About the skin
The skin is the largest organ in the body. Taking care of the skin is extremely important for children being treated for cancer, as the skin plays a number of roles in protecting our bodies and helping us grow. These include:
- Serving as a barrier, protecting the body from moisture, cold, sun, and germs
- Controlling body temperature
- Preventing dehydration and overheating
- Feeling sensations such as cold, warmth, pressure, itchiness, and pain
- Storing water, fat, and other products that affect the metabolism
- Producing hormones that control and regulate the activity of certain parts of the body
The skin is made up of three layers:
- The epidermis, the outermost layer of skin, which provides a waterproof barrier and creates our skin tone
- The dermis, which contains tough connective tissue, hair follicles, and sweat glands
- The subcutaneous tissue (hypodermis), which is made of fat and connective tissue
Children’s skin differs from adult skin and requires different care. While baby skin has the same three layers as adult skin, it is much thinner and its barrier and temperature-regulation functions are less developed. Baby skin is:
- Less resistant
- More sensitive to chemical, physical and microbial influences
- More prone to dryness
- More sensitive to UV rays, extreme temperatures, and changes in temperature
- More likely to be damaged faster, either by the elements or pressure
- More absorbent, requiring diligence when applying topical medication such as steroid creams
As children grow, so does their skin. Until the age of 6, children’s skin is thinner, with less pigmentation than adult skin and fewer active sweat and sebaceous glands. This means that many of the skin’s protective functions are relatively weak compared to adults. By the age of 6, most of the skin structure has fully matured. By young adulthood, the thickness of the skin will have increased by 20% from birth.
How skin heals
When skin is injured, the body sends blood to the skin with substances that protect it from infections and help speed healing. New cells are then produced to form new skin and blood vessels.
Children being treated for cancer may have side effects that impact how the skin heals and regenerates, including surgical incisions (cuts) or therapies such as radiation.
Scarring is also a possibility. Whether or not a wound in a child leaves a scar generally depends on how deep the wound is. Scars do not grow and will get smaller over time as the child grows.
Talk to your provider about the long-term scarring effects of cancer treatment and what options may be available.
Skin protection and the sun
Chemotherapy and radiation treatment can make a patient’s skin more sensitive to the sun. This both can result in the skin burning more quickly as well as increase the chances for secondary cancer such as melanoma.
To protect a child’s skin while he or she is being treated for cancer:
- Wear sunscreen with at least SPF 30 or higher when outdoors.
- Wear long sleeves and hats when outdoors. This is in addition to sunscreen, as even clothes with SPF-protection may not be enough to protect a child’s skin.
- Limit outdoor time as much as possible, particularly between 10am to 3pm when the sun is strongest.
Skin changes to look for
Skin reactions are common in patients undergoing treatment for cancer. The medical team should inform families about possible skin problems with treatments. Parents should look at their child’s skin regularly for:
- Flaky, red or rough-textured skin
- Cracks in the skin
- Any bleeding between the lines of skin covering joints, including knuckles or elbows
- Changes in color
- Changes in sensation (such as pain, numbness, burning, or tingling)
A doctor should be contacted if the child develops rough, red, or painful skin – or shows signs of infection, such as pus or experiencing tenderness near broken skin areas.
Caring for dry skin
Dry skin is dead skin and an infection risk, as dead skin is food for bacteria. Dry skin also weakens skin by making it easy to tear open and breaking down the outer “waxy” coating of skin that helps protect it.
Common causes of dry skin include:
- Frequent bathing
- Harsh soaps (any soap that is not pH balanced or neutral or has a fragrance)
- Extreme temperatures (inside and outside)
- Wind
- Sun exposure (including cloudy days)
- Medicines (such as chemotherapy or steroids)
- Bone marrow transplant (stem cell transplant)
- Dehydration (not drinking enough fluids)
- Steroid-induced hyperglycemia
- Certain infections
There are a number of ways to care for dry skin. These include:
- Applying moisturizer after bathing (see below)
- Drinking plenty of water and other fluids
- Protecting skin from the cold and wind
- Avoiding dry heat
- Keeping fingernails trimmed
Young adults may also want to consider:
- Using an electric razor rather than a blade to avoid cuts or irritation
- Using deodorants as directed by your provider
Moisturizing dry skin
Taking care of dry skin is important for children being treated for cancer. Children with dry skin should apply moisturizer twice daily, including once after bathing. As a general rule, simple formulas are best. Avoid scented lotions because they can contain alcohol, which can irritate the skin and make them less effective at moisturizing. Look for “scent-free” lotions, as lotions marketed as “unscented” may actually have a scent.
Ointments and creams are more effective than lotions for retaining moisture. Examples of moisturizing products for dry skin include:
- Ointments such as A+D® and Aquaphor®. These are petroleum-based and are the strongest treatments for dry skin.
- Creams such as Eucerin®. These are thicker than lotions and are effective at moisturizing the skin.
- Lotions such as Keri®, Lubriderm®, and Aveeno®. Lotions have water added to them and are the mildest moisturizers. They are best suited for mildly dry skin.
If skin is still dry and cracked after using a lotion multiple times a day, then try a cream. If a cream does not provide enough moisture, then try an ointment.
The best time to apply moisturizer is immediately after a bath or shower. Blot the skin dry before applying the moisturizer. This helps moisture stay in the skin. In addition, wear clothes that cover more skin, such as long-sleeved shirts. This will help keep skin from losing moisture into the air.
Talk to your medical team about skin care. This is especially important during radiation treatment, as there are restrictions as to what can be applied to the skin during this time. Also, be sure to check with your provider before using any home remedies or custom supplements, as they could interfere with treatment and/or increase the chance of irritation or infection.
Skin care and steroid medications
Steroid medications may be prescribed during cancer treatment to reduce inflammation, treat nausea or hypersensitivity reactions to chemotherapy or radiation, or sometimes as part of the cancer treatment itself. Although steroids are an essential part of cancer treatment for many patients, they can lead to thinning of the skin. This causes skin to be more delicate than usual and can increase risk for infection and impaired wound healing.
Steroids can cause weight gain that results in “stretch marks,” indented streaks in the skin caused by rapid growth or weight gain and the weakening of the skin. Stretch marks are often permanent and can also increase the chance for infection.
While on steroids, patients should take extra care of their skin. Keep skin clean and dry, and apply moisturizer as directed by the medical team. Many side effects from steroids go away once treatment has ended. Patients should talk to their providers about any long-term effects to the skin that steroids may cause.
Bathing and skin care
Bath and shower time is an important time to care for skin. While more than one bath per day can dry out the skin, patients with dry or flaky skin should:
- Take regularly scheduled baths or showers
- Use lukewarm water
- Use a mild pH neutral soap (such as Dove®)
- Avoid heavy scrubbing
- Pat skin dry
