Skin problems can be:
Symptoms of the lymphoma itself
Pruritus (itching) is a common symptom of some types of lymphoma, especially Hodgkin lymphoma and a type of skin lymphoma called T-cell lymphoma. Up to a third of people with Hodgkin lymphoma have itching as a symptom. It is less common in most types of non-Hodgkin lymphoma.
With skin lymphoma, such as mycosis fungoides, itching is felt in patches where the skin is affected by the lymphoma. These patches can be dry, scaly and itchy.
It is not fully understood what causes itching as a symptom of lymphoma. However, research suggests it could be due to chemicals called cytokines. These are released by the immune system as it reacts against the lymphoma cells. It is thought that cytokines irritate the nerves in the skin and make it itch.
For many people, the itching starts to go away once you start treatment. However, it can persist during or even after treatment.
Side effects of treatments for lymphoma
Some treatments for lymphoma can cause skin problems, including pruritus (itching), rash, soreness and photosensitivity (sensitivity to sunlight).
Side effects of chemotherapy
Some chemotherapy drugs can make your skin photosensitive, which makes you prone to sunburn. The drugs that are more likely to cause this are dacarbazine, methotrexate, vinblastine, bleomycin, cyclophosphamide and doxorubicin. Other non-chemotherapy drugs (eg antibiotics) may also cause skin photosensitivity. Your consultant should give you information about the possible side effects of your medication. You can also find information about the side effects of chemotherapy regimens (combinations) on the Macmillan Cancer Support website. If you have questions, ask a member of your medical team.
Photosensitivity usually stops a couple of months after you finish treatment; however, you may have longer-lasting sensitivity to sunlight.
Allergic skin reactions to chemotherapy are also possible. The most common of these is ‘papular rash’ (small, red rashes). Papular rash most often happens around 10 days after you have chemotherapy. It can, however, occur up to around 2–3 weeks later. If you notice a rash, tell a member of your medical team. Although not all rashes require treatment, it is important that the rash is assessed by a health professional in case it does.
Side effects of radiotherapy
If you have radiotherapy, the skin in the treated area can become pink, dry and itchy. Dark skin might become darker. Rarely, the skin can become blistered, a bit like sunburn. This is more likely in folds of skin, such as under the breasts or in the groin. Skin reactions are usually at their worst a few days after the end of radiotherapy treatment. Your skin then starts to heal. Speak to a member of your radiotherapy team if you have broken skin in the treated area. They can often give gel to help soothe the area.
A rare side effect is 'radiation recall', where you skin becomes red and inflamed. This can happen when certain chemotherapy drugs are given days or even months after radiotherapy. It may also happen with some biological (targeted) therapies. Radiation recall occurs in the area previously treated by radiotherapy. The reaction is triggered when you have the anti-cancer drugs. Usually, it is mild and goes away on its own within a couple of weeks. It is important to protect any inflamed skin from the sun. Seek medical advice if it is more severe or longer-lasting as you may need treatment for it.
Many factors can affect how likely you are to have skin problems and what skin problems you might develop. These include:
- skin colour
- the dose of radiotherapy you receive
- the size of the area treated with radiotherapy
- lifestyle factors (eg diet and alcohol intake).
- Your medical team can advise you on whether any of these factors are likely to have an effect on your skin.
If you have both radiotherapy and chemotherapy, your risk of a skin reaction is higher.
Side effects of stem cell transplant
Some people with lymphoma have an intensive type of treatment called a stem cell transplant. This is usually used for people who have lymphoma that has relapsed (come back) or that is at a high risk of relapsing. Most stem cell transplants for people with lymphoma are autologous stem cell transplants, which use your own stem cells. However, a few people have allogeneic stem cell transplants, which use stem cells from a donor.
A common complication of allogenic stem cell transplant is graft-versus-host disease (GvHD). GvHD happens because your new immune system (the graft) recognises your other body cells (the host) as ‘foreign’ and attacks them. GvHD can cause rashes and tightening of the skin. Sunlight can worsen rashes caused by GvHD. For this reason, your doctor might advise that you limit the time you spend in the sun.
Side effects of biological ('targeted') therapies
Some biological (‘targeted’) therapies cause itching and rashes. For example:
- Rituximab (Mabthera®) causes itching and rash in more than 1 in 10 people.
- Ibrutinib (Imbruvica®) causes rash in around 1 in 5 people.
- Brentuximab vedotin (Adcetris®) causes skin problems such as dryness and itching in around 1 in 10.
- Bortezomib (Bortezomib Accord or Velcade®) causes skin problems such as soreness, dryness or itching in around 1 in 10 people.
Ask your medical team for advice with skin problems. We give some general guidance below. We also have more information on our website on coping with itching and separate information on alleviating dryness and itching as a symptom of skin lymphoma.
To help with dryness
- Take short, lukewarm baths or showers instead of long, hot ones. Long baths or showers dry the skin and hot water can make itching worse.
- Let your hair dry naturally. Avoid hair dyes and perming solutions while you are having treatment. Make sure you do a patch test after chemotherapy in case you have developed sensitivity to products or chemicals.
- Talk to your doctor about suitable skincare products, including soaps, deodorants and moisturisers. You might have become sensitive to some products after reatment.
- Moisturise as soon as you get out of the bath or shower with water-based creams or lotions (eg E45, which is available from chemists and supermarkets). Apply the cream while your skin is still slightly damp. The cream will lock moisture in.
- Moisturise frequently throughout the day. Aim for 3–4 times a day using an anti-itch moisturiser (eg Balneum plus cream), which your doctor can prescribe. You might have to try a few creams before finding the one that suits you best. If one cream doesn’t help, ask for something else.
- Avoid using alcohol-based products such as wet wipes and antibacterial hand gel as these products can dry and irritate the skin.
To help with itching and skin irritation
Scratching 'rewards' the itch, which worsens it. Although it can be really difficult not to scratch, try not to. Some people find it helps to instead pinch skin near to the itch, or to place something cool on the itch. Some doctors prescribe a type of medicine called an 'antihistamine'. These are worth trying, although not everyone finds them effective. Generally, if they don't work within the first 2 weeks, they are unlikely to work for you. Ask your doctor if there is another medicine you could try instead.
- Use 100% cotton sheets and pillowcases rather than bedlinen made from man-made fibres. If you are staying overnight and your skin is sensitive, you could ask the hospital if it is OK to take your own bedding.
- Use mild washing powder suitable for sensitive skin. Give your washing an extra rinse to remove any remaining traces of powder.
- Wear loose-fitting (perhaps a size larger than usual) and lightweight clothes made from soft cotton, silk or bamboo. Wool and some man-made fabrics can irritate your skin.
- Avoid clothes and nightwear with many seams, exposed elastic, lace, buttons or embroidery that might irritate your skin.
- Use an electric razor rather than wet shaving, or avoid shaving altogether.
- Keep your nails short and have something to fiddle with to distract you if you feel itchy.
- When bathing or showering, avoid rubbing your skin with a towel – pat it dry instead.
- Avoid swimming pools because chlorine can irritate your skin.
- Avoid extreme temperatures (hot and cold) and strong winds, which can dry your skin.
To help with photosensitivity (sensitivity to sunlight)
- Protect your scalp by wearing a hat or high factor sun cream when you are out in the sun.
- Avoid the sun when it is at its strongest (11am–3pm in summer months).
- Use a cool (not freezing) compress to relieve painful skin.
- If your photosensitivity is severe, your doctor might prescribe a steroid treatment.
Make time to relax – stress and anxiety can make it harder to cope with itching. You may find relaxation and meditation techniques helpful. Eating a healthy diet and drinking plenty of water can help to keep your skin hydrated and healthy.
Note: Remember that you are more prone to infection if you have neutropenia (low neutrophils, a common side effect of chemotherapy). Protect your skin: wear gloves when gardening and take care to avoid nicks and cuts with knives in the kitchen, for example. Let your doctor know straightaway if you have any signs of infection, include soreness, redness or swelling around wounds. You may need antibiotics if you develop an infection.