Cancer drugs can change your skin and nails. But there are treatments that can help and things you can do to cope.
How cancer drugs can affect your skin and nails
There are many different types of drugs for treating cancer. Some can cause a variety of skin and nail changes.
Some of these side effects can be uncomfortable, painful or distressing. Changes to your skin and nails are visible and can be a constant reminder of your cancer. It can interfere with your sleep, make you feel low in mood and affect your .
But in most people, they can be managed and will clear up once treatment has finished.
Even if a drug can cause certain side effects, you might not get them. Drugs affect people in different ways. It isn't possible to tell in advance who will have which side effects. It depends on:
the drug or combination of drugs you are having
the dose
the route (by mouth or as an injection or a drip through a vein)
how you react to the drug
how you reacted to drug treatment in the past
Tell your doctor or nurse about any changes to your skin or nails during cancer drug treatment. They can tell you how to manage it or suggest treatments to relieve your symptoms.
Hormone therapies can also cause skin rashes, itching and nail changes in some people. Bisphosphonates very rarely cause skin problems.
Some of the skin changes caused by cancer drugs include:
Several types of skin rashes can happen with cancer drugs. Some of the most common ones include:
maculopapular rash - flat, red skin areas covered with small bumps. Your skin may also appear red and the rash might be itchy. This type of rash is common with a type of immunotherapy called , some chemotherapy drugs and targeted drugs called BRAF inhibitors and
acneiform rash - small, raised, red pus filled like acne bumps. They usually appear on the face, scalp, upper chest and back. This rash is very common in people having a type of targeted drug called or . But it can happen with other types of targeted cancer drugs
other rashes might include rashes similar to psoriasis or eczema
Hand-foot skin reaction can be a side effect of targeted cancer drugs called multikinase inhibitors. But it can happen with other targeted drugs.
Symptoms can include a burning, tingling or numb sensation. Your hands and feet might be red, swollen, and you might have thickened, hard skin.
Hand-foot skin reaction is different from hand-foot syndrome.
Some chemotherapy and targeted cancer drugs can cause changes to the skin on the palms of the hands and soles of the feet. This is called hand-foot syndrome or palmar-plantar syndrome.
The skin on the palms of your hands and feet can become sore, red, swell and may peel. You might also have tingling, numbness, burning, pain and dryness. Touching warm objects might be uncomfortable.
Hand-foot syndrome may affect your quality of life. Self care and dressing might be hard if you have severe symptoms. Most symptoms clear up once you have finished treatment.
Tell your doctor or specialist nurse if you have any changes to the skin on your hands and feet. They will suggest treatment and offer advice. To help relieve symptoms:
take medicines prescribed by your doctor
keep your skin well moisturised with creams from your doctor or nurse
keep your hands and feet cool
avoid very hot water
avoid tight fitting gloves or socks
Some chemotherapy, targeted cancer drugs and immunotherapy can make your skin more sensitive to sunlight. Some of these reactions include:
the skin looking severely sunburned after sun exposure. The skin might also be red, swollen, tender or painful in areas exposed to the sun. In severe cases, the skin might form blisters
an allergic reaction happening to the skin about 24 hours after sun exposure. Symptoms include itching and fluid filled blisters in sun exposed areas which may spread to unexposed areas
a sunburn like reaction that happens after having some chemotherapy drugs without exposure to the sun. The reaction may happen over previously sunburned areas from months or years ago
Some chemotherapy, targeted cancer drugs and immunotherapy can cause skin changes in areas involved with radiotherapy. These changes include:
the skin becoming red, inflamed and sore in areas previously treated with radiotherapy after having some drugs. Sometimes the skin can break down where the skin sheds or peels. The skin can also form ulcers. This can happen sometime after having the drug
having certain chemotherapy drugs with radiotherapy (chemoradiotherapy) can worsen the skin side effects of radiotherapy. The skin can become red, painful and swollen or break down
Some chemotherapy, targeted cancer drugs and immunotherapy can cause the skin, nails, hair and the inner lining (mucous membrane) of some body areas to change colour. The colour change could be darker (hyperpigmentation). With some drugs, colour changes could be lighter, this is also known as hypopigmentation.
Colour changes may happen:
in sun exposed areas
to the nailbeds
to the tongue, the thin layer covering the front of the eye (conjunctiva), face or
the palms of your hands and soles of your feet
skin folds
the moist inner lining of the body (mucous membrane), such as the inside of the mouth
Colour changes may follow a certain pattern on the skin. It may happen:
along a vein where you've had a cannula for treatment
an area where you've scratched or damaged your skin
Some targeted drugs can also cause skin discolouration turning it yellow.
Some checkpoint inhibitors can cause a complete loss of skin colour (vitiligo). This usually starts with small, light coloured spots on the skin that may slowly get bigger and develop into larger areas of lighter skin. It usually appears several months after you started treatment.
Hair colour changes
Hair colour changes include:
hair changing from light red to black or black to red
hair, eyebrows and eyelashes having bands of colour that alternates with the normal colour
Dry, cracked skin and itching are common side effects of:
targeted drugs
immunotherapy
chemotherapy
Your skin might become dry and crack on your fingertips, which can be painful.
Itching can be distressing, contact your healthcare team if you are struggling with itching.
Some chemotherapy, targeted drugs or immunotherapy can change your nails. Some of these changes include:
inflammation of the nail bed, nails might become loose and fall off
inflammation or infection of your nail folds
small, raised, and red bumps forming around the nail
Some chemotherapy drugs and targeted drugs can cause white or dark lines across your nails. Your nails might also:
become brittle and dry
grow more slowly
develop ridges or grooves
If your drip leaks while you are having a cancer drug, some of the drug may go into your skin and body tissues around the drip.
This is called tissuing or extravasation. You might feel a burning or stinging pain around the drip and the area may swell. Afterwards, the area might be warm, red and tender. Most cancer drugs will not cause severe problems when they leak into body tissues.
But some cancer drugs are . That means they may cause damage to the skin and surrounding tissue should they leak from the drip.
Your nurse follows strict guidelines to prevent extravasation from happening and treat it if it does happen. Should it happen with a vesicant drug, they will know what to do and offer further treatment and advice.
It is important to tell your healthcare team about any skin side effects you might experience. Severe skin changes can affect your quality of life.
Your doctor will suggest treatments. In some situations, they might have to adjust the dose or stop the drug for a while. Treatment might include a combination of:
moisturisers to keep the skin hydrated
- you might have it in more than one way such as into your bloodstream (intravenous), by mouth or onto the skin as a cream
medicine to relieve itching
medicine to treat infection such as antibiotics or antifungals
painkillers
Tips for managing skin problems
There are things you can do to help your skin and nails while having treatment with cancer drugs.
Check with your doctor or nurse whether you need to do anything to protect your skin. This might include avoiding hot showers and patting your skin dry with a towel instead of rubbing. This will prevent making it sorer.
Tell your doctor or nurse if you have any rashes or itching.
Water containing chlorine can worsen rashes, so don't go swimming if you have a rash.
To help prevent your skin from getting dry or itchy moisturise it daily. Use an unperfumed moisturising cream.
Don't use a cream on areas being treated with radiotherapy without checking with your doctor or nurse first.
Protect your skin from the sun by wearing sunscreen with at least SPF 30 and 4 or 5 stars. Use it generously, reapply regularly and use together with shade and clothing.
Nail care tips
There are things you can do to help your nails while having treatment with cancer drugs.
Use nail oils, balms or moisturising creams to keep if your nails and the skin around your nails hydrated and healthy.
Don't worry about marks on your nails as they will grow out in time.
Cover marked nails with nail varnish if you like but avoid quick drying ones as they can make your nails even drier. Choose a water based one. When removing nail varnish use an acetone free remover to prevent drying the nail out.
Wear cotton socks and comfortable shoes that are wide enough.
Keep nails short and clean.
Don’t delay seeing your doctor if you have any nail infection.
Avoid hand sanitisers with alcohol as it can irritate the nails and dry them out. Wash your hands instead.
Cover nails with a plaster or a dressing if they are loose, let them fall out naturally.
Don’t bite your nails and if you do try to stop by wearing gloves. Biting can increase your risk of getting an infection.
Wear gloves when gardening or washing up to protect the nails.
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The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk if you would like to see the full list of references we used for this information.
