When to Get Professional Help

Call the doctor or nurse if:

• Skin gets very rough, red, or painful. This may be a reaction (possibly allergic) to a new chemotherapy drug. A doctor may be able to substitute another drug.
  
• A cut becomes red, sore or swollen, or doesn't heal. Act early to prevent skin infection.
  
• A rash or hives start; this may signal a reaction to food, liquid, or a new drug.
  
• Severe itching lasts more than three days. This may be a reaction to a drug, or the body may be processing materials by pushing excess substances through the pores of the skin.
  
• Skin is scratched open and looks red. Red and open skin can become infected.
  
• Pus comes out of an opening or cut, usually indicating a skin infection.
  
• Skin turns yellow. This means that a major organ, such as the liver, is not working well.
  
• Urine becomes the color of tea. This is another signal that a major organ is not working well or that bleeding is occurring higher up in the urinary system.
  
• Bowel movements are clay-colored (more white than orange).
  
• A bruise does not improve in a week. Slow bleeding may be occurring.

When you call, you will need to be ready to answer questions that the doctor or nurse may ask:

1. When did the problem start? What do you think brought it on?
   
2. How bad or embarrassing is it? What helps it feel or look better?
   
3. What is the person's temperature?
   
4. What causes a bruise or a rash, and what makes either one go away?
   
5. Are any cuts not healing? If there is itching, where is it and what relieves it?
   
6. When was the last chemotherapy treatment? What other medicines are being taken?

What You Can Do To Help

If the skin problem is not an emergency, below are some things to help you deal with the problem.

1. Relieve itching
2. Prevent dryness and itching
3. Conceal dark skin, veins, or discolored fingernails
4. Treat acne
5. Limit sweating
6. Decrease sun sensitivity
7. Take care of skin during and after radiation therapy
8. Take care of the diaper area

Relieve itching

• Suggest bathing with cool water and using gentle soap. Try an oatmeal or oil soap. Alpha Keri; may be added to bath water; it eliminates the need for soap while it softens skin.
  
• Add baking soda to bath water. It soothes sensitive skin and reduces itching.
  
• Remind the person to rinse skin thoroughly and pat dry.
  
• Apply cool, moist compresses to itchy areas.
  
• Suggest keeping nails short and clean. They are less likely to scratch open the skin.
  
• Encourage the person to wear clean white gloves if he or she is scratching.
  
• Change bed sheets daily. This removes flaked dry skin and bacteria, which cause itchiness.
  
• Wash sheets and towels in gentle laundry soap, such as Dreft; or Ivory Snow.
  
• Avoid harsh laundry detergents, such as those that contain chemicals to attack oil and dirt.
  
• Keep room cool at 65-75 degrees F. When the body sweats more, itchiness increases.
  
• Encourage rest. Too much activity makes the skin sweaty and prone to itch and irritation.
  
• Avoid extreme cold or heat.
  
• Suggest covering up in the sun. Use a lotion with at least a SPF #15 sunblock.

Prevent dryness and itching

• Add mineral oil or baby oil to bath waterr. Oil will soak in and prevent skin dryness.
  
• Take sponge baths, which are cooler.
  
• Avoid full baths or showers, which expose skin to heat for a longer time.
  
• Use warm water, not hot water.
  
• Do not scrub skin. Scrubbing pulls on delicate tissues and removes important moisture.
  
• Pat skin dry. This is more gentle than rubbing and helps lock in needed moisture.
  
• Apply a mild water-based moisturizing cream to skin just after a bath.
  
• Limit bathing to once a day.
  
• Encourage drinking two quarts of fluids every day unless instructed otherwise.
  
• Avoid extreme heat, cold, or wind, which chafe the skin.
  
• Avoid colognes, after-shaves, or lotions that contain alcohol, which dries out skin.
  
• Remind the person to use an electric razor rather than a straight or blade razor.
  
• Avoid opening or popping blisters.
  
• Put dry clean gauze on any open areas.

Conceal dark skin, veins, or discolored fingernails

• Wear long sleeves to hide dark veins and provide some protection against bruising.
  
• Women may want to wear nail polish or a thin layer of make-up foundation.
  
• Keep nails clean, short, and filed smoothly.

Treat acne

• Keep skin clean with mild soap and warm water. Harsh soaps inflame blemishes.
  
• Pat skin dry. Gentle drying allows new skin to heal.
  
• Avoid astringents. Although they dry out blemishes, they dry the whole face and remove too much moisture. Keeping skin clean is the best treatment for acne caused by chemotherapy.

Limit sweating

• Dress in two light layers of clothing. Wear cotton closest to the skin. The outer layer should be light, to allow air to pass through.
  
• Change wet clothing as soon as possible. It can lead to chills and discomfort.
  
• Use a thin layer of corn starch (which absorbs sweat) in skin folds. However, when the white cells are low (often after chemotherapy), do not use corn starch because it can cause a skin fungus or yeast infection to develop.

Decrease sun sensitivity

• Cover legs and arms by wearing long sleeves and pants. Chemotherapy makes the skin tissue extra sensitive to the sun's rays, and sunburn occurs rapidly.
  
• Wear lightweight fabrics. They allow more air to pass through to the skin and keep it dry.
  
• Wear a wide-brim hat and sunglasses.
  
• Use a suntan lotion with a sunblock SPF rating of 15 or higher.
  
• Apply sunscreen to any newly exposed scalp.
  
• Stay in the sun for only a short time.
  
• Stay out of the sun from 11:00 a.m. to 3:00 p.m., when it is hottest and most dangerous.
  
• Cover all skin appropriately when outdoors. Reapply sunblock at least every hour if hot and sweaty. Sunburn can occur in as short a time as 15 minutes of direct sunlight. Remember that ultraviolet rays penetrate clouds, so use these tips on overcast days as well.

Take care of skin during and after radiation therapy

• Wash with lukewarm water and mild soap. Avoid scrubbing.
  
• Keep the treatment area clean and dry. Take a daily sponge bath or lukewarm shower.
  
• Avoid using scented or medicated lotions, rubbing alcohol, creams, body oils, talcs, perfumes, or antiperspirants. All of these skin will irritate the skin.
  
• Avoid using corn starch to control perspiration, or in areas that are moist or wet. If you have difficulty keeping an area of skin dry, consult the medical staff.
  
• Avoid ice packs. Ice irritates skin and may constrict blood vessels, inhibiting healing.
  
• Avoid hot water bottles and heating pads. Heat irritates skin and can further dry it out.
  
• Avoid direct sunlight to treated skin for at least one year after radiation treatment.
  
• Wear loose clothing
  
• Avoid scratching treated skin. It can lead to infection, irritation, or soreness.

Take care of the diaper area

• Change diapers often - every two to three hours during the day.
  
• Change diapers first thing in the morning.

Possible Obstacles

"It's only the skin and not the body."

Response: Skin problems need to be treated early to prevent infection and to decrease discomfort. If you notice changes, talk them over with the nurse or doctor. Don't wait until an infection or severe discomfort occurs.

"No one seems to know what to do about itching. I guess we'll just have to live with it."

Response: Itching is a very difficult problem to heal. Try a combination of strategies to relieve constant itching. Keep experimenting, and visit a dermatologist if necessary.

"I'm so afraid I'll get fried by radiation therapy."

Response: Radiation therapy does cause skin changes, but the intent is not to `fry' the skin. Although it does get red and sensitive, skin will heal. Be sure to call for help, especially if skin gets moist or wet and becomes sore. Clinic staff will keep a close eye on the skin, and the radiation therapist can stop the treatment and give the skin a rest.

Carrying Out and Adjusting Your Plan

Have you called for professional help when it was needed? Have you been able to relieve itching, prevent dryness, conceal dark skin, veins or nails? Have you treated acne when it occurred, limited heavy sweating, and decreased sun sensitivity?

If your plan doesn't work

If your plan does not seem to be working, or the skin problem seems to be getting worse, review "When To Get Professional Help." If you answer yes to any of those questions, call the doctor or nurse immediately and ask for help. Describe what you've done and what the results have been.  If the skin problem is not an emergency, select those symptoms that are of most concern, and develop a new approach using this homecare plan.

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