Chemotherapy Rash: What to Expect and How to Cope

Chemotherapy can cause skin changes, including rashes, dryness, itching, cracking, and photosensitivity (sun sensitivity). These effects happen because chemotherapy impacts fast‑dividing skin cells and can also irritate areas where drugs are infused. ^{[1] [2]} Skin changes may appear generally or locally along the infusion vein or at the injection site. ^[3] These rashes vary by drug; traditional cytotoxic agents and targeted therapies (like EGFR inhibitors) present different patterns. ^{[4] [5]}

Why chemo affects the skin

• The skin constantly renews itself, making it susceptible to chemo damage, which can lead to rashes and infections. ^[1]
• Changes can be widespread or localized along the vein used for chemotherapy. ^[3]
• Besides rashes, you might notice hyperpigmentation, peeling, nail changes, and photosensitivity. ^{[6] [2]}

Common rash patterns

• General rash and itchiness: Often with cytotoxic chemotherapies; may include redness, xerosis (dry skin), peeling, and sensitivity to sunlight. ^{[6] [2]}
• Acne‑like (acneiform) rash: More typical with EGFR inhibitors; can be managed with specific regimens and sometimes prophylactic antibiotics such as minocycline are used. ^[5]
• Nail and cuticle issues (paronychia, cracking, pigment bands): More common with targeted agents like EGFR and MEK inhibitors, but some nail changes occur with taxanes. ^{[7] [8] [4]}

Practical care tips

• Gentle cleansing: Use mild, fragrance‑free soap; avoid harsh scrubbing. ^[9]
• Moisturize daily: Apply fragrance‑free creams or ointments (e.g., Eucerin, CeraVe, Aquaphor) after bathing while skin is still moist; avoid lotions with alcohol. ^{[10] [9]}
• Sun protection: Limit direct sun; wear wide‑brimmed hats, long sleeves, light‑colored clothing, and use SPF 30+ (preferably 50+) sunscreen daily. ^{[10] [11]}
• Comfortable clothing and footwear: Choose soft fabrics and well‑fitting shoes to avoid blisters and friction. ^[12]
• Bathing habits: Consider shorter, lukewarm showers every 2–3 days; avoid saunas, steam rooms, and long hot baths that dry out skin. ^{[12] [9]}
• Hands and feet care: Keep them well‑moisturized; protect from trauma to reduce risk of cracking and infection. ^[10]
• Do not scratch: Scratching worsens irritation and infection risk; use soothing products and talk to your care team for targeted treatments. ^[11]

When to contact your care team

Seek advice from your oncology team if your rash is painful, spreading, oozing, blistering, or not improving with self‑care, or if you develop fever or peeling skin. ^[13] Severe rashes or nail infections can sometimes require dose adjustments or treatment changes, so timely reporting helps prevent complications. ^[8] Persistent or worsening skin problems should be evaluated to rule out infection and tailor therapy. ^[14]

Targeted management options

• For itchy dermatitis: Mild soap, thorough drying, and soothing lotions; your team may suggest topical steroids or antihistamines if needed. ^[9]
• For acneiform rash (EGFR inhibitors): Protocols often include topical clindamycin, topical steroids, and oral minocycline, with some centers using prophylactic minocycline to reduce severity. ^[5]
• For photosensitivity: Rigorous sun avoidance and high‑SPF sunscreen with protective clothing are key. ^[2]
• For nail issues/paronychia: Gentle nail care, avoiding trauma, and early treatment of inflammation help prevent dose interruptions. ^{[7] [8]}

Key takeaways

• Yes, chemotherapy can cause skin rashes and other skin changes, due to effects on fast‑renewing skin cells. ^[1]
• Simple, consistent skin care gentle cleansing, rich moisturizers, sun protection, and avoiding irritants can reduce symptoms. ^{[9] [10] [2]}
• Report concerning signs early to your oncology team, as some rashes signal infection or may require treatment adjustments. ^{[13] [8] [14]}