SUPPLEMENT INDIVIDUAL ARTICLE: Skincare for Cancer Patients in Scandinavia

December 2021 | Volume 20 | Issue 12 | Supplement Individual Articles | ss4 | Copyright © December 2021

Published online November 30, 2021

Ada Girnita MD PhD,a Henrik F. Lorentzen MD,b Sampsa Kauppi MD,c Charles W. Lynde MD FRCPC,d Maxwell B. Sauder MD FRCPC DABD,e Henrik Schmidt MD,f Anneke Andriessen PhD,g Andreas Stensvold MD PhDh

aSkin Cancer Center Karolinska University Hospital Stockholm, Sweden
bDepartment of Dermatology and Venerology Aarhus University Hospital, Denmark
cPrivate practice, Terveystalo and Epilaser Oy, Finland
dDepartment of Medicine University of Toronto, Toronto, ON, Canada; Lynderm Research, Markham, ON, Canada
ePrincess Margaret Cancer Centre; Pigmented Lesion Clinic, Toronto Dermatology Centre, Toronto, ON, Canada
fDepartment of Oncology, Aarhus University Hospital, Denmark
gRadboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands
hOncology Department Oestfold Hospital, Norway

patient, addressing the treatment protocol, potential cAEs, hospital visits, diagnostic tests, and management of cAEs, and preventative measures (Box 1: Information and Patient Education).10,12 The verbal information should be supported by printed or digital material to allow the patient to clarify and process the information (Box 2: Resources).10,12

Patients may underreport their cAEs as they may not recognize it as potentially serious or assume the condition is not treatment-related.10,12 When determining the severity of the cAEs, check for fever, pain, mucosal involvement and significant blood abnormalities.10,12 A glossary containing photographs and a checklist for identifying the cAEs risk may support non-dermatologists to undertake prompt and effective action (Figure 1).10,12

A dermatologist is to be involved in the early stages together with a plan for skin checkups at the beginning of the treatment and relevant time points during treatment. For instance, if cAEs occur in the first 2 weeks while the patient receives treatment with BRAF inhibitors, a dermatological appointment at that time should be scheduled.

Statement 3: Effective skincare for cutaneous toxicities should be based on evidence; it should be safe, effective, nonsensitizing, and have a pH close to that of the skin surface.

Preventive measures for cAEs, including a skincare regimen, should be used throughout cancer treatment and continued after that.10,12 A skincare regimen comprises gentle cleansers, moisturizers that help restore skin barrier integrity and function, photoprotection using sun avoidance measures, and sunscreen.10,12

Products that contain allergens and irritants such as common preservatives causing allergy, fragrances, and perfumes are unsuitable for oncology patients.12 Soaps, surfactants, and detergents, especially those with an alkaline pH (>7), remove skin lipids and elevate skin surface pH, triggering inflammation and lowering the diversity of the skin microbiome and should also be avoided.10,12

Moisturizers form a barrier that helps prevent transepidermal water loss (TEWL).10,12,34,36,37 Additionally, hydrophilic humectants, such as glycerol, propylene glycol, butylene glycol, alpha hydroxyl acids (AHAs) including lactic, glycolic, and tartaric, may help to retain moisture in the skin.10,12 AHAs should be used with caution as they can change the skin surface pH and be irritants.10,12 Other ingredients such as dexpanthenol support stratum corneum hydration, reduce TEWL, and maintain skin softness and elasticity (Table 3).33,34,36-39

The growing body of evidence on a skincare regimen for the prevention and treatment of cAEs shows benefits for cancer patients undergoing anticancer treatment and cancer survivors; however, the evidence on specific ingredients is scarce.5,6,10,12,16,19,33,34,36-39

A multicenter, prospective study of 253 women with breast cancer evaluated the tolerability and benefit of skincare for preventing cAEs.37 The regimen included thermal watercontaining products, a cleanser, emollient, healing cream, and sunscreen. It was used during the 6-weeks of radiation treatment and demonstrated fewer cAEs for those that used skincare every day compared to patients that applied less skincare.37