A cancer diagnosis is life changing. As one navigates through surgical intervention, anti-cancer drug therapy and radiation therapy, a shift in physical and emotional health will occur.
As part of MySkinSpa’s professional cancer skincare treatment in Raby Bay, I strive to help complete a circle of care by having the knowledge and experience to safely modify treatments on my menu to accommodate side effect commonly experienced by those who have cancer. I will support you and your skin throughout your journey by offering customised, bespoke and safe services. With extensive training and certification in Oncology Aesthetics, you can rest assured that my 25 years’ experience in the industry means you’ll ensure a service truly uncompromising in quality, safety and long-lasting results.
“Some days there won’t be a song in your heart, sing anyway” – Emory Austin
Cancer strikes abruptly and forces patient’s to change their familiar style of life, either completely or temporarily. As our largest organ, it’s no surprise that our skin is also forced to change routine and treatment, particularly during the phase of active therapy. The most important cancer treatment options include:
- surgical interventions
Skin care that actively supports skin recovery, peelings and techniques that stimulate the microcirculation are the most significant cosmetic measures to take after the wound healing process is complete. As your body and skin repairs itself, it’s important to be patient with the healing process. In the medium run, sun protective measures are a significant topic since the scar tissue still lacks melanin. Contrasts in pigmentation after skin grafts either are attenuated by applying liposomal vitamin C derivatives (sodium ascorbyl phosphate) or matched to the surrounding skin tone using pigment containing foundations and powders.
During radiotherapy, the skin either serves as thoroughfare organ for the radiation applied or it reacts to the scattered radiation from the body interior. A damage of healthy cells cannot be avoided in this context. Consequences are a retarded formation of basal cells and, depending on the radiation dose, reversible or irreversible DNA damages. The body’s own matrix metalloproteinases are activated dose-dependently and degrade collagen, the sebum secretion decreases and the barrier function of the skin is disturbed.
Dry and reddened skin, similar to a sun burn, is a visible consequence of radiotherapy. The erythema symptoms may be very intense (radiodermatitis). An intensified proliferation can be observed on the radio-damaged skin and it desquamates. The superficial barrier layers of the stratum corneum are shed. If the basal layer is severely affected, the barrier layer will peel off and leave weeping areas, in rare cases, also a necrotizing of the skin has been stated; oedemas may eventually form. In cases where the enzyme tyrosinase has been stimulated, the skin will darken due to the melanin production. If the hair root cells are damaged, the patient will shed his hair. Also the function of the sweat glands is impaired. Erythemas appear about two to three weeks after beginning with radiotherapy treatment. Even years later, so-called late reactions may lead to vascular dilatation, teleangiectases, pigment spots and atrophic skin.
The radicals are partly scavenged by amino acids (NMF) but also by hyaluronic acid which is essential for the turgor of the skin. Hyaluronic acid occurs in the extracellular matrix and degrades in the process which, in combination with the above mentioned collagen degradation, leads to the atrophic condition of the skin. Hence NMF and hyaluronic acid are key elements for the conditioning skin care before and after radiotherapy. Emulsifier free barrier creams with Derma Membrane Structure in combination with linseed oil nanodispersions have proved successful for the basic accompanying skin care. In cases of actinic keratosis, also boswellia nanodispersions can be integrated into the skin care concept. The phosphatidylcholine (PC) contained in the mentioned preparations protects the cells against gamma radiation. PC liposomes have regenerative effects on the gamma and UV radiation-damaged skin. Mixtures of avocado oil and PC, dispersed in water can be applied to cleanse and simultaneously nourish the skin.
It is strongly recommended to avoid – if possible – body cleansing products that contain aggressive tensides such as lauryl sulfate and lauryl ether sulfate. In most cases, lukewarm water is sufficient for the cleansing of the skin. Short chamomile baths have soothing effects. As regards men’s wet shaving using shaving soap, it also can be a source for skin irritations. Hence it is recommended to switch to dry shaving. When it comes to soothing the skin, CM glucan-containing hydrogels are an alternative to the aftershave lotions with high alcohol content. Hydrogels with alginates, hyaluronic acid, CM glucan, aloe vera, D-panthenol and amino acids (NMF) will keep the skin well hydrated. Some gels can incorporate vegetable oils whose omega-6 and omega-3 acids have anti-inflammatory effects. In the form of non-aqueous oleogels, the vegetable oils can be applied like a cream.
In contrast to Vaseline products, these oleogels have the beneficial effect of amply re-fattening and easily penetrating into the skin. In this context, an analogy can be drawn to the care of the neurodermitic skin which also shows barrier disorders, extreme dehydration problems and a disposition to irritations after mechanical stimuli such as tight clothing.
Irritating or potentially sensitizing additives in cosmetics are an additional source of problems and should be avoided since they easily penetrate through the disordered skin barrier. In cases where the skin barrier is damaged also the risk of infections is increased, a problem which can be confronted with the above-mentioned barrier creams and recovery supporting vitamin supplements (A, C, E, D-panthenol).
Powders containing urea will not dehydrate the skin and have anti-itching effects. For decorative preparations, the same criteria apply as for the basic skin care: as little additives as possible and no substances that impede the natural recovery of the skin. This implies that covering mineral oils and mineral waxes should be avoided.
An essential prerequisite for a fast recovery of the skin after the therapy is the adequate preparation of the skin before therapy starts. Hence, it is recommended to apply barrier creams already several weeks before a planned radiotherapy in order to provide an effective protection for the skin.
Chemotherapy is responsible for a multitude of different skin effects, as a range of destinations are targeted. If it damages the fast growing tumour cells, the systematic treatment affects the fast growing healthy cells of the skin and the mucous membranes. As a consequence, barrier disorders of the skin will develop. Symptoms may include dehydrated skin and an increased risk for infections, which is augmented by the weakened immune system. Frequently cutaneous mycoses and herpes infections appear, which you can treat with pharmaceutical drugs. Hence, hygienic conditions are an essential prerequisite. Similar to the radiotherapy-affected skin, moderate skin cleansing preparations are recommended to avoid additional problems for an already damaged skin barrier. It is advised to use medical hydrogels for the treatment of dry mucous membranes.
A multitude of side effects have been observed in connection with the cytostatics used in cancer therapy:
- Mitotic inhibitors such as vinca alkaloids have toxic effects and cause loss of hair.
- Alkylating cytostatics (as for instance cyclophosphamide) have toxic effects and cause loss of hair and erythema.
- Folic acid antagonists such as methotrexate may cause exanthema, erythema; frequently they also trigger symptoms such as itching and reactions around the injection sites.
- Pyrimidine antagonists (as for instance fluorouracil) are evidenced by photosensitive reactions and hyperpigmentation.
If anti-cancer drugs block the signalling channels of the body’s growth factors, modifications of the skin condition, the hairs and nails are inevitable:
The vascular endothelial growth factor (VEGF) induces the vascularisation process (angiogenesis) during the embryonic stage. Multikinase inhibitors impede the VEGF signalling channel, among others, and impair the tumour angiogenesis. Facial erythema, rashes (exanthema), itching and swellings have been observed.
Via its receptors, the epidermal growth factor (EGF) stimulates proliferation and cell growth. The EGF impedes the apoptosis (programmed cell death). Hence it also supports the growth and metastatic spread of tumours. Signal transduction inhibitors impede the transduction of the EGF signal to the receptor in the interior of the tumour cell. This reaction also occurs in the skin cells. The skin will dehydrate and chap. Itching, erythema, inflammations and pustules will develop.
The side effects described vary depending on the individual condition and the preparation that has been medicated. The most important skin care measure to take in this context is to support the skin barrier with non-irritant, in other words, emulsifier free products in combination with hydrating agents such as amino acids and hyaluronic acid. In how far the itching sensation can be successfully relieved with urea and the erythema treated with essential fatty acids and vessel stabilising extracts (Echinacea, butcher’s broom) has to be tested on an individual basis.
Immunotherapy is classed in either active or passive immunotherapy whereas both will support the immune response to the cancer cells. In other words, slow down the growth or even kill the cancerous cells. Active immunotherapy implies the use of vaccines produced from devitalized tumour cells or antigens in order to cause a natural immune response in the body to the cancer cells. If natural cytokines of the body, interferons also belong to this family, immunoglobulins or T-lymphocytes are applied, it is a matter of passive immunotherapy. Since the growth factors are manipulated by this kind of therapy, it can also affect the skin. Interferons may temporarily cause non-specific exanthema, dry skin or loss of hair. As to the rest, the skin care has to be adapted to the specific symptoms that appear. Apart from that, it is essential to avoid irritations and in individual cases, it may be recommended to apply lipid-enriched products.
Concluding, also the hormone therapy should be mentioned (as e.g. in the case of prostate, breast or uterus cancer). Since this specific therapy interferes with the oestrogen or testosterone balance, hormone specific skin conditions have to be taken into account. If the sebum glands are affected, liposomal skin care lotions, based on phosphatidylcholine are suggested; paraffin based products are counterproductive in this case. Abnormal skin reactions may prove to be side effects of the pain medication frequently administered together with the cancer-specific therapy. In this specific case, it is advisable to change the medication.
If you’re in the process of seeking treatment or have just finished treatment, MySkinSpa can assist in providing highly customised and bespoke cancer skincare treatment in Raby Bay. Working with your unique requirements and skin type, I will assist with your healing process. For more information, please call me today on 0438 735 990 or simply fill out our online enquiry form.
Source: Dr. Hans Lautenschläger