Rashes and Skin Changes
Skin changes, especially rashes, are one of the most common side effects of many cancer treatments. These changes can affect skin anywhere on your body, including your scalp. Skin changes and rashes may also be called cutaneous or dermatologic reactions.
There may be treatments available, depending on your symptoms and what is causing them.
What causes rashes and skin changes?
There are many reasons you might have rashes or other skin changes during cancer and cancer treatment.
Cancer treatments
Cancer treatments are the most common cause of rashes and skin changes in people with cancer. Most types of cancer treatment (including chemo, targeted drug therapy, immunotherapy, radiation therapy, stem cell transplant, and hormone therapy) can cause skin changes.
Medications
Many other types of medications used as part of cancer treatment (such as ones for pain, nausea and vomiting, or diarrhea) can cause skin changes.
It's important to know that if a skin rash is an expected side effect of a certain treatment, it is not considered an allergy or allergic reaction. However, people can have allergies to chemotherapy, immunotherapy, and targeted drug therapy, just like with any other medicine.
Talk to your doctor or cancer care team about your symptoms. They can help you understand what type of reaction you might be having.
Certain cancers
Rashes and skin changes can also be caused by certain cancers. For example, itchiness and night sweats can be symptoms of some lymphomas. Some leukemias and breast cancers can cause rashes.
Other health problems
Other health conditions not related to cancer can also cause rashes or skin changes, such as psoriasis or cellulitis.
Common rashes caused by cancer treatment
Rashes can be a side effect of certain types of chemotherapy, targeted drug therapy, immunotherapy, radiation therapy, or stem cell (bone marrow) transplants.
These are some of the most common rashes caused by cancer treatment:
Maculopapular
Maculopapular rashes have both flat and raised areas. They often look like pink-red bumps on light skin tones and purple-brown bumps on dark skin tones. Maculopapular rashes most often happen on the face, chest, stomach, and back, but they can develop on any area. Some are itchy or uncomfortable.
Papulopustular
Papulopustular rashes usually happen on the chest, upper back, or face. They may be itchy and painful. This is the most common skin rash associated with a type of targeted drug therapy called EGFR inhibitors. As many as 9 out of 10 people get papulopustular rashes as a side effect of EGFR inhibitors.
Acneiform
Acneiform rashes have papules or pustules (small, red bumps with or without pus). They usually happen on the face, scalp, upper chest, or back, and are often described as acne-like bumps.
Erythema multiforme
Erythema multiforme rashes often have raised, round spots known as target lesions because they look like a bullseye target. They usually have three rings with a small blister in the center. This type of rash most commonly affects the hands, feet, and face, but it can develop anywhere. It often appears pink-red on lighter skin tones and red-purple on darker skin tones.
Purpura
Purpura rashes aren’t directly caused by cancer treatment. They are tiny, flat, pin-point spots caused by broken blood vessels close to the skin surface. Low platelets (thrombocytopenia) are the most common reason for purpuric rashes.
Hand-foot syndrome
Hand-foot syndrome is a type of rash that causes redness, swelling, and pain or sensitivity on the palms of your hands or soles of your feet. Targeted drug therapy is the most common cause of this rash in people with cancer. The medical name for hand-foot syndrome is palmar-plantar erythrodysesthesia syndrome.
Steven-Johnson syndrome and toxic epidermal necrolysis
Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but very severe skin conditions most often caused by medications. Flu-like symptoms such as fever, muscle or joint pain, cough, or sore throat are common, followed by a painful rash.
The rash often starts near the upper body and spreads to other areas such as the face, arms, or legs. Skin often blisters and peels off in large sheets. SJS and TEN can also affect your mucous membranes (areas such as the mouth, throat, colon, or genitals).
SJS and TEN are medical emergencies. If you think you might have SJS or TEN, go to the emergency room or call 911 immediately.
Other common skin changes
You might see other skin changes because of your cancer treatment including dry or itchy skin, wounds or scars, and skin color changes.
Dry skin
Dry skin can be rough, flaky, red, and sometimes painful. It is often caused by not having enough oil and water in the layers of your skin. Common causes of dry skin include dehydration, heat, cold, or poor nutrition. Dry skin can be a side effect of cancer treatments like chemotherapy, radiation therapy, targeted therapy, and stem cell transplant.
Itchy skin
Itching is usually an uncomfortable feeling that can lead to poor sleep, anxiety, abrasions or wounds, and infection. The medical name for itching is pruritus. Certain cancer treatments, medicines, skin conditions, or other health problems can cause itching.
Skin color changes
Changes in skin color can happen in any person for different reasons. The medical name for skin color changes is cutaneous pigmentation. Changes in skin color can be caused by different types of cancer treatments or medicines.
They can also be a sign of another health concern. For example, yellow skin can be a sign of liver problems; pale or blue lips can be a sign of breathing problems; bruised skin can be a sign of low blood counts or bleeding.
Photosensitivity
Certain treatments and medicines can cause your skin to be more sensitive to light. This is known as photosensitivity.
Radiation dermatitis
Almost everyone receiving radiation therapy experiences some degree of radiation dermatitis (skin irritation that may be red, dry, itchy, or peeling). It usually happens only on skin in the area getting radiation. It may be mild or severe depending on the dose of radiation therapy and what area is being treated.
Radiation recall
Radiation recall is a rare side effect that happens to some people who receive chemotherapy after having radiation therapy. While not well understood, some people experience a skin reaction (dermatitis) in the area previously treated with radiation. Radiation recall can happen weeks, months, or years after getting radiation therapy.
Wounds and scars
Skin conditions that aren’t managed, surgical procedures, and complications such as pressure sores can cause wounds and scars.
Learn more: Scars and Wounds
Signs and symptoms
Rashes and other skin changes can show up on your scalp, face, neck, chest, upper back, and sometimes on other parts of your body. Rashes can itch, burn, sting, or be painful. Most rashes and skin changes develop within a few weeks of cancer treatment, but they can happen at any time.
Signs and symptoms include:
- Pain, discomfort, or skin sensitivity
- Dry, rough, scaly, or flaky skin
- Redness or swelling
- Pink, red, or purple spots that can be different sizes and patterns
- Cracked skin or nails
- Excessive scratching or scratch marks
- Sores or ulcers
- Yellowing of the skin or the whites of eyes
When to call 911 or go to the emergency room
Call 911 or go to the emergency room right away if you have signs or symptoms of an allergic reaction or anaphylaxis:
- Swelling around your face, throat, or mouth
- Shortness of breath (may have pale skin or bluish lips or mouth)
- Coughing or wheezing
- Fast, short breaths
- Fast or irregular heart rate
- Chest pain or discomfort
- Sweating or cold, clammy skin
- Hives, welts, or itchy skin
Or if you have skin changes along with any signs of infection, such as:
- Fever or chills
- Shortness of breath
- Fast or irregular heart rate
- Low blood pressure
- New or worse confusion
- Not having to pee or peeing only very little amounts that are dark orange or brown
When to alert your health care team
Let your health care team know if you have:
- New or worsening rash, skin changes, or wounds
- Itching that doesn’t go away or prevents you from being able to sleep for more than 2 days
- Rough, bright red, or painful skin areas
- Open, bleeding, or blistered skin
- Bruises that don’t go away within a week
- Yellowish skin or whites of eyes
- Skin problems with drainage, pus, or other fluids that smell bad
Treatments
Not all skin changes need to be treated. But if you have symptoms that are severe or don’t go away, you might get one or more of the following treatments.
Topical therapies
Topical therapies are the most common treatment for rashes and other skin changes, such as dryness or itchiness. A topical therapy is any treatment that is applied to the skin. This includes moisturizers, steroid creams, or other anti-inflammatory ingredients.
Steroids
Steroids are often used for rashes or skin changes caused by immunotherapy, targeted drug therapy, or stem cell transplant because they calm down the immune system reaction.
Immunotherapy
For very severe rashes that don’t respond to other treatments, certain types of immunotherapy can help suppress an overactive immune system.
Antibiotics
If you have a very severe rash or skin problem, or if you have signs or symptoms of infection, your health care team might suggest antibiotics to prevent infection. Antibiotics can be topical (applied to your skin), oral (pills that you swallow), or intravenous (through an IV in your vein).
Other therapies
Other treatments and therapies might be used, depending on your symptoms. For example, if you have itching that doesn’t respond to creams or steroids, you might be given medications such as antihistamines. Cool cloths can help with pain and swelling. Pain medicines might also be used, especially if you can’t sleep because of your symptoms.
Tips for managing skin changes and rashes
If you have skin changes, talk to your doctor or cancer care team about your symptoms. Ask what products or supplies they suggest using. If they don’t recommend anything specific, choose mild soaps, lotions, or moisturizers that don’t have perfumes or harsh chemicals. (Perfumes and harsh chemicals can irritate your skin or even make your symptoms worse.)
Here are some ways you can take care of your skin and prevent skin changes from getting worse:
Keep it clean. Wash the affected area at least once a day with gentle soap and warm water. Pat dry.
Keep it moisturized. Unless you’re told otherwise, keep the area moisturized. Use a hypoallergenic, cream-based moisturizer, preferably unscented.
Use clean, dry clothes and towels. Don’t share with other people.
Protect the affected area from extremely hot or cold temperatures.
Protect your skin from the sun and ultraviolet (UV) radiation. Use a broad-spectrum sunscreen with SPF of at least 30 and zinc oxide or titanium dioxide. Apply it at least 1 hour before going outside. Wear sunglasses with UV protection. Wear a hat or head covering to protect your scalp.
Avoid irritating the area as it heals. Wear loose, soft, comfortable clothing and shoes. Avoid tight clothing, very hot water, and products with strong perfumes or irritating chemicals.
Try to avoid scratching or injury to the area. This can make rashes and skin problems worse, break open skin, and increase your risk of infection and bleeding.
Avoid products with alcohol such as perfumes, colognes, and aftershave.
Use an electric razor to reduce your risk of damage or injury to skin.
Soothe irritated skin. if you have itchy or irritated skin, try soaks with baking soda, oatmeal, or bath oil.
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- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
American Society of Clinical Oncology (ASCO). Skin conditions. Cancer.net. Content no longer available.
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Last Revised: September 12, 2024
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