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Cancer and Skin Changes: Acnelike Rash

June 2014 issue of Skin Inc. magazine
Cancer and Skin Changes: Acnelike Rash

Steve was diagnosed with stage four lung cancer, and was receiving chemotherapy and targeted therapy, and his treatment plan was designed to stop the cancer’s progression. He was experiencing an acnelike rash on his face due to the drugs he was receiving to treat his cancer.

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Skin side effects associated with chemotherapy are generally not life-threatening, but care and treatment can be life-enhancing, helping to significantly improve quality of life. Not only is skin fragile because of cancer treatments, but also the majority of clients receiving targeted therapies experience an acnelike rash. In most cases, the rash appears on the face, scalp, chest, back and around the ears. Although labeled as acne, this is not the same as teenage acne. Why this acne occurs is not well understood. The signaling pathways for the formation of the skin layers are thought to be disrupted. There are not increased glandular secretions.

Some physicians may try to prevent the acnelike rash or treat it with antibiotics and/or steroid creams. Some may refer to a dermatologist. These rashes gradually disappear when treatment ends without any long-term consequences. Although not considered life-threatening, these skin changes are difficult and have caused some people to stop treatments.

Initial assessment and analysis. It is tempting to diagnose a client’s needs by virtue of experience. Of course experience helps, but first, a reminder about getting back to the basics. You should be using an intake form. The responses to the following questions will generate invaluable information.

  • What medical treatments has the client received?
  • What medical treatments is the client currently receiving?
  • How long has the client been in treatment?
  • What side effects are being experienced by the client?
  • Is the client having any pain?

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Steve’s Story

Steve came to Ahava the first time after he was diagnosed with stage four lung cancer. He was receiving chemotherapy and targeted therapy, and his treatment plan was designed to stop the cancer’s progression. This was not a curable situation. 

Although he had not been bothered by facial acne for many years, the acnelike rash that he now had on his face was due to the drugs he was receiving to treat his cancer. Steve had been treated medically for the rash, but combating chemicals with chemicals did not seem to be working for him.

Chemotherapy is a systemic cancer treatment often used when cancer has spread or metastasized beyond the initial tumor, or there is a very high risk of metastasis. It refers to chemical agents or drugs that are destructive to cancer cells. These drugs stop the cancer cell’s growth and development. In Steve’s case, the cancer had spread beyond his lung into parts of his liver when he came to Ahava.

Cancer cells reproduce largely uninhibited, and it is these cells multiplying that eventually form a tumor. At any time, cancer cells can also break away from the original site and be carried to distant body sites by the blood, setting up new cancerous growths. This is called metastasis and is a hallmark of cancer. There are a large number of chemotherapy agents that may be used alone or in combination for the treatment of cancer. A side effect of these drugs is the more or less indiscriminate destruction of reproducing cells. The cells of the gastrointestinal tract, bone marrow and hair follicles are commonly affected. Unfortunately, many chemotherapy agents are not smart enough to distinguish between the unwanted reproduction of cancer cells and the normal cells that are reproducing. This causes the side effects of nausea, vomiting, immune system suppression with infection and hair loss.

Additionally, Steve’s cancer treatment included targeted drugs with the chemotherapy, which are new technologies designed to block the mechanisms by which cancer cells are nourished, grow, divide and possibly spread. These targeted treatments are much smarter about blocking cancer cells without as many side effects as traditional chemotherapy. The one that he was receiving—an epidermal growth factor receptor inhibitor—blocked the cancer mechanisms while causing extreme skin dryness and an acnelike rash.

Cutaneous Appearance Changes Due to Cancer Treatment

  • Follicular eruption or acnelike rash
  • Nail toxicity, including dry, cracked and peeling skin around the nails, swelled cuticles, ingrown nails, nail-shedding and dark lines through nails
  • Ingrown hair follicles
  • Excessive dry skin with itchiness and irritation
  • Dry, peeling skin on palms and soles, also known as Hand-Foot Syndrome, may be accompanied by tingling, pain and swelling
  • Hair changes, including thinning, loss, or a change in color or texture
  • Increased growth of eyelashes and eyebrows
  • Hyperpigmentation, which may be generalized or focused on nail beds, mouth, tongue, palms and soles, or along veins
  • Telangiectasia, or eruption of tiny veins just below the skin’s surface

Approaching Clients With Cancer

  • Acknowledge their cancer. Use the word “cancer.” Although cancer should not be the only topic discussed, recognizing and being up front with the elephant in the room is helpful in putting clients at ease.
  • Ask whether the client is experiencing any pain at the time in order to provide the most comfortable care.
  • Ask how the client hopes to benefit from her spa services. What are her goals for this treatment? What is she looking forward to?
  • Remembering to look beyond the particular service or cancer diagnosis, and see the whole person.

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