgettable Total Protection Brush-On Shield SPF 50 ($69)
This water-resistant powder sunscreen can be applied under or over makeup, and its convenient on-the-go applicator makes it easy to stay protected all day. Dr. Waldorf recommends this gentle and noncomedogenic sunscreen, and it even won our 2020 NewBeauty Award for The Best Powder Sunscreen.
The mineral-based formula is backed up by antioxidants that further protect your skin from harmful UV rays. The lack of harsh chemicals prevents irritation and stinging, so it’s safe for the most sensitive of skin.
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La Roche-Posay Toleraine Double Repair Face Moisturizer UV ($25)
This long-lasting moisturizer doubles as an SPF and is perfect for sensitive skin. Ceramides and niacinamides work to repair the skin’s barrier to prevent damage, while glycerin provides powerful hydration.
Designed to immediately provide skin comfort for dry and sensitive skin, this lightweight formula provides essential moisture for up to 48 hours.
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Neutrogena Hydro Boost Gel-Cream Extra Dry ($23)
This quick-absorbing moisturizer is designed to last up to 48 hours and delivers powerful moisture to dry skin. Hyaluronic acid works in tandem with glycerin and other hydrating ingredients to provide deep, long-lasting relief.
The gel-cream formula allows for easy absorption without heavy oils that can lead to breakouts. Fragrance-free and safe for sensitive skin, this moisturizer is recommended for stubbornly dry skin.
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AmLactin Daily 12% Lactic Acid Moisturizing Lotion ($16)
This lactic acid–based moisturizer is another great option for gentle exfoliation that keeps the skin barrier intact. The non-greasy formula is designed to promote your skin’s own regenerative processes to reveal soft, smooth skin.
While this product is not suitable for broken skin or treating radiation dermatitis, it is perfect for the more general rough and irritated skin that chemo and immunotherapies can cause.
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Skin Better Science Sunbetter SHEER SPF 56 Sunscreen Stick ($55)
This sheer, broad-spectrum sunscreen stick is perfect for on-the-go use without worry of a ghostly white complexion. The stick applicator glides on a completely transparent all-mineral sunscreen for perfectly uniform and completely invisible coverage.
Sunbetter is water resistant for up to 80 minutes, and the smooth texture provides a seamless, easy application. Its lightweight formula smooths skin and won’t cause breakouts or irritation.
BUY ON SKIN BETTER SCIENCE – $55
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Aveeno Skin Relief Moisturizing Lotion ($14.50)
Powered by oats and shea butter, this moisturizing lotion is perfect for soothing irritated and itchy skin. The unscented formula is rich and creamy, gliding on for instant sensitive skin relief.
Gentle and fragrance-free, this lotion is designed for long-lasting moisture protection and delivers hydrating relief for even raw and peeling skin.
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Avène Cicalfate Absorbing Soothing Spray ($38)
This soothing spray is ideal for restoring and soothing broken, rashy and itchy skin. Zinc oxide works to dry out moist wounds and damp skin, while copper-zinc sulfate promotes a healthy environment for skin to heal.
Perfect for the moist reaction that can occur during cancer therapies, this spray provides immediate itching relief and works over time to prompt healthy wound healing.
