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Dry, sore and itchy skin

Skin irritations and problems such as dry, sore and itchy skin can be a symptom of lymphoma. Skin problems often start to go away once treatment for lymphoma starts. However, they can be a side effect of treatment and can develop during, or even after, treatment. They can also be worse if you already have a pre-existing skin problem such as eczema or psoriasis. This information gives tips to help you manage dry, sore and itchy skin.

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Itching as a symptom of lymphoma

Skin problems as a side effect of treatment for lymphoma 

Managing dry, sore and itchy skin


AnchorItching as a symptom of lymphoma

Itching (pruritus) can be a symptom of some types of lymphoma:

Itching can happen for lots of reasons and having itchy skin does not necessarily mean you have lymphoma.

Scientists think that itching as a symptom of lymphoma might develop because of cytokines. These are proteins released by your immune system when your body is fighting an infection or an illness, like lymphoma. It’s thought that cytokines cause itching by irritating the nerves in your skin.

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AnchorSkin problems as a side effect of treatment for lymphoma

Some treatments for lymphoma cause skin irritations such as itching (pruritus), rash, redness and soreness. This can happen with chemotherapy, radiotherapy, some targeted treatments and donor (allogeneic) stem cell transplants

Your skin might also be more sensitive to sunlight (photosensitive) after treatment for lymphoma. Photosensitivity usually stops within a couple of months of finishing treatment, but it can go on for longer. It’s therefore important to protect your skin from sunlight.

 
Skin problems can go on for several months and in some instances longer. It is important to tell your lymphoma team as soon as you experience any skin issues so they can be addressed before they become more problematic.
Amanda Lane, Haematology Advanced Nurse Practitioner.

AnchorSide effects of chemotherapy

Your medical team should talk to you about any side effects of treatment you might experience. Skin irritation (dryness, itching, soreness and redness) is more common with some chemotherapy drugs than others. For example, it can be more common with bleomycin, cyclophosphamide, dacarbazine, doxorubicin, methotrexate and vinblastine.

Photosensitivity is an uncommon side effect of chemotherapy, although it can be more likely with certain drugs. This includes dacarbazine, fluorouracil, methotrexate and vinblastine.

Allergic skin reactions to chemotherapy are also possible. The most common allergic skin reactions are small (up to 1cm), red, raised rashes (known as papular rash). Papular rash most often develops around 10 days after you have chemotherapy, but it can develop up to 2 to 3 weeks later. If you notice a rash, tell a member of your medical team as soon as possible. Although not all rashes need treatment, it is important to seek medical attention, in case you do need treatment.

 
Talk to your medical team about any new symptoms you experience as soon as possible. This can potentially help to identify the cause of the problems and how best to manage them.
Amanda Lane, Haematology Advanced Nurse Practitioner

Although it is uncommon, chemotherapy drugs can also trigger a side effect of radiotherapy called ‘radiation recall’.

Macmillan Cancer Support have an online search tool where you can find information about particular drugs, including their side effects.

AnchorSide effects of radiotherapy

You might experience skin changes in the area or areas of your body where you have had radiotherapy. For example, 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, in the groin or armpits. While your skin is affected, avoid using any products in these areas (including anti-perspirants) that haven’t been prescribed to you.

Many factors affect how likely you are to have skin problems as a side effect of radiotherapy. These are known as ‘risk factors’ and include:

  • age – people over the age of about 60 are more at risk of developing skin problems (due to the skin being thinner and taking longer to recover from damage)
  • skin colour – people with fairer skin are at greater risk of developing skin problems
  • the dose of radiotherapy you receive
  • the size of the area of your body treated with radiotherapy
  • having also had treatment with chemotherapy
  • having had a lot of steroids, for example for other conditions such as arthritis or eczema.

Following a healthy lifestyle can also help your overall health and wellbeing. This includes eating a balanced diet and not drinking a lot of alcohol.

Skin reactions are usually at their worst a few days after finishing radiotherapy treatment. Your skin then starts to heal. Speak to a member of your radiotherapy team if you have cracked or broken skin in the treated area. They can sometimes offer a gel to apply that can help to soothe your skin and to help to prevent infection.

AnchorRadiation recall

Radiation recall is a rare side effect of radiotherapy. It causes redness and inflamed skin in the areas that receive radiation.

Radiation recall can be triggered by chemotherapy drugs, and develops days, or even months, after having radiotherapy. Some of the drugs linked with radiation recall include doxorubicin, docetaxel, paclitaxel, gemcitabine and capecitabine. It can also happen with some targeted therapies

Usually, radiation recall is mild and goes away on its own within a couple of weeks. However, it is important to protect inflamed skin from the sun.

AnchorSide effects of targeted therapies

Some targeted therapies cause skin problems such as soreness, rash, dryness and itching (pruritis). This can include rituximab, ibrutinib, brentuxmab vedotin and bortezomib.

You might be at higher risk of developing skin problems as a side effect of targeted therapies if you have a history of skin reactions to medication. This could also be the case if have a skin condition such as psoriasis or eczema. Speak to your medical team for advice.

AnchorSide effects of donor (allogeneic) stem cell transplant

A common complication of a donor (allogeneic stem cell transplant) is graft-versus-host disease (GvHD). GvHD can cause symptoms such as skin rashes, changes in skin colour, raised areas of the skin, skin thickening or hardening, and a feeling of ‘tightness’ in the skin. Sunlight can worsen rashes caused by GvHD, so it’s important to protect your skin from the sun.

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AnchorManaging sore, dry and itchy skin

Your medical team is best-placed to give you advice about how to manage any skin problems you experience. We give some general guidance below that you might like to talk to them about. We also have separate information about coping with itching and about alleviating dryness and itching as a symptom of skin lymphoma.

Skin irritation can affect both your physical and emotional wellbeing. For example, you might feel stressed and anxious. Your quality of sleep might be affected. All of this can make it harder to cope with skin symptoms. 

As well as being an essential part of physical health, leading a healthy lifestyle can also benefit your overall sense of wellbeing. This can help to make symptoms of lymphoma and side effects of treatment feel more manageable. 

AnchorTips to help with dry or itchy skin

Temperature

Avoid the following, as they can dry your skin and worsen skin irritations:

  • High temperatures, including bath and shower water, indoor and outdoor temperatures.
  • Very cold temperatures and wind.
  • Sudden changes in temperature.

Bathing or showering

Talk to your doctor about suitable skincare products, including soaps, deodorants and moisturisers. The following tips might help to prevent further drying out your skin and causing or worsening irritation:

  • Avoid spending a long time in water, and keep the temperature warm instead of hot.
  • Avoid using fragranced products and those that contain alcohol (such as wet wipes and antibacterial hand gel – if you can, wash your hands)
  • Use a coconut or oat-based product in the bath, to help moisturise your skin.
  • Pat your skin dry with a towel instead of rubbing it.
  • Moisturise as soon as you get out of the bath or shower, while your skin is still damp, with a water-based emollient cream. 
  • Let your hair dry naturally rather than rubbing it with a towel, using a hair dryer or any other heat-styling devices, like straighteners.
 
You can use emollient cream as a soap, but take care when using them in the bath and shower as they make the surfaces slippery.
Amanda Lane, Haematology Advanced Nurse Practitioner

Moisturising your skin

To help keep your skin moist:

  • Drink plenty of water.
  • Use a moisturiser frequently throughout the day. Aim for three to four times a day using an anti-itch moisturiser – your doctor might be able to prescribe one. You might have to try a few creams before finding one that works well for you. If one cream doesn’t help, ask your doctor if you can try something else.
  • Consider using a humidifier to hydrate your skin.

Lifestyle

To minimise skin irritation, you could try the following tips. It can help to keep your fingernails quite short to stop yourself from scratching itchy skin.

  • Wear loose-fitting clothes that are made of soft fabrics – for example, cotton and bamboo are generally less itchy than wool and denim. 
  • If you wear make-up, speak to your doctor about suitable products: those labelled ‘hypoallergenic’ (designed to cause fewer irritations) might be suitable if your skin is not broken.
  • Eat a healthy diet and drink plenty of water to help keep your skin healthy. 
  • Make time to relax – stress and anxiety can make itching worse and make it harder to cope with.
  • Use an electric razor rather than wet shaving, or avoid shaving altogether. Avoid hair removal methods such as waxing, threading and hair removal (‘depilatory’) creams.
  • Avoid hair dyes and perming/straightening solutions while you are having treatment for lymphoma. Once your medical team advise that it’s safe for you to use these, make sure you do a patch test in case your skin has become sensitive to products or chemicals.
  • Avoid chlorinated swimming pools.

AnchorTo help with sensitivity to sunlight (photosensitivity)

If your skin is sensitive to sunlight, it’s important to protect it from the sunlight, in order to minimise irritation and further damage.

  • Protect your scalp by wearing a hat or high factor (50) sun cream when you are out in the sun.
  • Use a high factor (50) sun cream and reapply it frequently, including after swimming.
  • Avoid the sun when it is at its strongest (11am to 3pm during summer months in the UK).
  •  Avoid using sunbeds.
  • Use a cool (not freezing) compress to soothe painful skin.
  • If your photosensitivity is severe, ask your doctor if a steroid treatment is suitable for you and whether they can prescribe you one.

Cancer Research UK has more information about sun safety.

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