Skin and Nail Changes During Cancer Treatment

This page is for anyone whose skin or nails change during cancer treatment. It covers what different treatments can do, what to watch for, and ways to manage mild changes.

Cancer treatments may cause changes to your skin and nails. Skin problems from radiation therapy and chemotherapy are often mild, but they may be more severe if you are receiving a stem cell transplant, targeted therapy, or immunotherapy.

Let your health care team know if you notice any skin changes so they can be treated promptly. Talking with your team also helps you learn which side effects your treatment may cause.

• Radiation therapy can make the skin in the treated area dry and peeling, itchy, and red or darker. Your skin may look sunburned or become swollen or puffy. Sometimes sores develop that become painful, wet, and infected. This is called a moist reaction.
• Chemotherapy can make skin dry, itchy, red or darker, or peeling. You may get a minor rash or sunburn easily (photosensitivity). Some people have color (pigmentation) changes. Nails may be dark and cracked, and cuticles may hurt. If you had radiation in the past, that area may become red, blister, peel, or hurt. This is called radiation recall. A sudden or severe rash, hives, or burning may be a sign of an allergic response.
• Stem cell transplants can cause graft-versus-host disease, when the donor's immune cells attack your body. It may lead to a rash, blisters, or thickened skin.
• Immunotherapy can cause a severe and sometimes extensive rash, and skin may be dry or blistered.
• Targeted therapy may cause dry skin, a rash, and nail problems. If you develop a rash, talk with your doctor before stopping targeted therapy.

Skin changes can include:

• acne, rash, or blisters.
• bed sores or painful sores.
• burning or pain.
• dry, itchy, peeling, or crusty skin.
• hand-foot syndrome (redness, swelling, or pain on the palms and soles).
• darker, lighter, or red areas of skin.
• easy sunburn.
• swollen skin.

Nail changes can include cracked nails, swollen or painful cuticles, nail infections, and yellow nails.

Make note of all the problems your health care team asks you to call about.

If you have a severe, extensive, blistering, or painful rash and are receiving immunotherapy, call your doctor for advice. It's especially important to call about rashes that involve the eyes or a mucous membrane, such as your mouth, caused by immunotherapy.

Talk with your team about whether you should manage these problems at home. Depending on your treatment, they may advise steps like these:

• Use only recommended skin products. Choose mild soaps that are gentle on your skin, and ask your nurse for specific recommendations. During radiation, ask about products like powder or antiperspirant to avoid before treatment.
• Prevent infection. Keep peeling or wet skin clean and dry, especially in skin folds. Your nurse can show you how to clean the area and may prescribe special dressings or antibiotics.
• Moisturize your skin. Use recommended creams or lotions to keep skin from getting dry and itchy, since irritated skin can become infected.
• Protect your skin. Use sunscreen and sun-protective lip balm, and wear loose, covering clothing and a wide-brimmed hat outdoors. During radiation, don't use heating pads, ice packs, or bandages on the treatment area, and consider shaving less or using an electric razor if skin is tender.
• Prevent or treat dry, itchy skin. Avoid products with alcohol or fragrance. Your nurse may suggest colloidal oatmeal baths to reduce itching. Take short, lukewarm showers, apply recommended cream while skin is still a little damp, and use a cool washcloth or ice for itchy areas.
• Care for your nails. Keep nails clean and cut short, wear gloves for chores like dishes, avoid manicures and pedicures, don't wear tight shoes, and ask your nurse about nail products.
• Ask about rash treatments. Some rashes need medical treatment, such as a medicated cream (topical corticosteroids) or a pill (oral corticosteroids or antibiotics).

Prepare for your visit by making a list of questions. You might ask:

• Which skin and nail changes are common with my treatment?
• How can I prevent them?
• Which problems should I call about?
• Which soaps and lotions are best for me?
• Would seeing a dermatologist (skin doctor) help?