Skin and Nails

Split Skin or Nails on Fingers and / or Feet

Patients on a certain targeted therapy seem to be predisposed to this particularly painful, skin- related issue. Be careful with your hands, fingers, nails as they can become very dry and can split or crack around the fingernail bed, which is quite painful. I found a wonderful product, a nail and cuticle conditioner, originally used for horse hoof maintenance. I rubbed this conditioner into my fingers and nails (heels, too, as needed) at night and had really good results with this routine. My Oncologist noticed how well it worked and asked what I was using to recommend to other patients.

Recommendations

• Healthy Hoof Intensive Protein Treatment. (Find it at a local beauty supply store or online.)

• Use Newskin, Nexcare, other waterproof bandages, superglue for split fingers, heels and skin cuts. Wash, dry the split first, then apply; it lasts approximately three days.

• Wear vinyl, non-latex medical gloves or rubber gloves when house cleaning, washing dishes or applying nail polish remover.

• File nail edges in a rounded shape as a sharp or square nail edge is more likely to cut the skin.

• Avoid tight shoes and high heels.
  
  

Extremely Dry, Sensitive Skin

I took showers infrequently and used moisturizing soap sparingly. Use tepid/warm water to wash and rinse. I stopped taking baths as it was too drying for my skin. Let your skin dry fully before applying lotions or cream to avoid stinging. Be judicious about keeping your skin moisturized.

Recommendations

• Lindi Body Lotion: Lindi makes products specifically for people going through chemotherapy. Cerave body lotion.

• Emu oil (yes, from the bird); I add it to the lotion as it's very concentrated, soothing and absorbs well.

• Mild, moisturizing soaps such as Shea Butter soap, Dr. Bronner's Pure Castile soap (liquid soap) or hard-milled soaps. 

• Cetaphil or Cerave Facial Cleanser, Soap and Lotion; non-soap cleansers. Both are mild and contain no perfume.

• Avoid all skin products containing alcohol.

• If you want to take a bath, try using epsom salts or bath oil & bathe in warm, not hot water

• Avoid bubble baths as the soap is too drying.
  
  

Face, Body Skin Rash

Avastin can initially cause a disturbing face and possibly a body rash -- extremely red pustules, tender sores, swelling -- which is a bit unnerving, but later it dries out and heals. Be careful until you see which topicals work for you. The rash will calm down and wax and wane as does the scalp rash if you get it. I became quite sun sensitive so the sun made the reddish rash on my cheeks become quite red, or more red rather quickly. At times later on it looked as if my cheeks were flushed; it could present itself in a butterfly-shaped manner or appeared as if I had rosacea.  

Recommendations

• Warm moist compresses for 15 minutes, 3 times a day can help clear up the pustules and are soothing.

• Cetaphil Facial Cleanser: very mild, no perfume.

• Lindi Moisturizing Face Serum: Lindi makes products specifically for people going through chemotherapy.

• Your oncologist may prescribe a supplemental antibiotic and steroid cream to reduce the rash occurrence or related skin infection.
  
  

Fungal Skin Infections

Mild rashes in creases or folds in skin (ie inside of elbow) can be fungal infections.

Recommendations

Keep the area clean and dry. Over-the-counter treatments for athlete’s foot or jock itch (ie clotrimazole) will address this issue. Use a fungal powder to avoid recurrence.

Note: Use of steroid cream will worsen fungal infections.

Photosensitivity

Certain targeted therapies cause the skin to be photosensitive even if you aren’t presenting the facial rash or redness. Avoid, prepare for sun exposure as your skin will be extremely sensitive to the sun so cover up as much as you can during any extended time spent outside. Sun sensitivity can occur more quickly and more severely than under normal circumstances.

Recommendations

• Wear a hat and longer sleeves, even if you use sheer cotton shirts as an overlay to short sleeves.

• Use good quality, moderate SPF, non-comedogenic sun lotion, sun blocks on face, arms, legs. I've discovered a good face sunscreen; Supergoop! Mineral Matte Screen, SPF 40. It has a light color skin tint but blends in well and doesn't feel sticky. I buy it directly online.

Plugged Pores / Acne

Pores can become clogged with tiny waxy-like sebaceous plugs which can result in bumps or acne, especially when on longer term maintenance treatment intravenous chemotherapy such as Avastin.

Recommendation

Use a sensitive-skin cleanser. Try not to pick at the bumps / acne. Clean the area as you are showering or washing your face once your pores are open.

Scalp Rash

Periodically I had a pimply, itching, burning rash & pustules on my scalp when I was on Avastin. The condition seemed similar to hives and scratching the bumps made them really burn. This scalp rash drug reaction can also cause scabs on your scalp. This condition waxed and waned with ongoing targeted therapy treatment.

Recommendations

• Calamine lotion soothes the scalp rash.

• Caladryl clear helps for scalp rash and also helps with pain; it contains camphor.

• Zinc Shampoo DHS (prescription) for scabs on scalp helps.

• Ciclopirox 1%, Capex or Olux (foam) Shampoos (both prescription) for itchy, bleeding scalp.

• Use non-soap shampoo to prevent drying (ie Shea Moisture co-wash).

• For spot treatment try using a Q tip dipped in alcohol to apply on to the affected pustule, sore to sanitize it