Expert talks
Cancer treatments are becoming increasingly targeted in how they destroy cancer cells. Their skin side effects require targeted care of their own. Hédi Chabanol, Manager of the centre for skin care and clinical studies at Institut Curie, explains two skin side effects resulting from cancer treatments, folliculitis and hand foot syndrome, and offers advice to minimise them.
Cancer cells renew and spread quickly. Chemotherapy and targeted therapies aim to prevent them from spreading. "Skin and mucus cells also renew quickly, and cancer treatments therefore affect them as well," Hédi Chabanol explains. Folliculitis and Hand Foot Syndrome are two skin side effects caused by different cancer treatments. "Both can really impact patients’ daily life, including instrumental activities (using the phone, preparing meals, doing the laundry…) and basic activities (eating, washing, moving…). For minimal skin side effects, it’s important to adapt advice before and during treatment, and take care of skin using products that respect each skin type’s physiology."
Some treatments, such as anti-EGFR (epidermal growth factor receptor) therapies, can cause folliculitis to develop. It appears quite quickly after treatment begins.
"Folliculitis is an acne-like rash that can cover in particular the face, neck, torso and back. It looks like acne, and patients can be tempted to pop the spots. But it’s not a real acne, and doesn’t appear in the same way" Hédi Chabanol summarises.
For some patients, their folliculitis can prevent them from going out, deeply affecting their quality of life. They may not be able to run errands, or even dress due to the sensation of clothing on their rash. They feel uncomfortable facing other people. Hédi Chabanol is reassuring. "Regularly using the right skincare products can have a big impact on its development. Patients must take care of skin and moisturise daily, even as soon as skin starts to feel tight."
Don’t hesitate to use day and night creams when skin is really dry and needs greater nourishment. And it’s always a good idea to ask your healthcare professional for advice.
"Caring for one’s appearance is as important as caring for skin." Hédi Chabanol continues, "Patients may think they shouldn’t put on make-up. It’s perfectly all right to wear make-up over folliculitis, as long as it’s non-comedogenic and the skin can still breathe." She suggests powder and green-tinted corrector to hide the rash, and cleansing and drying skin carefully.
Hand Foot Syndrome, or HFS, is another skin side effect.
"It can be both diffuse or localised, depending on the type of treatment. Here, hands or feet, or hands and feet together, become very dry and have a burning sensation. They can heat up so much that it becomes difficult and too painful to use hands or to walk. When handling items or walking, skin becomes very sensitive and splits, and in the case of their feet, patients may feel unsteady when standing."
When patients feel these sensations, it’s important to consult a podiatrist who can provide specialist advice, including specific foot care and orthotic insoles.
"Moisturising is important here, too. However, all patients are different. According to their skin type and daily habits, some are more used to applying skincare products than others. People who put cream on their feet are rare. So it’s important to also work on contributing factors, meaning caring for hands and feet in their daily environment."
This includes covering hands up in cold weather, wearing gloves for housework, not carrying heavy bags. "Hands especially during the Covid-19 pandemic are in a fragile state from using hydroalcoholic gel and repeated washing." Restoring hands' hydrolipidic film aids in managing hand-foot syndrome. As for feet, throw the pointy toes and high heels to the back of the closet, except for special occasions. Treat them to cotton socks and comfortable shoes with soft soles. "All of this helps to reduce perspiration and prevent split skin."
Having adapted skincare products and clear instructions can make a real difference to overall treatment.
Having adapted skincare products and clear instructions can make a real difference to overall treatment.
Hédi Chabanol, Manager of the centre for skin care and clinical studies at Institut Curie
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Skin side effects such as folliculitis and HFS tend to be dose-dependent and cumulative. They can get worse as therapy continues and often improve when treatment is finished.
In both cases, prevention is the best medicine.
"Above all, adherence is key," Hédi Chabanol encourages. "Having adapted skincare products, with fewer ingredients to reduce allergy risk and a pH that respects the skin’s, and clear instructions as to how to apply, when to apply and how much to apply can make a real difference to overall treatment."
