Your skin, nails and cancer drugs

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 checkpoint inhibitors, some chemotherapy drugs and targeted drugs called BRAF inhibitors and tyrosine kinase inhibitors

• 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 EGFR inhibitors​ or MEK inhibitors. 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 genitals

• 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 vesicants. 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.

Read more about having chemotherapy into your vein