As humans age, they see the signs of time, such as: wrinkles, puffiness, loss of muscle tone, dehydration, dry skin, hyperpigmentation and loss of volume. However, most people do not see these signs of aging until later in life. Those with cancer often see the aging process at a younger age, as a result chemotherapy and hormone therapy medications.
Looking and feeling good improves self esteem and ultimately the quality of life for humans. For those undergoing cancer treatment, the boost in self esteem can help them fight the disease, and for cancer survivors, the boost can help them stay healthy. In this article, we will discuss the two main body agers in cancer treatment—chemotherapy and hormone therapy—and discuss proper treatment for an improved quality of life.1
Cytotoxic Chemotherapy
Chemotherapy is a type of cancer treatment that uses medications to destroy cancer cells. These medications can also affect all fast-growing healthy cells. So, it is not surprising that many people feel that they age dramatically during chemotherapy.
During chemotherapy, the epidermis loses its ability to hold on to moisture, which leads to fine lines in the skin's surface. In the dermis, the collagen and elastin break down, which weakens the skin's support structure. At the same time, subcutaneous tissue starts to disappear, especially if the client is nutritionally deficient.
Skin treatment. Clients should be encouraged to drink water, as enzymatic functions in the skin are dependent on water intake. Cutting back on alcohol, coffee and other factors that cause chemical and physical dehydration need to be accomplished. Any fat-free diets are a major problem, as they can result in essential fatty acid deficiency, which compromises the health of the keratinocyte cell membrane due to low epidermal lipids.
Chemotherapy appears to be easier on the skin than on the hair. Irrespective of a skin type, chemotherapy tends to make the skin drier because some medications can interfere with oil and sweat glands. So, it is important to keep the skin as moist as possible during treatment and to try and keep it looking young and healthy. The focus on skin care during chemotherapy needs to be on soothing, hydrating and protecting the skin.
Frequently applied moisturizers can prevent any excessive dryness, itching and tearing of the skin, which can result in infection in a person who is immune suppressed. Pay attention to the client’s dry lips, as many medications can also cause dry mouth. In addition to moisturizing the skin, skin care should be used that keeps moisture in the skin. Simply applying moisture to the skin surface with humectants and hydrating masks have an immediate but temporary effect on the skin; however, the client needs slow transepidermal water loss (TEWL) in the long-term with occlisive agents to help prevent evaporation.
It is imperative that the client undergoing chemotherapy should never use products or have esthetic procedures that are aggressive. This client should also use strong sun protection, as the skin may be sensitive during chemotherapy and more prone to burning. Chemotherapy medications that create a photosensitive reaction can include: 5-fluorouracil (5-FU, Efudex, Carac, Fluoroplex), vinblastine (Velban, Velsar) and dacarbazine (DTIC-Dome).
When the client has completed chemotherapy and the skin starts to recover to regain its status to the new normal, the opportunity arises for application of anti-aging treatments and products. Estheticians can then start to work with products that contain antioxidants and/or exfoliants once they are in recovery. Ingredients such as topical retinoids, L-ascorbic acid, alpha hydroxy acids, polypeptides, hyaluronic acid and various plant extracts can be used to rejuvenate and restore the skin.2-3 It is important for estheticians to know about these ingredients and how to effectively use them and when.
Hormone Therapy
Hormone therapy drugs are administered for breast, prostate, endometrial and adrenal cortex cancers. These clients have an excess amount of hormone in their body, and the hormone is the cause of their cancer. The purpose of these drugs is to inhibit hormone synthesis, and/or block the hormone from attaching to the matching receptor on the surface of the cancer cells.
Hormones are chemical messengers that have specific effects on certain cells of the body. Hormones, which are produced by endocrine glands, are released into the bloodstream where they are carried to all parts of the body. But they will only effect cells that have specific receptors for that particular hormone. Hormones can only have an effect if they are able to bond to a receptor. If they cannot bond to it, they will have no effect no matter how high the hormone levels are. The skin contains receptors for several types of hormones, but this article we focus on estrogen.
Some of the benefits of estrogen on the skin are an increased rate of cell turnover in the basal layer of the epidermis. It reduces the size and activity of the sebaceous glands; keeps sebaceous secretion thin and less fatty; and increases the action of the enzyme hyaluronidase, which produces hyaluronic acid and keeps the skin metabolically active. It provides the skin with its ability to resist stretching and keeps the skin firm and moist, giving the skin the smooth, soft feel. Estrogen can also accelerate cutaneous wound healing, improve inflammatory skin disorders, offer some protection against skin photoaging and some mortality fates from both non-melanoma and melanoma skin cancers.
Too little estrogen in women causes the skin to appear dull, thin and finely wrinkled with some loss of tone. The lack of estrogen also causes a reduction in the action of the enzyme hyaluronidase. The low dermal glycoaminoglycans (hyaluronic acid makes up a large percentage of these substances) means that the skin becomes thinner and loses its supple texture. The skin can remain soft to touch but can feel less smooth. There is also a decrease in the reflection of light from the skin, leaving the surface looking dull and dry. Without estrogen, the skin can age.4
Some hormone therapy drugs can induce menopause, which then triggers a sudden onset of skin aging a few months after menopausal symptoms start. Menopause causes hypo-estrogenism, accelerating age-related deterioration and resulting in a thinner skin, an increase in number and depth of wrinkles, increased skin dryness and decreased skin firmness and elasticity.
Skin treatment. Taking care of the skin with no estrogen support requires gentle cleansers and soothing products without fragrance or any other irritating ingredient. The client needs to hydrate their skin at all times and to avoid activities that would cause further dryness.
A report in the Journal of Clinical Oncology warns that rejuvenating skin creams often contain estrogen. In fact, 40% of those tested contained what researchers are calling significant amounts (up to 0.61%) of estriol or estrone, two potent forms of estrogen.5 Estrogen helps the skin retain water, and may improve skin tone on a limited basis—but at what risk to the client? Clients with a history of breast cancer, or who are undergoing treatment for breast cancer should be especially concerned about any product that could raise the level of blood estrogen through the skin through commercially available topical moisturisers.
What may, or may not be important to the client is corrective makeup to reduce the aged look. Skillfully applied makeup can definitely enhance a person’s appearance, An unhealthy sallow color during treatment (green/grey) can be combated using a lavender/lilac type corrector to brighten the skin. Therefore, the focus would need to be getting the skin related issues resolved first, then onto creating the healthy glow.
References
1. www.simmsmanncenter.ucla.edu/index.php/center_events/cancer-and-aging/
2. www.ncbi.nlm.nih.gov/pmc/articles/PMC3930538/
3. www.surgery.org/consumers/ask-a-surgeon/safer-facial-filler-juvederm-restylane-absorbed-faster
4. www.ncbi.nlm.nih.gov/pmc/articles/PMC2685269/
5. www.ncbi.nlm.nih.gov/pubmed/19652049
Morag Currin is an esthetic instructor with more than 25 years of spa industry experience, and more than 10 years of training and training management experience. She pioneered the Oncology Esthetics advanced training for spa professionals, and is the author of Oncology Esthetics: A Practitioner’s Guide Revised & Expanded (Alluredbooks, 2014; www.alluredbooks.com) and Health-challenged Skin: The Estheticians’ Desk Reference (Alluredbooks, 2012; www.alluredbooks.com).
