If you’re reading this, it means that you or someone you care about may be navigating a cancer diagnosis and the twisty path that follows. Having lost my mother too early to cancer, I’d like to start by saying that cancer sucks, and that I’m sending you a huge wave of warmth, courage, and support right now.
As a medical doctor and a skin expert, I thought it might be helpful to summarize some of the most common skin issues that can arise during cancer treatment, and offer some ways to support your skin before, during, and after treatment. One of the reasons I created so many unscented, gentle products in our line was because I wanted to provide some beautiful options for taking care of your skin during a difficult time.
I hope this article helps, and please reach out to us if you have any questions after reading.
What Are the Most Common Skin Changes During Cancer Treatment?
Skin reactions during cancer treatment are extremely common. Radiation-induced skin reactions may be more common than chemotherapy-induced skin reactions, which makes sense since radiation treatment is happening directly through the skin, but problems can happen with either form of treatment.
Having both radiation and chemotherapy together can increase both the likelihood and the severity of skin reactionsas some chemotherapy medications can make your skin more sensitive to radiation damage.
Hair loss, which you probably don’t think of as a “skin change,” is one of the most common and distressing skin reactions to chemotherapy.
Skin cells divide rapidly, and cancer treatments are often designed to target rapidly dividing cells. Unfortunately, that includes healthy skin cells along with cancer cells. The result is often dryness, inflammation, impaired barrier function, and increased sensitivity.
Common Skin Changes During Chemotherapy
As mentioned above, hair loss is a very common side effect that is usually reversible after treatment is over. Some forms of chemotherapy and immunotherapy can cause non-specific skin symptoms like dry skin, increased sensitivity and reactivity, rashes, itching, and burning.
Some medications can cause pigmentation changes in the skin, making your skin or nails either lighter or darker. Some chemotherapy drugs can also make you more sensitive to UV rays, making it much easier to get a sunburn during treatment. Be sure to use a mineral sunscreen to protect your skin, during treatment and beyond.
Another chemotherapy reaction is called Hand Foot Syndrome, or PPE (Palmar-Plantar Erythrodysesthesia). This can happen with certain drugs like cytarabine, doxorubicin, and 5-FU, and occurs on the palms and soles about 2–6 weeks after treatment. Symptoms include tingling, pain, redness, swelling, peeling, and blistering, and may require patients to wear special gloves or footwear, or reduce activities that place too much strain on the skin of the hands and feet, like excessive walking or lifting weights. If symptoms become severe, dose modification may be necessary, which should always be discussed with your oncology team.
Radiation Dermatitis and Other Skin Changes During Radiation Therapy
During radiation treatment, people often experience what is called acute radiation dermatitis. The symptoms are often dependent on the dose, with the most severe symptoms like ulceration occurring in patients who receive the highest doses.
At lower doses, acute radiation dermatitis presents as redness, pain, and hair loss at the site of radiation. Patients can also experience itching, scaling, dryness, and pigmentation changes. Symptoms can begin a few hours, days, or weeks after treatment, and damaged skin usually starts to heal after about two weeks, although healing time varies widely.
Dermatitis can sometimes be worse if someone is also receiving certain types of chemotherapy, or if someone is receiving multiple doses of radiation without sufficient time to heal in between treatments. If your skin gets to the point where it is super angry, raw, and moist, you need to talk to your care team to make sure you’re doing all you can to prevent infection; you may need special wound dressings or prescription creams or gels.
Another phenomenon, called radiation recalloccurs when an area of the skin previously treated with radiation becomes inflamed after treatment with certain chemotherapy drugs. Most radiation recall happens when the chemotherapy is administered within two months of radiation, but it’s possible for it to occur after a longer period of time as well.
Chronic radiation dermatitis is the big bad wolf of radiation-induced skin changesbecause it’s less likely to repair itself, and more likely to result in permanent skin changes like fibrosis, hypopigmentation, and atrophy. It can even lead to a secondary skin cancer, especially if the dose was high or the patient’s radiation treatment happened at a young age. Long-term barrier support and vigilant sun protection remain important after treatment ends.
How Common Is Radiation Dermatitis?
Unfortunately, up to 85–95% of people have some form of radiation dermatitis. Considering that up to 70% of people with cancer end up needing radiation, and the fact that about two million people a year in the US get diagnosed with cancer, we’re looking at well over a million people in the US each year who could be dealing with a skin rash during cancer treatment. That’s a lot of unhappy skin.
A few factors that increase your chances of radiation dermatitis include female sex, advanced age, chronic sun exposure, smoking, and other systemic illnesses like diabetes. And, of course, the higher the dose of radiation, the greater the chance of having a more serious skin reaction.
How to Prepare Your Skin Before Chemotherapy or Radiation
There is no magic pill here, but there are a few things you can do to support your skin before you start treatment to minimize your chances of skin problems, or reduce their severity if it does happen.
The most important thing you can do is have healthy skin going into treatment. Daily washing with a gentle soap and water is a great way to prepare for treatment, as well as using an unscented body oil or body mousse on wet skin to fortify your skin’s barrier function in preparation for treatment. Avoid introducing new active ingredients or exfoliants in the weeks leading up to treatment.
Additionally, paying great attention to your nutrition and hydration prior to treatment can help prepare not only your skin, but your entire system for treatment. Adequate protein intake supports tissue repair, and hydration supports skin elasticity and resilience.
Another thing to note is that if you have a history of eczema, it can get much worse during cancer treatment. It’s a good idea to try to get your eczema under good control before your treatment begins, which you may be able to do with a few simple changes.
Talk with your healthcare provider to ask if the use of a steroid cream or ointment could be helpful prior to treatment. While it’s wise to use steroids sparingly given the chance of rebound dermatitis, there is some evidence to show that pre-treatment with a topical steroid can help reduce the severity of radiation dermatitis.
How to Treat Skin Rashes During Chemotherapy and Radiation
In a word, gently.
I generally recommend using simple, unscented products (not even essential oils) and avoiding ingredients like sodium lauryl/laureth sulfate and synthetic fragrance, both of which can make your skin more susceptible to irritation. Take a look at your laundry detergent, shampoo, toothpaste, and hand soap to make sure they’re free of those two ingredients as well.
In case you’re thinking about slathering your skin in diaper cream after radiation treatment, which would be a reasonable thing to think, don’t do it. It turns out that creams or treatments with metals like zinc and aluminum can actually increase the dose of radiation to the surface of the skinwhich could make the dermatitis worse. Opt for a balm that does not contain any metallic ingredients instead.
Another thing that could make your rash worse is using powders to dry the irritated areas, so keep the areas clean and dry, but don’t use powder to try to dry it out more.
If inflammation is significant, your oncology team may recommend prescription topical steroids, barrier films, hydrogel dressings, or other wound-care protocols. Follow their guidance closely.
Daily Skin Care Tips During Cancer Treatment
Other than the products you’re using on your skin and in your home, here are a few simple things that can be helpful:
- Wear loose fitting, soft clothing
- Avoid super hot showers or baths
- Do not exfoliate or shave any irritated or sensitive skin
- Wear hats, sunglasses, protective clothing, and sunscreen when outdoors
- Continue to pay attention to nutrition and hydration the best you can during treatment to nourish your skin from the inside
Small, consistent habits often make the biggest difference.
Are Essential Oils Safe During Chemotherapy or Radiation?
It depends on how your skin is doing.
Don’t ever use undiluted essential oils on your skin, and if your skin is upset, avoid them entirely. If you want a little aromatherapy along the way and your skin is doing well, you can use a properly formulated face wash, serum, or body oil with a low dose of essential oils. If you experience any irritation, go back to using unscented products until you’re a few months out from your last treatment.
When in doubt, unscented is safest.
When Should I Call My Doctor About a Skin Reaction?
This is an important question.
Mild redness, dryness, and itching are common during chemotherapy and radiation. But certain symptoms warrant prompt medical attention.
Call your care team if you experience the following:
- Severe pain
- Blistering or open sores
- Weeping or oozing skin
- Signs of infection such as warmth, pus, or fever
- Rapidly spreading rash
- Skin breakdown that interferes with daily function
It is always better to ask early than to wait too long. Oncology teams are very familiar with treatment-related skin reactions and can often intervene quickly to prevent complications.
Your skin is not just cosmetic. It is a protective organ. When its barrier is compromised, infection risk increases, especially during treatment when immune function may already be suppressed.
Frequently Asked Questions About Skincare During Cancer Treatment
Should I stop retinol or exfoliating acids during cancer treatment?
Yes. Retinoids, AHAs, BHAs, and other active exfoliants should generally be discontinued unless your physician specifically advises otherwise.
What is the safest type of sunscreen during treatment?
A mineral sunscreen containing zinc oxide or titanium dioxide is typically preferred, as it is less likely to irritate compromised skin.
When will my skin go back to normal after treatment?
Acute reactions often improve within weeks of completing treatment. Chronic changes may take months, and some may persist. Gentle, consistent care remains important long after treatment ends.
Cancer sucks. But skincare during cancer treatment does not have to add to your burden. Protect your barrier. Reduce irritation. Nourish yourself the best you can. Trust your organs to do the heavy lifting, and lean on your care team when needed.
And if we can help in any way, we’re here.
The information contained in this post is for educational interest only. This information is not intended to be used for diagnosis or treatment of any physical or mental illness, disease, or skin conditions.
Resources:
Bray FN, Simmons BJ, Wolfson AH, Nouri K. Acute and Chronic Cutaneous Reactions to Ionizing Radiation Therapy. Dermatol Ther (Heidelb). 2016 Jun;6(2):185-206
Salvo N, Barnes E, van Draanen J, Stacey E, Mitera G, Breen D, Giotis A, Czarnota G, Pang J, De Angelis C. Prophylaxis and management of acute radiation-induced skin reactions: a systematic review of the literature. Curr Oncol. 2010 Aug;17(4):94-112
Ryan JL, Bole C, Hickok JT, Figueroa-Moseley C, Colman L, Khanna RC, Pentland AP, Morrow GR. Post-treatment skin reactions reported by cancer patients differ by race, not by treatment or expectations. Br J Cancer. 2007 Jul 2;97(1):14-21
Skin Changes During Cancer Treatment by saintjude.org
Skin and Nail Changes during Cancer Treatment by NIH/NCI
