Skin, Nail, and Hair Changes During Chemotherapy

Skin and nails are made of fast-growing cells, which is exactly what chemotherapy targets. That is why so many of these changes show up together, and why they usually improve once treatment ends. Most are uncomfortable rather than dangerous — but a few are not, and the difference is worth knowing.

Chemotherapy can cause dryness, itching, redness or darkening of the skin, peeling, and a minor rash. It can also increase sun sensitivity and change pigmentation. Other treatments cause their own patterns: radiation therapy can cause dryness, peeling, itching, redness or darkening, swelling, and a sunburned look; targeted therapy causes dryness, rash, and nail problems; stem cell transplants can lead to graft-versus-host disease with rash, blisters, or thickening of the skin.

If you had radiation therapy in the past, some chemotherapy drugs can trigger a reaction in the previously treated area. This is called radiation recall.

Dryness and itching are the most common complaints, and the basics genuinely help. Moisturize with creams and lotions your team recommends, and apply them while your skin is still damp. Use lukewarm rather than hot water. Avoid products containing alcohol or fragrance. Colloidal oatmeal baths can ease itching.

Photosensitivity means you sunburn easily — sometimes after sun exposure that never used to bother you. Prevention is straightforward: sunscreen, protective clothing, and a hat. This matters year-round, not only on obviously sunny days.

Hyperpigmentation shows up as darker areas of skin, tongue, and joints. It can look dramatic, particularly along veins used for infusions or across knuckles and finger joints. It is a pigment change, not damage.

Nail changes are common, easy to dismiss, and worth mentioning early. Chemotherapy can cause darkened and cracked nails and painful cuticles. Reported nail changes include:

• Ridges and lines. Beau's lines are horizontal ridges or grooves across the nail. Mees' lines and Muehrcke lines are other banding patterns.
• Weaker nails. Thinning or reduced strength, leading to breakage.
• Discoloration. Yellowing, discoloration, or over-pigmentation on the nails or nail beds.
• Nail lifting. The nail plate lifting or falling off, known as onycholysis.
• Painful nail beds. Delicate, sensitive nail beds or cuticles.
• Infection. Paronychia — infection around the nail — which is more likely if nails are cracked or open.
• Slowed growth. Nails may grow more slowly, or stop growing for a while.

Chemotherapy drugs particularly associated with nail changes include vincristine, paclitaxel, fluorouracil, etoposide, daunorubicin, bleomycin, cyclophosphamide, dacarbazine, and methotrexate. Immune checkpoint inhibitors can affect nails, and targeted drugs — especially EGFR inhibitors and antiangiogenic agents — frequently cause nail problems.

For pain and swelling around the nail, daily vinegar soaks made from equal parts white vinegar and water are one suggested measure, along with over-the-counter anti-inflammatory medicines. For weak nails, a water-soluble nail lacquer or a prescription nail polish may help, and biotin has been suggested. An infected nail may need antibiotics, antifungals, steroid ointment, anti-inflammatory medicines, or other treatment. Severe lifting occasionally requires surgical removal of the nail.

Most nail changes are temporary, but some can last long after treatment ends, or can even be permanent.

Painful redness and swelling specifically on the palms of the hands and soles of the feet is a distinct side effect: hand-foot syndrome, also called palmar-plantar erythrodysesthesia. It is managed differently from ordinary dryness. See our page on hand-foot syndrome during cancer treatment.

Hair loss is a separate topic with its own practical decisions, including scalp cooling. Our pages on hair loss during cancer treatment and cold caps cover it in detail.

Let your health care team know if you notice any skin changes so they can be treated promptly. Tell your team about nail symptoms even if they are not painful or bothering you, and as soon as you notice any change, expected or unexpected.

Rash carries a specific warning. If you have a severe, extensive, blistering, or painful rash and are receiving immunotherapy, call your doctor to get their advice. It is especially important to call about rashes that involve the eyes or a mucous membrane, such as your mouth, caused by immunotherapy.

Rashes may be treated with a medicated cream (topical corticosteroids), or with medicine you take as a pill (oral corticosteroids or antibiotics). Radiation can produce a moist reaction, where sores become painful, wet, and infected — another reason not to wait and see.

Hand-Foot Syndrome During Cancer Treatment, Radiation Burns and Skin Changes, Immune-Related Side Effects, Side Effects Overview, and Questions About Treatment Side Effects.

• National Cancer Institute, Skin and Nail Changes during Cancer Treatment
• American Cancer Society, Nail Changes