Managing Skin-Related Side Effects during Cancer Treatment

Q&A with Mario E. Lacouture, MD, Memorial Sloan-Kettering Cancer Center

Mario Lacouture, MD, is the author of Dr. Lacouture’s Skin Care Guide for People Living with Cancer (Harborside Press, 2012; $29.95). Here, Dr. Lacouture shares insight into some of the most common issues patients encounter when managing side effects that affect the skin.

 

Which cancer treatments produce side effects that affect the skin?

The cancer treatments that have resulted in the most side effects are targeted therapies, which are used against the most frequent kinds of cancer, including lung, breast, colorectal, kidney, and pancreatic cancer. These drugs, introduced in the past 10 years, have resulted in improved survival, but they also unexpectedly brought on a whole constellation of dermatologic side effects that affect the majority of patients.

In addition, up to 80 percent of patients who receive radiation therapy, especially for cancers of the breast, head and neck, and genitals, are affected by skin burns and color changes. These can be painful and itchy and are associated with significant discomfort.

What are some of the most common conditions that arise as a result of cancer treatment?

Although more than 50 different side effects can affect the hair, nails, and skin, four major conditions can result.

First, patients can develop an itchy, painful rash that looks like severe acne, affecting the face, scalp, chest, and back; it has replaced hair loss as a visual indicator of cancer treatment. This condition is one of the most debilitating side effects.

Second, people can develop painful blisters on their hands and feet, a condition called hand-foot syndrome. These blisters make it impossible for them to participate in daily activities and can sometimes even prevent them from being able to walk.

The third side effect of targeted therapies affects the hair, causing it to become very curly and wiry, and sometimes causing patients to grow more hair on their face. This can also affect the eyelashes, causing them to get very long and curly.

Finally, the fourth common change occurs in patients’ nails. They can become brittle and painful, making daily tasks like dressing, eating, and wearing close-toed shoes or gloves very difficult.

 

How can these conditions affect patients emotionally?

As these cancer treatments become increasingly effective, patients want to continue to live their lives as normally as possible, and these skin conditions—which may have seemed trivial in the past—are becoming more and more important. I have seen people of all ages saddened because they don’t want to leave their homes because of a rash on their face. I have heard stories of people being asked to leave airplanes because other passengers are worried the rash is contagious. I have heard patients describe wanting to attend weddings or events and not being able to go because these conditions are so debilitating. Parents agonize over having to answer tough questions from their young children; and people of all ages want to stay home and not leave because of these conditions.

I try to tell patients that in the majority of cases there are tools we can use to mitigate these side effects and, in some cases, resolve them. We can use medication to provide long-term relief, and we can provide tools to improve things in the short term. For example, there are cosmetic foundations that can be matched to people’s skin tone to cover rashes or acne, and we can recommend powders and hair thickeners to cover the scalp and increase hair growth for people who experience thinning hair.

 

Are there treatment options available for these conditions?

Yes, most skin side effects can be treated effectively. We use many topical and oral antibiotics, most of which are prescription items, for patients who develop rashes. Also, oral and topical anti-inflammatory medications or corticosteroids are used to treat painful, itchy, or inflammatory skin conditions. Latisse® (bimatoprost ophthalmic solution) is recommended for people who may be losing their eyelashes—it has been shown to more than double the thickness and the length of lashes—and we recommend specific shoes and gloves for people experiencing hand-foot syndrome.

 

Are there steps patients can take before treatment begins to lessen or prevent some of these conditions?

By using antibiotics before and at the outset of treatment, we can reduce the severity of a certain type of rash by more than 50 percent, as well as the inflammation around the nails. For patients who experience hand-foot syndrome, we recommend that they not walk barefoot and always use very soft slippers and shoes; we also recommend that they use exfoliating creams during the first month, which can reduce the blisters by about one-third. In some women receiving traditional chemotherapy who are concerned about hair loss, we advise the use of minoxidil during chemotherapy because it has been shown to reduce the duration of hair loss by about two months. And if the patients use Latisse, eyelashes can remain twice as long and thick. In summary, many side effects can be minimized by treating them before they occur, without affecting the effectiveness of the anticancer treatment.  _

Mario E. Lacouture, MD, is a board-certified dermatologist with a special interest in dermatologic conditions that result from cancer treatments. His clinical focus is the recognition and the management of the side effects and the conditions of skin, hair, and nails that may arise in cancer patients and survivors as a consequence of surgery, chemotherapy, radiation, or transplantation. His research focuses on exploring new skin treatments that do not interfere with the effectiveness of anticancer medications.

Dr. Lacouture received his MD degree from Javeriana University in Colombia. He completed residencies at Cleveland Clinic and the University of Chicago and a fellowship at Brigham and Women’s Hospital. Prior to his current position as an associate member at Memorial Sloan-Kettering Cancer Center, he was an attending physician at Northwestern University’s Feinberg School of Medicine, where he founded the SERIES Clinic to care for people living with cancer. He lives in New York City.