Skin side effects are changes to the skin caused by a disease or treatment. These changes can range from mild to severe. Skin side effects are common in children with cancer, sickle cell disease, immune disorders, and other serious illnesses.
Skin problems can be uncomfortable and may increase the risk of infection. Finding and treating skin problems early can help keep them from getting worse.
Your care team can explain which skin side effects may happen with your child's treatment and how to help prevent or manage them.
Follow your care team’s instructions and check for skin changes regularly. Tell your care team about any concerns right away.
Types of skin side effects
Common skin problems caused by a disease or treatment include:
Skin side effects of radiation therapy (radiation dermatitis)
Skin problems during radiation therapy are common. Many children have skin changes in the treated area.
Possible skin changes include:
Pain, soreness, or tenderness
Redness, discoloration, tanning, or darkening of the skin
Dry, itchy, or peeling skin
Hair loss in the treated area
Skin breakdown leading to moist patches and open wounds
Skin side effects usually appear during the first few weeks of treatment. They often improve after treatment ends.
But skin may stay sensitive to the sun during and after treatment. Some children may also develop a skin reaction called radiation recall after getting chemotherapy.
Radiation recall is a skin reaction. It happens when certain chemotherapy medicines are given after radiation treatment. The skin in the radiation treatment area becomes red and inflamed. It may look like a severe sunburn. The symptoms usually improve after the medicine is stopped.
Skin side effects of chemotherapy
Chemotherapy can affect healthy skin cells. Your care team can tell you what skin changes to expect based on the type of chemo your child receives.
Common skin side effects of chemotherapy include:
Rash
Redness
Itchy, dry skin
Hair loss
Sensitivity to the sun
Certain chemotherapy medicines can make the skin, nails, or hair become darker or change color.
Some medicines can irritate the skin around the IV or injection site. If medicine leaks outside the vein, it can damage nearby skin and tissue. Tell your care team right away if your child has pain, burning, stinging, swelling, or redness near the IV or injection site.
Skin side effects of steroid medicines
Steroid medicines are used to help treat many conditions. These medicines can cause skin side effects such as:
Thin skin
Easy bruising
Acne
Stretch marks
Slow wound healing
Higher risk of skin infections
Skin side effects depend on:
The dose
How long the medicine is used
How it is given (by mouth, on the skin, or by injection)
Skin side effects of targeted therapy
Targeted therapies can affect healthy skin cells. Many skin side effects of targeted therapy are mild. They depend on the type and dose of the drug.
Possible side effects include:
A rash or red small bumps
Itching
Dry skin
Sensitivity to the sun
Changes in skin color
Ingrown nails
Hand-foot syndrome
Hand-foot syndrome
Hand-foot syndrome, also called palmar-plantar erythrodysesthesia, is a skin reaction that can happen with some chemotherapy and targeted therapy medicines. It usually affects the palms of the hands and soles of the feet. Severe symptoms can make it painful to walk or hold objects.
Signs and symptoms of hand-foot syndrome may include:
Blisters, calluses, or peeling skin
Pain, numbness, tingling, or burning
Redness or swelling
Increased sensitivity to heat
Medicines that may cause hand-foot syndrome include:
If hand-foot syndrome is severe, your care team may change or pause treatment until symptoms improve.
If your child has hand-foot syndrome, they should:
Treat skin gently
Use warm, not hot, water for bathing and washing
Avoid activities that rub or put pressure on their hands and feet
Wear shoes or slippers instead of going barefoot
Avoid sports and activities that involve running, jumping, or gripping objects
Skin side effects of immunotherapy
Immunotherapy uses the body’s immune system to fight cancer. Sometimes the immune system can also affect healthy cells, causing side effects.
Skin side effects may include:
Rash, bumps, or blisters
Itching
Light patches of skin
Hair loss
Skin side effects of stem cell transplants
Children who have a stem cell transplant (bone marrow transplant) may have skin side effects due to chemotherapy, radiation, or graft-versus-host disease (GVHD). GVHD happens when donor cells attack healthy tissues. It can be acute (short-term) or chronic (long-term).
Symptoms of acute GVHD of the skin include:
Rash
Red, inflamed skin
Bumps or raised areas on the skin
Sores or blisters
Skin peeling
The rash often starts on the neck, ears, shoulders, palms of the hands, or soles of the feet.
Symptoms of chronic GVHD of the skin include:
Rash with itching or burning
Dry, scaly skin
Bumps, sores, or blisters
Hair loss
Fingernail damage or loss
Changes in skin color
Thick, hard, or tight skin that can make it harder to move the joints
GVHD can be severe. It may develop months after transplant. Tell your care team if you think your child has signs of GVHD.
Managing skin side effects
Treatment depends on the type of skin problem your child has and how severe it is.
To manage skin problems:
Keep skin clean and moisturized.
Protect skin from sun, irritation, injury, and infection.
Use skin care products recommended by your care team.
Tell your care team about any new or worsening skin changes.
Your health care provider may prescribe:
Steroid medicine
Antibiotics
Antihistamines
These medicines may be applied to the skin or taken by mouth.
If treatment causes severe skin problems, your care team may lower the dose, pause treatment, or change to a different treatment until symptoms get better. Your child’s care provider may refer them to a dermatologist, a doctor who specializes in treating skin conditions.
Tips for families
Tell your care team about any skin problems during and after treatment.
To help care for your child’s skin:
Take photos of the skin to help keep track of changes.
Treat the skin gently. Do not rub, scrub, or scratch irritated skin. This can make skin problems worse.
Use mild, hypoallergenic, fragrance-free soaps, shampoos, cleansers, and laundry detergents.
Have your child wear soft, loose-fitting clothes.
Make sure clothes, shoes, and medical devices do not rub the skin.
Have your child take warm (not hot) baths and showers.
Encourage your child to drink enough fluids to stay hydrated.
Protect skin from the sun. Use sunscreen of SPF 30 or higher, wear protective clothing, and stay in the shade when possible.
Avoid using makeup or cosmetics on irritated skin.
Do not use over-the-counter anti-acne medicines unless your care team says they are safe. Acne medicines may dry out and make skin problems worse.
When to call your care team
Contact your care team right away if your child has:
New or worsening rash
Signs of infection
Pain, burning, swelling, or redness near an IV or injection site
Symptoms such as sores, blisters, or peeling skin that get worse or do not improve, or that make it hard for your child to do daily activities
Always talk to your care team before using a new skin care product or medicine. Tell your care team about any skin changes or worsening skin problems. Early treatment can help prevent infection and other complications.
Questions to ask your care team
What skin side effects are most likely with my child's treatment?
What can we do to help prevent skin problems?
What skin care products are safe to use?
What skin care products should we avoid?
Are there any activities my child should avoid because of skin side effects?
How can we help relieve dry skin, itching, or a rash?
What signs of infection or other skin problems should we watch for?
When should we call the care team about skin changes?
Could severe skin side effects affect my child's treatment plan?
Key points about skin side effects
Tell your care team about any new or worsening skin problems. Early treatment can help prevent infection and other complications.
Skin side effects are common during treatment for cancer, sickle cell disease, and some immune disorders.
Skin problems may include rash, dry or itchy skin, changes in skin color, blisters, peeling, hair loss, and nail changes.
Different treatments, such as chemotherapy, radiation therapy, targeted therapy, immunotherapy, steroid medicines, and stem cell transplant, can cause different skin side effects.
Good skin care, including keeping the skin clean and moisturized and protecting it from the sun, can help prevent or reduce skin problems.
Use only skin care products recommended by your care team. Avoid products that can irritate the skin.
Follow your care team's instructions for managing skin side effects so your child can stay as comfortable as possible during treatment.
Cancer and other medical conditions can cause skin problems and delayed wound healing. Learn about wound and skin care and how to protect your child’s skin.
