Side effects of cancer treatment on Black skin
Almost 400,000 people in the UK every year are told they have cancer.
According to Cancer Research UK, there were 18.1 million new cancer diagnoses globally in 2020. Cancer treatment can have some harsh physical side effects on the body, including hair loss, rashes, changes to fingernails and dry skin. As well as causing physical discomfort, these side effects can also cause emotional distress. But what does this mean for someone who is Black and has a darker skin tone?
Firstly, what is cancer?
Cancer can affect almost any area of the body, and anyone can be diagnosed. Although white people are more likely to be diagnosed with cancer overall, there are certain cancers, which are more common in Black people. Black men are twice as likely to get and die from prostate cancer and Black women are 41% more likely to die from breast cancer and have more aggressive and inflammatory sub types of breast cancers. There is also evidence that Black people tend to present to medical professional much later than white counterparts which can also contribute to higher mortality rates.
Cancer occurs when abnormal cells in the body divide uncontrollably and begin to spread. As the abnormal cells multiply, depending on the type of cancer, they can create a growth known as a tumour. To treat cancer, the abnormal cells need to be destroyed and removed from the body.
How do cancer treatment side-effects impact Black skin - and what can you do to treat them?
There are a wide range of treatments for cancer and what is suggested for you will depend on the type of cancer you have, and the stage of diagnosis. Your oncologist will cover these treatments with you and explain why any specific treatment is right for you. You may need a combination of different treatments. It is important to remember that your cancer treatment will be individual to you so you may not experience every side effect. Some common side effects and how they affect Black skin are:
Fingernail changes
Some chemotherapy, targeted cancer drugs and immunotherapy can have a range of effects on your fingernails - and this may affect up to 45% of patients. On darker skin tones this may show as the fingernails darkening, black lines appearing along the nails, the nails becoming brittle or ridged, and in some instances the nails loosening or detaching. Changes to the fingernails can be upsetting and very uncomfortable.
What can you do?
Some patients find that the best way to cover the discolouration of their nails is with a simple, cheering nail polish! Please remember to speak with your doctor to make sure this is safe for you. They may recommend sticking to water based nail polishes which are more gentle on the nails. If you are experiencing loss of your nails or changes to their texture, speak with your oncologist as they may be able to prescribe medication to reduce any pain or discomfort.
Dry or sensitive skin
Chemotherapy, immunotherapy, and hormone treatments often cause your skin to become drier and more sensitive, this can also include being more sensitive to the sun and UV light. This happens because your skin cells are shedding faster and can be uncomfortable leaving your skin feeling tight and looking dull. It may also lead to your skin being inflamed, which in Black skin is a key cause of hyperpigmentation.
What can you do?
BSD listed clinician and Consultant Dermatologist, Dr Mary Sommerlad says ‘keep facial skin well hydrated with a Hyaluronic acid serum followed by a face cream or lotion beneficial of your skin type. For the body, choose body creams which support the skin barrier such as those containing ceramides as well as softening and hydrating ingredients such as Shea butter, squalane and glycerin. Avoid harsh soaps and long hot showers/ baths which can dry the skin out.’ If your skin is feeling very sensitive, consider avoiding ingredients such as colour and fragrance as they may sensitise your skin more. Remember to wear sunscreen daily, to protect your skin and prevent sun sensitivity.
When your skin is dry and sensitive, it’s important to repair and strengthen your skin’s barrier. Salcura’s Bioskin Derma Serum Daily is packed with Omegas, Vitamin E and Vitamin C to hydrate and strengthen the skin. For the skin on your body La Roche Posay’s Lipikar Lait Urea 5+ Lotion is a great option to keep your skin feeling soothed and moisturized. Brands such as Cosmedix are a brand that focus on effective but gentle formulas which fortify and repair the skin barrier with natural ingredients.
Rashes
Rashes are a common side-effect of many cancer treatments and can appear in many ways:
Maculopapular rash - Flat areas of skin with small bumps which may be itchy. If your skin is a lighter tone, there may be redness in the area as well
Acneiform rash - This appears as small, pimple-like bumps on the skin. They are incredibly common when taking certain targeted drugs called EGFR inhibitors. These include cetuximab (Erbitux), erlotinib (Tarceva), gefitinib (Iressa) and panitumumab (Vectibix). EGFR inhibitors encourage the normal growth of tissue to prevent further abnormal cell development.
Other rashes which appear as eczema or psoriasis.
These rashes will cause your skin to become inflamed, which may lead to hyperpigmentation or hypopigmentation (a loss of pigment in the skin, leading to lighter patches). This inflammation may occur for part of your treatment or throughout.
What can you do?
Speak with your doctor to establish the cause of any rashes before figuring out how to tackle them. If you are experiencing acneiform rash, avoid using any salicylic acid or benzoyl peroxide as these may cause the skin to become overly dry. Dr Mary Sommerlad advises ‘If you are getting acne, tender bumps, tender hands and feet speak with your Oncologist as they may need to prescribe specific medication to help manage the side effects.’
Burns
Burns are a common side effect from radiotherapy. They may appear in a similar way to sunburn on Black skin, with itchy, dry or peeling skin and hyperpigmentation. Burns are likely to appear over the course of your radiotherapy rather than just from one treatment, and your radiologist will be monitoring these side-effects.
What can you do?
Your radiologist will advise on how to treat specific burns, or skin reactions from radiotherapy, however some things you can do which will help to keep your skin calm are:
Avoid rubbing the affected area as this may cause irritation
If your scalp is being treated, avoid using a hairdryer as heat may cause discomfort
Wear light clothing made of natural fibres such as cotton to prevent your skin from becoming to warm
Avoid swimming, as chlorine in the water may cause your skin to become quite dry
Hyperpigmentation
Hyperpigmentation is a common skin concern for Black skin, and unfortunately, many cancer treatments can exacerbate this frustrating condition. Hyperpigmentation can arise from chemotherapy, radiotherapy and some immunotherapy treatments.
It can appear in larger areas over your body, or may appear in specific patterns - often following the line of veins where you have had treatment. In some cases unfortunately, hyperpigmentation following cancer treatment is permanent, in other instances it may be treatable.
What can you do?
For some professional hyperpigmentation treatments, such as chemical peels or laser, you may need to wait for a period of time after your cancer treatment has finished. You may be able to include pigmentation inhibiting ingredients such as kojic acid, resorcinol and alpha arbutin, into your skincare routine during your cancer treatment, but make sure you speak to your doctor about whether this is safe. Wearing a broad spectrum sunscreen with minimum SPF 30 every day is also important to prevent hyperpigmentation, however this may not prevent all skin darkening during cancer treatment, depending on the original cause.
Scarring
Scarring can arise from IV treatments, when a cannula is inserted into your arms, or due to surgery. Patients with Black skin may find scarring is more likely to occur, and is also harder to treat. It may appear as hyperpigmentation or as a larger scar which may be raised (and may be keloid - which Black skin is more prone to).
What can you do?
Unfortunately, when going through cancer treatment, some scarring may be unavoidable, however you may be able to consider certain treatments such as laser, following your surgery. If you are prone to keloid scarring, it is important to let your doctor and surgeons know so they are aware and can plan your aftercare accordingly. If it is safe to do so, they may recommend a product such as Kelo-Cote to help prevent any scars from forming.
Hand-Foot Syndrome
Commonly caused by certain types of chemotherapy, Hand-Foot syndrome results in the skin on the palms of your hands and soles of your feet becoming thick and hardened. This can result in numbness and tingling or a burning sensation, which can be very uncomfortable and may make day to day activities such as getting dressed difficult.
What can you do?
If you are experiencing Hand-Foot Syndrome, speak with your doctor as they may be able to prescribe medication to help. Also, keep your hands and feet as cool as possible and avoid wearing tight fitting socks and gloves. Plain emollient moisturisers such as CeraVe Moisturising Cream or Epaderm Cream will also help to keep any hardened skin feeling more comfortable but remember to speak to your oncology team to make sure any products are safe to use during your treatment.
Is there anything to avoid during cancer treatment?
Your oncologist will make sure you are aware of anything specific you should avoid during cancer treatment. Dr Mary Sommerlad notes ‘Chemotherapy reduces the immune system. A suppressed immune system means the skin is at an increased risk of infection. Any procedure that pierces the skin can potentially introduce infection therefore treatments such as microneedling, fillers and wrinkles smoothing injectables such as Botulinum Toxin (Botox) are best avoided during active treatment due to the risk of complications such as bacterial and viral infection. Chemotherapy and Radiotherapy can both compromise the skin barrier leading to a fragile skin that takes longer to heel therefore skin peels and laser therapy is best avoided until after completing treatment.’
It’s been shown that patients who are prepared for the cosmetic side effects of cancer treatment, as well as the medical side effects are able to manage their cancer journey more comfortably.
Cancer is a difficult condition to manage emotionally and physically, and the effects can have a long term impact. If you are concerned about how cancer treatment has affected your skin, look at our Directory to find a specialist who can help you to manage these side effects.