Skin and Nail Changes

Did you know that cancer treatments can cause changes to your skin? Sometimes these changes are simply cosmetic, but other times they may require attention from your care team.

To better understand skin changes that happen during cancer treatment and how best to address these side effects, we spoke with Anisha Patel, M.D. Here’s what she had to say.

What types of cancer treatments cause skin changes?

All cancer treatments have side effects, but patients are sometimes surprised by the skin changes they see when receiving chemotherapy and immunotherapy. Since these therapies are used to treat a variety of cancers— and we’re constantly expanding and improving their use through clinical trials — skin changes are common.

What are common skin changes during cancer treatment?

The most common things we see are rashes and dry skin, which may be accompanied by itchiness or burning of the skin.

Chemotherapy and immunotherapy can also change the color, or pigment, of the skin, but it’s less common. You may not even notice. Depending on the therapy, you may see lightening or darkening of skin, hair and nails.

A less common side effect that we see with newer treatments is the development of new growths, such as moles, warts and raised areas of the skin.

It’s important to know that the type of skin side effect you may experience depends on your medical history and the type of treatment you’re receiving, so talk with your doctor about what you should expect.

Why do these skin changes happen?

Chemotherapy and immunotherapy fight cancer by targeting specific molecules in tumors. Those same molecules are also in our skin, hair and nails, so patients can experience side effects in those areas during cancer treatment.

Are these skin changes permanent?

Typically, changes to your skin related to chemotherapy and immunotherapy aren’t permanent. When you stop treatment, we’ll see your skin return to its previous state.

Also, these changes aren’t necessarily negative. Research has shown that certain rashes correlate with having a better tumor response to the treatment. So in some cases, when a patient gets a rash, despite it being uncomfortable and possibly itchy, it can be an indicator of a good overall treatment outcome.

What can I do to cope with skin changes during cancer treatment?

Unfortunately, you can’t avoid treatment-related skin changes entirely, but there are steps you can take to help reduce the discomfort. Before beginning cancer therapy, we suggest you start moisturizing your skin regularly. Also, if you have a history of eczema, psoriasis or skin cancer, see a dermatologist to address those concerns before beginning treatment so that they aren’t amplified during chemotherapy or immunotherapy.

Also, some types of chemotherapy and immunotherapy can make you more sensitive to the sun, so we commonly see sunburns. In order to prevent that, practice sun safety by limiting your time in the sun and wearing sunscreen with SPF 30 or higher, as well as sun-protective clothing, whenever your skin is exposed.

Lastly, try wearing comfortable shoes. We’ve seen a few therapies where patients experience an associated rash in areas that are under pressure such as the balls of the feet or with bunions. If your shoes are too tight and rub your feet, you’re at a higher risk of experiencing this rash.

Are any of these changes dangerous?

New growths related to cancer treatment can be concerning. Most are benign (non-cancerous), but others are malignant forms of skin cancer. It’s possible to develop skin cancer that’s caused by your cancer treatment, even if you’ve already received treatment for another type of skin cancer.

We advise our patients to conduct a monthly skin self-exam to catch these growths quickly. Let your oncologist know if something seems suspicious so that you can get a referral to a specialized dermatologist. If you’ve had a history of skin cancer or are at increased risk, make sure you see a dermatologist regularly during your cancer treatment. If you’re a patient at MD Anderson, you can ask your doctor to refer you to one of our dermatologists.

Is there anything else you’d like patients to know?

Don’t be alarmed if you experience skin changes during treatment. Helping patients cope with these changes is a big part of what MD Anderson’s dermatology team does. We may not always be able to make the change go away immediately, but we can help provide relief. Our goal is to make sure you’re as comfortable as possible so that you can continue on the best course of treatment for the cancer you’re facing.

Request an appointment at MD Anderson online or by calling 1-877-632-6789

Cancer treatment can cause physical and emotional side effects. You may notice changes to your nails if you receive chemotherapy or certain targeted therapies as part of your cancer treatment.

But how long do these changes last, and how can they be managed? We spoke with dermatologist Anisha Patel, M.D., for answers to these questions and more.

What are the most common nail-related changes caused by cancer treatment?

The three most common are:

Ridging

Patients who receive cytotoxic chemotherapy, often used as the first treatment for breast cancer and colon cancer, may begin to see horizontal ridges on their nails. These ridges are called Beau’s lines. Every time a patient has an infusion, the nail plate stops growing. They may grow a little between infusions, but the temporary disruption creates ridges in the nails.

Nail lifting

Sometimes, patients’ nails may lift from the nailbed or come off completely. This can be caused by the chemotherapy drug taxotere or some targeted therapy drugs like fibroblast growth factor receptor (FGFR) inhibitors. It can be painful and may increase the risk of infection under the nail.

Nail fold inflammation

Certain types of chemo and targeted therapies can cause the cuticle to break down next to the nail. This is not a nail problem; rather, it’s a skin problem in which the skin on the side of the nail gets inflamed. You can also get infections on top of the inflammation.    

Do these changes affect fingernails and toenails?

Yes, these changes can affect the nails on the fingers and toes. Patients will notice the effects more, depending on whether they use their hands or feet more heavily. For example, people who work in oil and gas and wear restrictive steel-toe boots may notice nail changes more on their feet.

How can these side effects be managed?

Of the three side effects mentioned, nail ridging is the least aggressive and usually doesn’t require any treatment.

If a patient’s nails are lifting, we often suggest clipping the nail back. This isn’t painful; it just looks funny to some patients.

We can do a small surgery in our clinic to help alleviate nail fold inflammation. We’ll numb the whole finger or toe, then split and pull away the lateral edges of the nail. Then we use a chemical like a high percentage phenol to remove the matrix, which is the tissue under the nail. This makes it so the nail doesn’t grow back on the lateral edges, and it gets rid of the friction point between the skin and the nail.  

No matter the side effects, we don’t want infection on top of that. So, we ask all our patients to soak their nails in a rinse of one-half white vinegar and one-half water. This decreases the amount of bacteria and yeast and lessens the chance of surface infections. It’s an easy thing patients can do at home. We ask patients with nail fold inflammation to do the soaks every day and apply a steroid liquid at the edges of the nail to help it absorb in the skin.   

How long do these side effects last?

Most patients’ nail changes are short-term, and their nails grow back healthy after they complete cancer treatment. But some nail changes from cytotoxic chemotherapy may be longer-term. Some patients may have a random nail that grows back thick and painful. We can take the nail off and see if it grows back normally. If it doesn’t, sometimes we’ll take the nail off and kill the whole matrix, so the nail doesn’t grow back at all. Often, patients would rather have no nails than nails that cause them pain.

It's hard to predict who will have longer-term side effects, and we won’t know until after they complete treatment. At that point, we try to address their symptoms as best we can.

What precautions should patients take with their nails during treatment?

Try to avoid getting manicures or pedicures. You do not want your cuticles manipulated. There is an increased risk of infection, and if you already have some treatment side effects, it could make them worse. Typically, the fingers and toes that experience more friction or pressure have worse inflammation.

We recommend gentle hand and foot care. Keep your hands and feet moisturized and avoid using abrasive or harsh chemicals. Lotions should be bland emollients like plain, white petrolatum. They shouldn’t contain any perfumes or active ingredients.  

When should patients see their doctor about nail changes?

See your doctor if the nail changes cause symptoms, like if you’re having pain, or there’s an odor. Nail ridging is normal and doesn’t cause symptoms, so you wouldn’t need to see your doctor for that.

What else should we know about nail changes during cancer treatment?

Patients receiving chemotherapy can have increased pigmentation in their nail plate that does not go away. It’s not symptomatic, but many patients worry that they have nail melanoma, or skin cancer under their nail.  

If you develop a new dark line on a single nail, you should seek medical care. But if you have reason to have pigment in your nails, such as a vitamin deficiency, and multiple nails are affected, it’s likely nothing to worry about.

Remember to be gentle and take care of your nails during cancer treatment. If you notice changes to your nails that cause symptoms like pain or an odor, see your doctor to get them checked out.   

Request an appointment at MD Anderson online or call 1-877-632-6789.