Aesthetic Treatments for Cancer Patients

A guide to skin problems in cancer patients

Both the disease itself and anti-cancer treatment may have many negative effects on the patient’s skin, mainly because both factors impair the skin barrier, the hydrolipidic mantle that covers the entire skin surface and protects it from external aggressions and transepidermal water loss.

Although this is a well-described and widely recognised fact, these skin toxicities are not always identified and addressed promptly and correctly, often because of the understandable desire to prioritise the efficacy of cancer treatment in eradicating the tumour.

At Grupo Pedro Jaén, however, we believe it is necessary to pay attention to these secondary problems, since in many cases they may be significant and can noticeably worsen the patient’s quality of life, a key factor given that many cancer treatments continue for several years.

Skin toxicity caused by anti-cancer treatments

Cytotoxic drugs (standard chemotherapy) essentially act by inhibiting cell division in order to destroy the tumour at different stages of its evolution. However, this mechanism affects both cancer cells and healthy cells, especially those with faster cycles in which cell division takes place more rapidly, such as skin cells and their appendages (hair follicles, sweat and sebaceous glands, mucous membranes), as well as the hair and nails.

Although immunotherapy and hormonal treatments act more selectively than the chemotherapeutic drugs mentioned above, they also have effects on other areas of the body, including the skin.

Side effects affecting the skin and nails

The mechanism of action of anti-cancer agents gives rise to a very wide range of manifestations of highly variable intensity, ranging from photosensitivity and dryness of the skin and mucous membranes to xerosis so severe that it may lead to fissures, ulcers and skin cracks. Other effects include sweating alterations, acne, urticaria, toxic erythema, abscess formation secondary to folliculitis, wounds, blisters, skin pigmentation changes, mucositis, Raynaud’s phenomenon, acral erythema (inflammatory-type eruptions on the palms of the hands and soles of the feet), and many others.

Particular mention should be made of nail problems associated with anti-cancer therapies, as the nails are especially affected by the consequences of cancer treatment.

Chemotherapy often causes changes in the shape of the nails, which may become concave or appear lifted. Changes in colour may also occur, with the nails taking on a yellow, green or dark brown tone. Nails also become fragile and brittle, making them more likely to break or peel.

All these nail alterations increase the risk of infection, which in turn may present with pain, inflammation and pus-filled abscesses. In extreme cases, patients may temporarily or permanently lose the nail (onycholysis).

“Differential diagnosis begins at the first consultation and allows for a comprehensive approach to care.”

The importance of early diagnosis and treatment

Skin toxicity caused by chemotherapy drugs may develop as soon as treatment begins because of an adverse reaction, while treatment is being administered because of direct damage to previously healthy tissue, or as a result of cumulative effects. It may even occur some time after the cycles have been completed.

For this reason, dermatological toxicities caused by chemotherapy agents must receive an early diagnosis by professionals experienced in their management. Otherwise, cutaneous conditions may worsen, the cancer patient’s quality of life may be significantly impaired, and there may be a greater risk of poor adherence to anti-cancer treatment.

On the other hand, the appearance of skin lesions in a patient receiving chemotherapy should undergo differential diagnosis in order to rule out infectious complications, paraneoplastic syndromes, nutritional deficiencies or cutaneous metastasis.

In the Grupo Pedro Jaén Oncology Aesthetics area, we are committed to carrying out this differential diagnosis through a multidisciplinary approach involving both the dermatologist and the oncologist, in order to establish the most appropriate treatment as early as possible. In this setting, in addition to the patient’s general characteristics and medical history, the circumstances arising from their cancer treatment are assessed: dose, number of cycles, drug combinations, whether radiotherapy is also being received and whether it is concurrent with chemotherapy, previous surgeries or the likelihood of future surgery.

In addition to treating the dermatological problem specifically, it may also be considered — whenever possible and on an individual basis for each patient — whether to replace the cytotoxic medication, adjust the dose, frequency or drug combination being used, or temporarily interrupt treatment, always while prioritising the goal of treating the tumour as effectively as possible.

Dermatological sequelae of radiotherapy

Like the other treatments mentioned above, radiotherapy also produces negative dermatological effects. In this case, however, they are limited to the area of skin receiving the radiation directly.

In general terms, this appears as erythema similar to sunburn, with itching, stinging, redness and hypersensitivity to friction and touch. This complication usually appears around two or three weeks after the radiotherapy sessions begin and depends directly on the frequency and intensity of the radiation applied. It usually leads to a dark patch that fades progressively once cancer treatment has finished.

It is important that patients receiving radiotherapy are given not only dermatological treatment, but also specialised dermocosmetic advice and appropriate treatments to relieve skin symptoms and prevent worsening. For this reason, these patients may also benefit from specific supportive aesthetic care and from the support of our Parapharmacy service.

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