Skin and Scalp Care During Chemotherapy: Advice from the Experts


You might find yourself feeling guilty and vain for worrying about your appearance after a cancer diagnosis, but be reassured that you are not alone — the thought of losing hair frightens most cancer patients, and some even stop treatment because of skin damage.

When at age 55 Dr. Cynthia Bailey found out that she had aggressive breast cancer, her whole life was turned upside down. As a dermatologist, she decided to fight back by focusing on her area of expertise: while undergoing chemotherapy, Dr. Bailey tested out various skincare products to help herself and other women receiving the same aggressive treatment.

Sharon T. Mclaughlin-Weber, MD, FACS, is a lymphoma cancer survivor, board certified plastic surgeon, and founder of New York City-based Wrinkle Helper. Her cancer journey included chemotherapy, radiation, and surgery.

Drs. Bailey Mclaughlin-Weber each have over 20 years of professional experience in skincare. Here is their advice and up-to-date recommendations for keeping your skin, hair, and nails healthy. But first, let’s break down the science behind chemotherapy.

Why Is Skin Care Important During Chemotherapy?

Skin is an important barrier. It serves to stop germs, dirt, pollution, and chemicals from entering your body. Chemotherapy weakens your immune system, including that skin barrier, making you vulnerable to outside attacks. You need healthy skin to prevent and fight them.

“Healthy skin is essential for your physical well-being during this difficult time,” Dr. Bailey emphasises.

Skincare is also part of a bigger transformation, from surviving cancer to self-care and thriving. It’s empowering to know how to help yourself and care for your appearance. For many cancer patients, that knowledge is synonymous with taking back control on their lives.

Why Does Chemotherapy Cause Skin and Hair Damage?

Cancerous cells grow uncontrollably — much faster than normal cells. Chemotherapy specifically targets and destroys the cells that grow faster, but there’s a catch: chemotherapy drugs need to be in your blood to reach the cancer cells, and during that process they can cause side effects by impacting healthy cells as well.

Healthy cells that grow more quickly — namely in the skin and hair, as well as the blood and digestive tract — suffer more damage. This is why chemotherapy patients typically experience skin damage, hair loss, and nausea. When the treatment affects white blood cells, it can also decrease immune response. If it injures the red blood cells, you can suffer from anemia.

Newer cancer drugs work by boosting your immune system to “target” cancer more precisely. Recall how you feel when you’re fighting off a cold and your immune response goes into overdrive: you experience fever, chills, muscle aches, low energy, and nausea. A similar reaction takes place with targeted cancer therapies. For the same reasons, skin allergies, acne, and rashes are also quite common.

How Does the Skin Change During Chemotherapy?

There are a number of ways that the skin can be affected by chemotherapy:

  • 60% of patients report skin dryness during breast cancer chemotherapy. The skin can also become more susceptible to infections, hyperpigmentation, and sensitivity to sunlight.
  • The scalp can become dry and itchy.
  • Hair can become weak and thin, or fall out completely.
  • Newer drugs can cause a skin rash, acne, itching, and increased facial hair.
  • The skin on hands and feet can peel, and hands and feet themselves can swell painfully.
  • Nails can become brittle, darkened, cracked, or even fall off. Drugs used to treat breast, prostate, and lung cancer (called taxanes) often damage nails.
  • Attendant anemia can make you look pale and lifeless.

Not all drugs injure the skin, depending on the drug type and dosage. Let your doctor know if you experience any signs of infection, inflammation, or rash. Also take photos of the affected areas to show your doctor, as their appearance can evolve rapidly.

Most damage is usually temporary, and your body will gradually recover after treatment.

Boosting Skin Health During and After Chemotherapy

Start making a plan for skin care at least one week before chemotherapy, so you’ll have the essentials once you start.

More sensitive skin means you may become allergic to products you used without problems in the past, so be extremely gentle with your skin. This is the golden rule for all products and techniques. Dr. Mclaughlin-Weber sums up what to always keep in mind: “Honestly, the least amount of ingredients, the better.”

Sun protection is also very important to avoid skin damage. Use broad protection sunscreen with a sun protection factor (SPF) of at least 30. Cover up with long sleeves, a hat, and gloves.

“I remember covering myself up but did not think to cover my hands. The back of my hands actually blistered, and I wasn’t even out in the sun for that long,” Dr. Mclaughlin-Weber tells us. Sensitivity to sunlight can continue for a couple of months after treatment.

“Drink plenty of water to help prevent dehydration,” Dr. Mclaughlin-Weber also suggests, and support your body with nutrients from a healthy diet. Not only will it help your skin, but it also will increase your energy levels.

Moisturizing and Daily Skin Care

Moisturizing is key: gently pat your skin dry with a towel after showering, and moisturize immediately after so that the water you soaked up while showering is trapped in. If you wait more than five minutes, the water can evaporate. Note that creams and ointments are better than lotions at holding in moisture.

Try Bag Balm (a natural moisturizer with lanolin) if you have chapped, dry skin, or brittle nails and cuticles. Vaseline can also be used on the hands or extremely dry areas.

Your daily skin care regimen should include mild, hypoallergenic products that contain salicylic acid, urea, ammonium, lactic acid, and natural oils such as macadamia, jojoba, and shea butter. According to Dr. Bailey, hyaluronic acid and products containing green tea antioxidants are also great skin hydrators.

And don’t forget your lips: use a balm with oils and SPF protection throughout the day.

Washes and Soaps

Use products that won’t strip your skin of its natural oils. You’ll know this by the feel under your fingertips while washing: don’t go for that “clean” rubbery feeling, or your skin will end up being too dry. Dr. Mclaughlin-Weber recommends oil cleansers (100% oil) that are free of polysorbates and preservatives.

Every few days you can avoid soaps altogether, and wash with water only. Some dermatologists also recommend reducing bathing time to 5 minutes, but Dr. Bailey disagrees, as she has found that immersing skin in water is good for hydration.

Consider foamed soap for your hands. It’s easier to wash out and reduces irritation from soap residue.

Hands, Feet, and Nails

Cooling your hands and feet in ice or wearing cold gloves during chemo can reduce side effects. It restricts blood flow, so less of the drug reaches the hands, feet, and nails.

For everyday use, favor creams with glycerin or just use jojoba oil. Creams containing urea (Carmol 20 or 40) are recommended to treat skin reactions, while Vitamin B6 can help with skin peeling.

Avoid cutting cuticles, and keep your nails short and clean. If you use nail polish, go for natural ingredients and water-based removers. Use Nuvail or any other prescription nail strengthening solution if your nails are brittle.

To avoid damage, wear gloves when working with your hands, and wear comfortable shoes that don’t put pressure on the toenails.

After chemotherapy, you can resume manicures and pedicures or take supplements for hair and nails, such as biotin and collagen.

Treating Skin Rashes

Antibiotic and steroid creams reduce skin itching and rashes while preventing skin infections. Your physician may also recommend creams containing anesthetics, or cooling creams with menthol, camphor, or pramoxine.

Consider antihistamines like Benadryl and Reactine if you are experiencing allergy-like symptoms of itchiness and skin irritation. If you do experience a rash, try not to scratch and don’t despair — it may be a sign that your treatment is working.

What to Avoid

Avoid products and activities that will dry out or damage your skin, such as:

  • Hot water; use warm water instead.
  • Harsh detergent and dishwashing soap; find allergen-free products.
  • Products containing alcohol, preservatives, or perfumes (including deodorants).
  • Synthetic clothes; go for cotton.
  • Wired bras that can cut into the skin.
  • Wet shaving, and products that may scratch or scrub the skin.
  • Waxing; pluck or thread unwanted facial hair.
  • Makeup with harsh chemicals; go for gentle products.
  • Extreme weather conditions, if you can.
  • Fake nails, manicures and pedicures.
  • Gardening; if you can’t avoid gardening altogether, be very careful, as dirt can cause serious infections in cancer patients.

Tips for Hair and Scalp Care

Hair loss usually starts 1 to 3 weeks into chemotherapy. It takes 1 to 3 months for the hair to grow back once the treatment is over.

Scalp cooling is a popular method to reduce hair loss. During chemotherapy it helps reduce blood flow to the scalp, so less of the drug gets to your hair. Depending on your treatment scalp cooling may be combined with scalp compression, which works the same way.

Certain products containing antioxidants, melatonin, vitamin D3 or proso millet may also help reduce hair loss, although various scientific studies into these alleged benefits present conflicting positions.

Use a gentle hairbrush and pH-balanced shampoo, and wash less or just rinse with water. Baby oil, mineral oil, or mild lotions with tea tree oil help calm scalp sensitivity.

Bimatoprost, an eyedrop that’s used to treat glaucoma, has been shown to increase length and thickness of eyelashes in patients receiving chemotherapy.

Cutting your hair short before it falls out is a big decision. Many patients prefer to do so, as watching clumps of hair fall out can be distressing. If you decide to wear a wig or a scarf, do some research beforehand to be prepared.

In Closing

Your skin is constantly exposed to the outside world’s germs and harmful chemicals, and chemotherapy suppresses your immune system’s ability to protect you from these threats.

By keeping your skin healthy and avoiding certain products, you can counter many of cancer treatments’ most common side effects.

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