It’s not just your Hair that takes a beating from Chemotherapy
Last time I shared my experience of hair loss in chemotherapy, despite using a cold cap to reduce hair loss. However, it isn’t just your hair that takes a beating from chemotherapy. Skin and nails can also be affected.
Your skin can become very sensitive (to the sun particularly) and prone to rashes. You’re advised to stay out of the sun during chemotherapy and if you have to be out in it to wear SPF 50. Even with SPF 50 your skin isn’t safe, as I found out to my cost. During my chemo I visited the Penny Brohn centre (a charity that provides support and well being to cancer patients)
https://pennybrohn.org.uk
and decided to drink my coffee sitting outside in their lovely garden. I had SPF50 on and a baseball cap and only sat out for around 20 minutes (as long as it took to drink a cup of coffee). Nevertheless, I developed a photosensitive rash on my cheeks that was very red and angry. It lasted a few weeks and I had to try various products to calm it down. That cup of coffee in a sunny garden really was not worth the price I had to pay!
There are a number of skin products recommended to cancer patients to try in these circumstances. Not all by your healthcare providers necessarily. Often it is by the charities active in supporting cancer patients and very often by other patients. My approach to cut through the plethora of recommendations was to focus on those most frequently recommended by multiple sources and by cancer patients themselves. I also relied on the recommendations of experts such as Cancer Hair Care
https://www.cancerhaircare.co.uk
, Look Good Feel Better
https://lookgoodfeelbetter.co.uk/
and Macmillan Cancer Support
https://www.macmillan.org.uk
When seeking recommended products from cancer patients I didn’t just go to the wild west that is the internet. Rather I used the support groups and Facebook groups (closed membership) offered by Target Ovarian Cancer
https://targetovariancancer.org.uk
, Ovacome
https://www.ovacome.org.uk
and Macmillan Cancer Support, as well as those from the aforementioned Cancer Hair Care and Look Good Feel Better. These proved invaluable and reliable. As well as the support groups, websites and newsletters these charities also offer webinars, YouTube channels, podcasts, newsletters and online events as sources of information. All have helplines with access to nurses and subject matter experts according to their stated purpose. The Macmillan nurse was particularly helpful to me when I called for advice regarding my skin rash.
I must also give particular mention to my pharmacist Pete who runs an independent pharmacy in our community. Pete always goes over and above and constantly ins awards and plaudits from the community he serves. He is the guy who will ring you at 9pm to say he has just received a prescription for your antibiotics and knows you must need them urgently, wanting to know if you are able to collect them or should he drop them around (the store has been closed for 3 hours at this point)! Pete often proved more knowledgeable (or at least sharing of the knowledge he has) than my doctors or nurses. He gave me excellent advice on dealing with my sun rash and on the extremely pruritic chemotherapy rash I experienced after my first infusion (of which I have previously written).
I will share what products I used and what I found worked. These are not necessarily the best products, but they are what worked (or didn’t) for me. I am sure there are many other excellent products out there with proven credentials and a body of evidence from other cancer patients. I just haven’t used them. There are also plenty of useless products or products with far-fetched yet unsubstantiated claims out there too. The problem is that beauty (as opposed to medical products) do not undergo the rigorous assessment of the claims that they make and their testing endorsements (82% of women agreed their complexion was improved by “Rover’s Drool” for example) do not bear scrutiny. When you read the small print you discover this is from a very small pool (82% of 50 women, for example). You also don’t know the demographic makeup of the testers. What are their ages, skin type or racial background? All this can affect how a product performs. Just because 41 young women aged 20 years of age who have oily skin thought a product improved their complexion, does not have any bearing on whether it will work for me, or even make mine worse! The testing done is also not under scientific conditions. Testers often receive the product for free, which may well sway their rating (particularly if they hope to receive more free products to test in future). Essentially there is unconscious bias in the reviews of the testers and they need to be treated with appropriate caution. I should know. I am signed up with Home Tester Club https://www.hometesterclub.com/uk/en and receive free products (subject to passing screening) in return for real reviews and ratings. Sometimes this is for research and development feedback. Other times it is reviews on retailer websites or posts (including photo or video) on social media to support existing or newly launched products that are required. Home Tester Club source genuine reviews from genuine people who have tried the product (unlike the fake reviews that plague retailer and rating and review websites these days), but there is always the risk of unconscious bias encouraging the reviewer to be kinder or more generous in their scores and comments. So some healthy scepticism and due diligence is required in the choosing of products to treat your delicate face, body and hair during cancer treatment.
For my sun skin rash, also known as polymorphic light eruption https://www.nhs.uk/conditions/polymorphic-light-eruption/ , I tried a few products before it finally began to recede. Having suffered with PMLE since the perimenopause I already knew to take antihistamines to help with the symptoms (and was already for hay fever anyway); but if you aren’t then make sure you take antihistamines as well as treating the rash with creams. Staying hydrate dis also important. Cold compresses or ice packs on the affected area can really help. Your doctor can prescribe a steroid cream to be used sparingly, but as my rash was on the face I wanted to avoid this.
I will caveat these product references by saying they are not recommendations, just my personal experiences. I will also point out that the links I share are to the manufacturer website to ensure you get the actual (not counterfeit) product should you decide to buy and also to ensure you get the absolutely correct facts, claims and ingredients list. I have no relationship with these brands and am receiving no benefit from highlighting these products. I will state the obvious and say that you may be able to get these products cheaper elsewhere or benefit from sale or discounted prices. They are commonly stocked at larger pharmacies, beauty retailers, department stores, as well as at online retailers such as Sephora
https://www.sephora.co.uk
or Look Fantastic
https://www.lookfantastic.com
and of course the ubiquitous Amazon. If you use Amazon marketplace be very cautious about who the retailer is to ensure you get genuine products. You will often find that by signing up to newsletters at the manufacturer website or the retailer’s you will receive welcome bonuses and online discounts. You ca further bring prices down by using deal hunting websites and extensions such as Honey https://www.joinhoney.com/explore who will look for online promotional codes, coupons and deals for you. I mention this not to patronise those who already know (and have plenty of funds for buying new products) but to help those for whom these things are not obvious and where funds may be tight.
The first product I tried was Dr Hauschka’s Rose Day Cream. https://www.drhauschka.co.uk/day-creams/rose-day-cream/
I’d been aware of it for years and always thought it sounded nice, but it isn’t cheap (to me anyway). It smelled absolutely wonderful (of roses naturally). It is aimed at dry, irritated and sensitive skin. It is a rich cream but there is a lighter version available. It is the product on which Dr Hauschka and Elizabeth Sigmund founded their company in 1967. If I were buying it again I would go for the lighter version as I found the original a little dense for my taste.
Unfortunately it didn’t do the job and after a week (yes I could have kept going longer, but I wanted this rash to improve!) I switched to La Roche Posay Toleraine Dermallergo soothing cream,
La Roche Posay is the number one dermatologist recommended brand in the UK. They have a specialist Cancer Support team and their website has a section devoted to cancer support. They also partner with Macmillan Cancer Support. I was already using their La Roche Posay Toleraine Dermo Cleanser,
and had found it very kind during my chemotherapy. Toleraine Dermallergo soothing cream had come highly recommended for hydrating skin and soothing signs of irritability. It is approved by Allergy UK as a gentle formula to redness and itchiness associated with dry skin. Now technically I wasn’t suffering with dry skin but rather a rash. Perhaps this is why this cream also did not help alleviate my symptoms. I kept going with it for about ten days before giving up.
Now it may be that both previous creams had helped me and it was just coincidence that when I began the third cream I saw improvement. Maybe the rash would have cleared up on its own at this point anyway. All I can say is that the third cream was the charm!
Moo Goo literally came about because a dairy farmer’s son noticed that his mother was using a cream formulated to keep the skin on the dairy cows udders in good condition for milking to soothe her psoriasis. I kid you not! It was thick and greasy and he decided to take it upon himself to reformulate it to be lighter and non-greasy. A brand was born in 2005. It has grown to 40 products and many countries since. Controversially I decided not to try the iconic Skin Milk Udder Cream,
which comes so highly praised, but rather I chose to try the Soothing MSM Moisturiser,
https://moogooskincare.co.uk/collections/moisturise/products/soothing-msm-moisturiser
This is a calming moisturiser for sensitive or irritated skin and contains MSM (an organic sulphate that has skin soothing properties). Within days my rash was clearing up and I am still using it today (it is very well priced and you get a generous tube). I did buy direct (as they are not so commercially available) and enjoyed a welcome discount; but they also have their own shop on Amazon (which helps avoid delivery charges without a minimum spend if you have Prime).
Moo Goo have some nice little gift packs specifically for cancer patients. Check out their small and large oncology gift sets if you are looking for a gift for a cancer patient starting chemo or radiotherapy.
I should also mention that since starting chemotherapy I had switched to CeraVe facewash. CeraVe was created 20 years ago to focus on improving the skin barrier. They noted that many skin conditions such as psoriasis, eczema, blemishes and acne had a compromised skin barrier in common. All their products contain three essential ceramides to protect the skin barrier. Their products are well priced and good value for money in my opinion. I have been using their CeraVe Hydrating Cleanser for normal to dry skin that you massage into wet skin and rinse,
https://www.cerave.co.uk/skincare/cleansers/hydrating-cleanser
Obviously I wasn’t using any serums, skin peels or exfoliants during this time. I also wore make-up very rarely. This helped protect my fascial skin. After I completed chemotherapy I did gradually reintroduce these items, but commencing with very gentle products to begin with. I will give a shout out to the Simple range of serums, using their Hyaluronic Acid day and night, layered with Niacinamide at night and Vitamin C in the morning,
https://www.simple.co.uk/products/serums.html
I was lucky to receive a lovely beauty advent calendar from Look Fantastic and found a product in there that made a noticeable difference to brightening my complexion, Medik8 Press & Glow PHA Exfoliating Toner used day and night,
After this experience, I decided to research and replace my sunscreen as well. After much research I chose La Roche Posay Anthelios Hydrating Body Lotion SPF50,
https://www.laroche-posay.co.uk/en_GB/anthelios-hydrating-body-lotion-spf50/LRP_022.html
for the body and for the face La Roche Posay Anthelios UVMUNE 400 Invisible Fluid SPF 50 + Sun cream for Sensitive Skin,
I decided that my balding head would be best protected by hats and headscarves, but should you want to go out bare headed I would recommend La Roche Posay Anthelios Anti Shine Face Mist SPF50,
This is particularly useful if you have thinning hair or patchy hair, when rubbing in ordinary suncream for the body would just make your hair greasy.
I previously wrote about skin rashes in the body when I talked about the side effects of chemotherapy and my own allergic reaction to Paclitaxel, one of my two chemotherapy drugs. I found it important to use a very gentle bodywash / soap and a hydrating and soothing body lotion. My oncology team recommended Aveeno bodywash and body lotion. Aveeno are well known for their products which are kind to the skin. I had first been prescribed Aveeno body lotion by my doctor years before when I was diagnosed with a UVA allergy and Polymorphic Light Eruption.
The oncology team recommended Aveeno Skin Relief Moisturising Bodywash,
https://www.aveeno.co.uk/products/skin-relief-body-wash
and because this was recommended by them my doctor’s surgery put it on repeat prescription for me. It is important to be aware in the England that if you have a cancer diagnosis you can apply for free prescriptions (in Northern Ireland, Scotland and Wales prescriptions are free due to the devolved nation status in the UK, which just leads English residents being charged for things other nations get free).
The oncology team recommended Aveeno Skin Relief Moisturising Lotion,
https://www.aveeno.co.uk/products/skin-relief-lotion
However, my doctor’s surgery substituted this on repeat prescription for the cheaper Epimax Oatmeal Cream,
https://epimax.co.uk/products/epimax-oatmeal-cream/
which is more equivalent to the Aveeno Daily Moisturising Body Lotion. As I had previously been using this product I decided to give the Epimax a try (after all as a self employed person not earning as much due to being unable to work as much as I had before if the free product worked I would stick with it). I am pleased to say I have found it a very acceptable daily moisturiser; although if I were suffering on a daily basis I would buy the Aveeno Skin Relief moisturising lotion.
During the period of the skin rash (and before I had been assessed by oncology and received their recommendations) I resorted to two products that I had previously seen highly recommended for chemotherapy patients experiencing side effects. For general body moisturising I began using La Roche Posay Lipikar AP&M,
https://www.laroche-posay.co.uk/en_GB/lipikar-moisturising-balm-apm/LRP_096.html
It is not cheap for everyday use, but when you have a horribly itchy rash it was worthwhile!
I also ordered the previously mentioned Moo Goo products, but didn’t try them until I had the later fascial rash, as I found the Lipikar was very effective.
I did use a thicker cream on the worst areas of rash and also for moisturising drier areas such as hands and feet. Again I turned to CeraVe and found it very effective and great value for money. I used the CeraVe Moisturising Cream for dry to very dry skin,
https://www.cerave.co.uk/skincare/moisturisers/moisturising-cream
Your nails, as well as your skin need protection during chemotherapy.
With chemotherapy your nails will grow more slowly and break more easily. Ridges can appear, as well as white or dark lines. Nails can also become loose and fall out. I met a lady who had lost most of her finger and toenails and they had not grown back a year after treatment on two toes. She had also got an infection in one finger where the nail had fallen out and had developed sepsis. In the end she had needed a skin transplant after the sepsis had been successfully treated. This definitely made me want to make nail care a priority!
Moisturising nails and cuticles regularly was advised. I was also advised to cut my long nails short (an interesting experience after years of long nails!). Longer nails are more likely to experience pressure onto the nail bed and possibly loosen the nail. Wearing gloves assiduously (or persuading others to do the washing up if you can) was important. Wearing loose shoes that didn’t press on the toe nail bed was recommended, as was avoiding flip flops and sandals due to the risk of losing nails. Obviously (well perhaps not to some) wearing false nails or using gel or acrylic varnishes or acetone based nail varnish remover was a no no. Interestingly, wearing nail varnish was a yes yes. Nail varnish would help to protect the nails from sunlight, as they would also become very photo sensitive. You will see my nails turning a very becoming shade of what is laughingly known as “Paclitaxel Brown” (yes you do still laugh undergoing chemotherapy.
Using water based nail polish was what was recommended, being kinder to the nails. Not something I think I will adopt in future as water based polish is harder to apply and peels off more easily. However, it did an important job for me in chemotherapy. I used Aquarella polish and they were very helpful to me with my queries.
https://acquarella.com/collections/nail-polish
I also invested in an acetone free nail varnish remover and will be sticking with this in future. I found the Opi acetone free polish remover excellent and no more difficult to use than products with acetone (so why on earth switch back when acetone will damage anybody’s nails),
https://www.opi.com/en-GB/products/nail-polish-removers-acetone-free-polish-remover
Black (or at least very dark colours) polish is often recommended as it will protect the nails from the sun. This was noticed by an Australian nurse two decades ago and has now become commonly recommended. As a bonus dark colours will cover the damage and discolouration better than very pale colours. There is no scientific evidence of the benefits of black nail polish, but there is persistent positive anecdotal feedback. Whatever polish you choose, it is important to remove and have a day or two of polish free between applications. Carefully examining nails for signs of damage or infection whenever you remove polish.
Using a really good cuticle oil and constantly moisturising is very important. I have two suggestions for cuticle oil. The first and more affordable is Dadi’ Oil,
https://dadioil.com/?srsltid=AfmBOopv9h7Pf1PCZ8MkCb5f2mqxoX4-1MzDUWyzGcURS_o44_syKbzx
The second and more expensive is Polybalm,
https://polybalm.com/product/polybalm/
Polybalm is the only clinically proven and scientifically tested product to profoundly reduce chemotherapy induced nail damage. I would massage Polybalm into the skin and cuticles around my finger and toe nails twice a day.
Problems to the skin and gums inside your mouth can also occur. I was advised to use a soft toothbrush and be careful using dental floss. I was also provided with a mouthwash to reduce pain and inflammation, Difflam,
https://www.nhs.uk/medicines/benzydamine/
I was very lucky not to get the mouth ulcers and sore mouth and throat that can come with chemotherapy. These can be particularly debilitating, making eating and drinking very difficult.
Whilst hair loss and thinning is a well-known side effect of chemotherapy, some of the effects on face, body, nails and mouth are less well known. I hope I have shed some light on these and offered some options, borne from personal experience, for those treading the path of chemotherapy after me.
If you’ve experienced something similar or have any questions, please leave a comment below. I’d love to hear your thoughts and experiences.
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Stay healthy and take care!
1 out of 1 Jill's agree that their complexion was improved by cat kisses.