One of the many side-effects of cancer treatment are changes to the skin. For almost a decade, cult favourite skincare brand, La Roche-Posay, has worked to support people and their skin, as they undergo treatment.
“Dryness, itching, burning, sensitised skin and inflammation around the nails are examples of painful side effects [that will be] all too familiar to people receiving treatment for cancer,” says Dr Justine Hextall, La Roche-Posay’s consultant dermatologist. “In one study of 27 patients receiving targeted cancer treatment, four in five experienced some form of cutaneous side effect. Sadly, some patients will even discontinue crucial treatment because these side effects are so severe.”
As part of a new partnership with Macmillan Cancer Support, La Roche-Posay will be dedicating one per cent of its turnover to help provide information on the side effects of cancer treatment on skin, and ways to alleviate them. This will include a donation to Macmillan Cancer Support to support the experts working on the Macmillan Support Line, who are on hand to offer practical or emotional support to those undergoing treatment.
Below, Dr Hextall and Dr Kara Heelan, consultant dermatologist at the Royal Marsden Hospital and a specialist in oncodermatology, share their expert advice on adapting your skincare routine when undergoing cancer treatment.
What happens to your skin when you have cancer treatment?
Dr Hextall, La Roche-Posay’s consultant dermatologist, says combining her own expertise with her husband’s has had a significant impact for some patients. “We have been able to minimise the impact on skin and speed up the healing process,” she says. “A pre-emptive strike with the right skincare had such a significant impact that I started to lecture oncologists, pharmacists and clinical nurse specialists nationally, to ensure all patients could have access to this advice.”
Depending on the treatment you receive, skin can be affected in different ways, with common side-effects ranging from itchy, dry and sensitive skin, to increased sun sensitivity, pigmentation, or becoming more susceptible to infection. Dr Heelan explains that “approximately half of people treated for cancer will develop a dermatologic issue during treatment affecting hair, skin or nails. Chemotherapy, radiotherapy or targeted treatments work by killing cancer cells, while immunotherapy treatments boost the body’s own immune system,” she says. “These effects can have repercussions, not just on the target organ, but also on other organ systems including the skin.”
Which ingredients should you avoid?
All cases are unique to the individual, but “broadly I would advise skincare that has as few potential sensitisers as possible,” says Dr Hextall. “For example, when receiving radiotherapy, the skin will invariably become red and irritated like a sunburn. This ‘sunburnt’ skin barrier is less robust and more likely to be irritated and sensitised by certain ingredients, such as perfumes and preservatives. There is a temptation to immediately seek out ‘natural’ and ‘organic’ topical products but remember, these terms do not necessarily mean they won’t irritate the skin or cause allergy,” she points out. “Some of the most common sensitisers are essential oils, in themselves a ‘natural’ product. I would advise looking for products specifically created for sensitive skin, with as few potentially sensitising ingredients as possible. There are some very good creams developed specifically for ‘post-procedure’ skincare.”
Dr Heelan recommends avoiding “harsh toners, and any facial treatments that contain alcohol, BHAs (beta-hydroxy acids), irritant anti-acne products such as salicylic acid or benzoyl peroxide and scrubs, harsh exfoliants or bead containing products. Patients often ask me about continuing their ‘active’ topical skin treatments, like vitamin C or tretinoins. However, this often needs to be dealt with on a case-by-case basis, depending on the individual’s cancer treatment and the specific topical product constitution. Patients should consider consulting a dermatologist with a special interest in oncodermatolgy.”
The products you should use
“Exchange soaps for mild, gentle fragrance-free soap substitutes or washes, and take short, warm—not hot—showers and baths,” suggests Dr Heelan. When it comes to the skin on your face, Dr Heelan advises gently patting or dabbing your skin dry after washing and applying moisturisers or other products at this stage. “When the skin is damp, there is increased absorption of topical agents.”
Dr Hextall recommends “looking for a very gentle cleanser, preferably perfume-free, and if possible preservative-free. Look for skin-calming ingredients in moisturisers that hydrate the skin without trapping heat. I do not recommend using petroleum-based creams on warm, post-radiotherapy skin, as they can trap heat and make the skin redder and more uncomfortable.”
“Look for those that will clean the skin without stripping it. I recommend La Roche Posay’s Toleriane Dermocleanser, as this can be wiped off or rinsed and is preservative-free. I also like CeraVe’s Hydrating cleanser, and for the shower Avene’s Xerocalm cleansing oil. If skin is inflamed after radiotherapy these will be well tolerated, with very low risk of allergy or irritation.” says Dr Hextall.
Dr Heelan recommends moisturising regularly. “It’s extremely important for treating dry skin. Moisturisers hydrate and also create a skin barrier, so using them preemptively or prophylactically before starting cancer treatment will help enhance your skin barrier. On arms and legs, apply in a downward motion in the same direction as skin growth. This will help reduce or prevent folliculitis or inflammation of the hair follicle. Creams and ointments are usually better at hydrating the skin than lotions or gels, and ceramides can also be quite soothing. For skin pain or rashes, along with moisturisers, topical lidocaine or strong steroid ointments are sometimes used.”
Dr Hextall likes La Roche Posay’s Cicaplast Baume to “reduce inflammation and hydrate skin”. “This immediately soothes, hydrates and reduces the risk of infection. SkinCeuticals Phyto Corrective Fluid can be applied for immediate relief to red inflamed skin. CeraVe creams and lotions are rich in ceramides that have been clinically proven to give lasting hydration, and La Roche Posay’s Lipikar AP+ Baume hydrates and supports a healthy microbiome. La Roche Posay Lipikar Baume AP+M Baume is preservative and perfume-free, and offers rich hydration.” She adds: “Previously well tolerated perfumes and creams may irritate vulnerable healing skin, so stick to calming, hydrating products that are created for sensitive skin, to reduce the risk of sensitisation and allergy. My go-to range that I know has been specifically developed for sensitive skin is the Toleriane range by La Roche Posay – studies have also shown it to be safe and effective during cancer treatment.”
Dr Heelan also emphasises how crucial sun protection is. “Sun-sensitivity can be particularly severe depending on the drug you are on, and can occur quite quickly. Protect your skin with clothing and SPF and use lip balms with a high SPF, as lips can be particularly sensitive. You don’t have to avoid sunshine holidays, but be very careful and wear protective clothing, and regularly apply sun cream with a high SPF of at least 30. Look for mineral or physical sunscreens, which can be less irritating on very sensitive skin, particularly for acne type skins.”
Dr Hextall agrees: “After surgery or radiotherapy, the skin may take time to heal and settle. In the early stages when there is a new scar, or the skin is still red or inflamed after radiotherapy, there is an increased risk of pigmentation, particularly in those with skin of colour. I advise wearing a high factor broad spectrum sunscreen, even in winter, to protect against unwanted UV damage.”
Being COVID aware
“After surgery and radiotherapy, the skin is more vulnerable to infection. Dermol 500 is antiseptic and hydrating, and ideal if there are concerns about possible skin infection. At the moment there are real concerns about COVID-19—particularly for those undertaking cancer treatment,” explains Dr Hextall.
This article first appeared in British Vogue.