All about skin issues

Colorectal cancer treatments come with unique potential side effects. Changes in your skin and nails are quite common across many treatments — and they can range from mild and annoying to severe and affect treatment plans.

So what potential problems might you experience? And what can you do to feel better?

Read on to learn more about types of potential skin reactions, signs and symptoms you should know, and how to describe your symptoms to your doctor.

We also include a range of suggested solutions from COLONTOWN members: What treatments could help, what to avoid, and practical tips for living life while taking care of your skin. 

The big picture

Select a treatment:

Healthy skin habits

No matter what treatment you’re on, here are some rules of the road to support your skin and nail health: 

  • Start good skin care before treatment begins. This may not prevent all problems, but it gives you a better starting place
  • We know it’s really hard, but don’t scratch. It can lead to more itching and infection later on
  • Avoid hot water — that means try not to take long showers, don’t wash your hands (or dishes) excessively, and stay out of hot tubs
  • Cool compresses or refridgerated skincare products may be soothing. One exception is you are on oxaliplatin and experiencing cold sensitivity
  • Pat, don’t rub your skin dry. Avoid friction from clothing or repetitive motions
  • Clean your skin with soap-free gentle cleansers
  • Moisturize! Choose gentle, no-alcohol, fragrance-free products and aim to use them twice a day. Pay close attention to feet, hands and other sensitive areas
  • Use cotton-lined gloves when cleaning, washing dishes, or gardening
  • Keep nails clean and trimmed. Don’t cut or bite your cuticles
  • Keep an eye out for signs of infection — redness, pain, swelling, pus heat. Let your care team know if you suspect an infection is starting
  • Try to stay out of the sun. If you want to take an afternoon walk, use good sun protection, such as wide-brimmed hats, long sleeved light shirts, and SPF 50+ gentle sunscreen. Test the sunscreen on a small area before slathering your entire body!
  • Drink plenty of water
  • Consider using a humidifier if the air in your home is particularly dry. The ideal humidity range is 40-60%, but you might me more comfortable at the high end of that
  • As always, keep talking with your care team. Let them know about any skin changes you’re experiencing. At the bottom of this page, we have a guide on how to document and describe your skin reactions to your care team


When you’re being treated for cancer, patients commonly report getting rashes. Issues range from mild to severe — but any sort of rash should be monitored. Our skin is important. It’s our barrier between us and the world, and taking care of it can make you feel a lot better while on treatment. Some rashes are more generally connected to chemotherapy, but other treatments can cause very specific rashes, such as EGFR inhibitors and regorafenib (Stivarga). Below we go over all of this and how to solve some of these issues. But let’s start with the basics.

EGFR inhibitors

If you’re taking cetuximab or panitumumab, you may be very familiar with what’s known as the “EGFR rash”

What is the EGFR rash?

The rash patients experience on EGFR inhibitors is quite different than other rashes. It often shows up as an acne-like rash on the face. You may feel like you’re back in middle school! Reactions can show up just about anywhere on the body, including the scalp and genitals.

Rashes can range from mild to severe, or you may not experience them at all. Some patients report that the rash is worse in the first three to six months of treatment, and it can begin as soon as two to four weeks into treatment.

What are the symptoms?

There are a variety of rashes that patients can experience, but two of the main types are called — get ready for some hard-to-pronounce names — follicular rash and acneiform rash. We tell you this because your doctor might use these terms to describe your rash.

Follicular rash

Also called folliculitis. This rash looks like small, red, itchy bumps on areas such as your face, scalp or upper body. Often these bumps will lead to the next form of rash, called acneiform.

Acneiform rash

Also referred to as papulopustular rash. This rash may make you feel like a teenager again! Red bumps and pus-filled pimples can be found most commonly on the face, scalp and upper body, but can sometimes be found in other areas. Depending on the severity, it may cause redness, inflammation, pain and itching — but don’t be tempted to treat this rash with standard acne products! We go into this in more detail below.

Acneiform rash is often called EGFR inhibitor rash because it is very common when taking cetuximab or panitumumab. Studies show that more than 65% of patients — and an even higher percentage of men — on these drugs will experience some form of this rash, starting within the first four weeks of treatment. Some other drugs such as encorafenib can cause it as well.

We don’t completely understand why this acneiform rash starts, but it appears that EGFR inhibitors block a protein that can lead to skin inflammation and ramp up oil production.

What levels of severity are there?

Your oncologist might use a grading scale of 1 to 4 to monitor your rash and skin problems. This helps them see how things are changing over time.

How do I treat or prevent it?

First of all, it’s important to let your care team know if you start seeing any type of skin issue. Telling your doctor early can help them keep track of how the rash progresses, and help minimize unwanted side effects.

Over-the-counter options

Gentle skincare is key to helping with treatment-induced rashes. Avoid skin products that contain alcohol or fragrances.

Just because your rash looks like acne, doesn’t mean it should be treated the same way! You may be tempted to try standard over-the-counter (OTC) acne treatments containing salicylic acid, but they are harsh and you should avoid those. Traditional acne products have drying ingredients including alcohol — which should never be used on an EGFR rash. Instead, you want to choose alcohol-free products that add moisture to your skin. 

Many COLONTOWN members recommend moisturizing products like:

  • Reconval B6
  • Cerave
  • Aveeno
  • Cetaphil
  • Aquaphor
  • Eucerin
  • Udderly Smooth
  • Sween 24
  • Creams with Vitamin K1

With EGFR rashes, some people find rubbing Milk of Magnesia on the areas can help. It’s inexpensive and isn’t harmful, but it can be a little messy. Others have found the occasional use of Afrin nasal spray mixed in gentle lotion can help reduce redness.

Also remember that refridgerating whatever OTC products you use may help with itching and burning feelings.

Searching COLONTOWN groups for terms like “rash,” “redness,” “EGFR rash,” and “skincare” will take you to many detailed discussions on skin remedies. You can even jump into the discussion yourself! Join here.

Prescription options

Your doctor might prescribe you topical (cream or lotion) or oral (pill) steroids and/or antibiotics to treat this rash. These drugs are meant to reduce inflammation, tamp down itching and burning, and help prevent or treat an infection. Most commonly, you may get antibiotic pills like doxycycline or monocycline.

There are a range of options available, so continue to work with your doctor to try out different solutions and find the best option for you. For instance, a steroid cream may help. You may consider bringing up a prescription for a steroid cream called clobetasol propionate with your doctor. This cream is used to treat eczema. It reduces swelling, redness, itching and rashes.

Some patients have been prescribed isotretinoin (Accutane) or triamcinolone acetonide cream. But be careful to NOT use over-the-counter acne products as these may actually make things worse.

Be aware that if you use a steroid cream or oral drug for an extended period of time, don’t stop taking it suddenly. You should slowly reduce your use, or else you may have a rebound of your rash. You can talk to your doctor about the best way to do that. 

Knowing how common these rashes are, many treatment centers like to start you on a prescription before the rash starts to help prevent it from getting too bad. Work with your care team to decide which route is best for your situation. Sometimes more severe skin problems will involve a dermatology referral.

When might side effects go away?

Symptoms often lessen when treatment ends. Sometimes it takes a while for you to get back to where you used to be. Other times skin side effects may be something you deal with in the forseeable future. Your skin has gone through a lot, so be gentle with it and patient with the recovery process. Keep notes on how you’re recovering, and keep your care team up to date. If you have any questions about your recovery, work with them to find a solution that is right for you.

Does EGFR rash mean the treatment is working?

You may have heard online that getting a severe skin reaction while taking an EGFR inhibitor is actually a good thing — as it suggests the treatment is working as intended. While some studies have shown that getting a rash from EGFR inhibitors, no matter if it is severe or mild, might mean you are responding well to treatment, everyone is a bit different. Also, if you were given a prescription before starting treatment to prevent the rash, it will affect whether or not the rash occurs.

The bottom line is, a rash or lack of rash can’t tell us much about whether or not your treatment is working. We recommend following up with your care team if you have questions about your specific situation, and scans will help determine if the EGFR inhibitor is working for you.

Importantly, DON’T stop your EGFR inhibitor if you get a rash, it can actually be a good sign. And if you don’t get a rash, don’t jump to conclusions.

My name is Jeff and I was diagnosed with colon cancer in 2017. I have done multiple surgeries, clinical trials and 86 rounds of chemo. In Dec 2023, we decided that Vectibix was my next best option for chemo treatments.

Before I started, my doctor talked to me about the potential side effects. The main issue that people report is a skin rash on the face and upper torso.

The interesting thing about the rash is that there are studies showing that the worse the rash, the better the chemo is working. For the first two weeks after doing the chemo, it was a strange feeling of dreading a skin rash, but also hoping for it at the same time.

The doctor had told me ahead of time that there were drugs they could give me that would help with the rash, but she preferred to wait and see how bad the rash is before taking the extra meds. I agreed. I was not excited about a skin rash, but I did want to see how bad it got before I added more medicine.

After the first round, I did not notice much for over a week. I had my typical bouts of nausea and fatigue, but that was not surprising since I was also taking irinotecan.

After about a week and a half, I started to see the first signs of the rash. It was mainly pimples on my face. I was a little self-conscious about my appearance. But surprisingly, unless you were in really bright light environments, most people did not notice. I could point out the rash and then people could see it.

But before that most people were not aware. To them, it just looked like normal acne that anyone could deal with.

About two weeks in, I started to get the rash on the top and back of my head. They were blister-like and very painful. I had not considered that aspect of the rash. It was painful to lay down, even with a pillow.

I had a hard time sleeping. Every time I moved, it would hurt on my scalp.

We got some different shampoos to try to help. I used Scalpicin, and it hurt/burned while it was on, but after would feel better. But only temporarily. I used lotion with 5% hydrocortisone on my face. Overall, I did not have much trouble with itching. My main problem was the painful sores on my head.

When I went back to the doctor, she saw the rash and immediately said we should start a doxycycline antibiotic. It is a twice a day pill. After a few days on the antibiotic, I started to feel relief. The rash was still there, but the sores were not nearly as painful. I was very glad that the antibiotics were helping. I was truly nervous about whether I was going to be able to continue on Vectibix because the sores were so painful.

I have also noticed hair falling out. My doctor did not think that was a typical side effect from Vectibix, but I think it could be from the rash. In early January, the hair on my head fell out in clumps. And I do not have much hair on my arms or legs. The hair on my head did grow back and has not fallen out again.

It is now May 2024 and I have been on Vectibix for 6 months. At this point, the side effects do not bother me. I have to be very careful about being in the sun. And now that the weather is warming, I make sure to have sunscreen if I am going to be outside any longer than 10 minutes. I can feel the sensitivity in my skin when I am in direct sunlight.

For 6 months, this chemo regimen seems to be working. My CEA dropped sharply and has held steady.

My cancerous lymph nodes have not enlarged. I can deal with a lot of side effects if I feel like the treatment is working.

Recent research

Additional treatments for EGFR rash are currently being studied:

LUT014 for the Reduction of Dose-Limiting Acneiform Lesions Associated With EGFRI Treatment of mCRC


Important information about encorafenib (Braftovi)

Braftovi has some of the same rash risks as many other CRC drugs. But this drug is unique in raising the risk of new skin cancers (called cutaneous squamous cell carcinoma or basal cell carcinoma). Your doctor should help you monitor for new or changed warts; skin sores or reddish bumps that bleed or do not heal. Monitoring often starts before your first dose, then every two months on treatment and for up to six months post-treatment.

Sometimes encorafenib is given alongside cetuximab. If so, your risk of dermatitis acneiform or “EGFR rash” is increased.

Regorafenib (Stivarga)

Not all patients taking regorafenib get a rash. Patients may find that the regorafenib rash is not as noticable as the notorious EGFR rash, but it has some distinct features and can cause a lot of pain.

What are regorafenib rashes?

Some people describe regorafenib rashes as feeling like a severe sunburn pain. The rash might not look that bad from the outside, but can be pretty uncomfortable. 

What are the symptoms?

Here are some of the ways patients describe this rash:

  • Itchy
  • Sores on lips, in mouth, or nose
  • Pain or tenderness
  • Redness
  • Small blister-like bumps

As with any of these skin reactions, involve your care team from the beginning. They may refer you to a dermatologist if you need more support. Below is an image of what a regorafenib rash may look like (viewer discretion advised!)

How do I treat or prevent it?

Clobetasol can be helpful for hand foot syndrome caused by regorafenib. Ask your doctor about treatment options.

When might side effects go away?

Symptoms often lessen when treatment ends. Sometimes it takes a while for you to get back to where you used to be. Other times skin side effects may be something you deal with in the forseeable future. Your skin has gone through a lot, so be gentle with it and patient with the recovery process. Keep notes on how you’re recovering, and keep your care team up to date. If you have any questions about your recovery, work with them to find a solution that is right for you.

I was on Stivarga for 2.5 years as part of a combination clinical trial. When I started, I was told the biggest side effect of the combo was a rash (an intensified version of the rash some get on Stivarga alone). While it didn’t sound as painful as other rashes I had gotten, others had to stop the trial because of the rash which I really didn’t want to be the case. I woke up every morning those first few weeks anxiously checking for a rash. Turns out, I got no rash at all. Goes to show that everyone’s different.

In terms of other ‘skin stuff,’ the effects were pretty mild which could’ve been due to the relatively low dose I was on. But, I did have very sensitive skin that would tear easily. Even certain bandaids would rip my skin off. I also had some Hand Foot Syndrome with burning in my hands and heels. My hair also got extremely dry & coarse to the point of breaking off. I had Einstein-like wisps on top of a Brillo pad. Not the look I sent in for my high school reunion ‘look at them now’ picture, but luckily was fleeting. Skin all back to normal now too.


What are radiation rashes?

Radiation can be hard on the skin. After repeated treatments, your skin may be sensitive and have a host of skin problems.

What are the symptoms?

Some people may experience burning, rashes, redness, dryness, flaking and skin discomfort where you get your radiation treatment. This is called radiation dermatitis.

When can it show up?

It often takes a while for these side effects to become an issue. These symptoms usually don’t show up until the last week or two of treatment (if at all).

How do I treat or prevent it?

Your radiation team may be able to provide you with skin care product samples, but the same principles apply in all these situations – cleansing and moisturizing with mild, non-fragranced products is best. Also, don’t rub the areas – pat them dry and treat them gently. Be careful not to over-moisturize prior to going for your radiation appointments. You want to make sure any lotions are completely absorbed into the skin. Some people find using a fan on the area to cool it may reduce skin discomfort. Make sure your team is looking at your skin regularly and let them know if you experience changes. 

Radiation rashes happen because radiation treatment can damage your skin’s microbiome (the healthy bacteria that live on your skin). A good way to prevent this is to wash the skin in the path of radiation with antibacterial soap and water before each treatment. Importantly, if you start to get a rash, stop using antibiotic soap as it may make things worse. One option with proven efficacy for breast, head and neck cancer is a plastic film called Mepitel. This film is applied before treatment then kept on the skin for two weeks afterwards. Although we have not seen it used in rectal cancer radiation specifically (and it might be hard to place on your buttocks!), you can ask your care team if it could be applied in your situation for metastatic radiation. Importantly, do not delay radiation treatment to wait for this film or other interventions. 

When might side effects go away?

Radiation rashes can extend beyond treatment by several weeks. They usually resolve within a month of completing treatment. Sometimes it takes a while for you to get back to where you used to be. Other times skin side effects may be something you deal with in the forseeable future. Your skin has gone through a lot, so be gentle with it and patient with the recovery process. Keep notes on how you’re recovering, and keep your care team up to date. If you have any questions about your recovery, work with them to find a solution that is right for you.

Hand foot syndrome

Hand foot syndrome is a common side effect of some chemotherapy drugs. It is known by several names — Hand Foot Skin Reaction (HFSR), Hand Foot Syndrome (HFS) or Palmar-Plantar Erythrodysesthesia (PPES). Your doctor may refer to any of these names, but they all mean the same thing. For our purposes, we’re going to call it hand foot syndrome.

What is hand foot syndrome?

HFS is a chemotherapy side effect that can cause redness, swelling, painful cracks, blistering, or peeling of the palms of the hands and soles of the feet. Symptoms of HFS may present differently for individual patients. Your skin tone and the health of your skin prior to treatment can also play a role in how HFS shows up for you.

What are the symptoms?

Every patient is different. If you’re concerned about HFS, talk to your care team.

Some symptoms of mild to moderate HFS are:

  • Calluses or blisters on the palms of the hands or the soles of the feet
  • Feeling like your skin is tight
  • Burning or tingling sensations
  • Tenderness to touch
  • Swelling or redness that appears to look like a sunburn
  • Redness (usually the entire skin surface, as opposed to in spots)
  • Hyperpigmentation (skin color darkening)

Severe HFS symptoms include:

  • Blisters
  • Ulcers or sores
  • Cracked, flaking and peeling skin
  • Difficulty walking
  • Difficulty using the hands to do things like buttoning a shirt
  • Mild to severe pain
  • Some people will temporarily lose their fingerprints from HFS (making opening your phone with your fingerprint hard!)

What can cause it?

Some CRC treatments known to cause HFS are capecitabine (Xeloda) and regorafenib (Stivarga). Capecitabine is part of CAPOX and XELIRI treatment regimens. It also infrequently can be caused by IV 5-FU, which can be found in common treatment regimens like FOLFOX and FOLFIRI.  

What might it look like?

Wondering what this might look like? Click the boxes below to see some examples. Just a heads up, the pictures show both mild and severe rash examples.

When can it show up?

Everyone is different. If you’re on a targeted treatment, you may notice HFS developing as early as in the first six weeks of treatment. If you are on chemotherapy, HFS may not manifest for two to three months. If you notice HFS starting to present itself, or if you notice your symptoms worsening, it’s important to notify your care team.

What levels of severity are there?

There are three grades of HFS that your doctor may use to diagnose and monitor your symptoms. Below are some example images. Note that the pictures show both mild and severe rash examples.

How do I treat or prevent it?

First of all, review the healthy skin habits guidelines at the top of this page.

Here are some other suggestions from COLONTOWN members:

  • Try placing ice packs under the hands and feet while receiving chemotherapy, with the approval of your care team. Do not apply ice directly to the skin.
  • Keep your hands and feet cool for several days following treatment. This can be done by using ice packs (do not apply directly to the skin), a cool towel wrapped and your hands or feet or running your hands and feet under cool water for 15 minutes at a time several times a day.
  • Limit the use of hot water that comes in contact with your hands and feet, such as while bathing or doing dishes. If hot water is required, wear gloves to protect your hands. Do not use vinyl directly on the skin (it traps heat). Consider wearing soft cotton gloves underneath.
  • During treatment, avoid activities and clothing that rub the feet, such as jogging, aerobics, gloves, and tight socks and shoes.
  • Use natural cleaning and laundry products.
  • Avoid pressure to the hands and feet, including pressing against hard objects such as gardening tools.
  • Keep your hands and feet well-ventilated to allow air to freely hit your skin. You can do this by wearing loose-fitting shoes. Do not walk barefoot. The use of soft socks or slippers can prevent friction to the feet.
  • Remove thick nails and calluses on the hands and feet prior to starting treatment. You can see a podiatrist or dermatologist to get these removed.
  • Applying henna paste on skin can help reduce HFS for some people. Ideally you should start this before hand foot syndrome starts, but if you have broken skin, do not use this treatment. You can purchase henna at a south asian grocery store or online. There are two types of henna, black henna and green henna. Make sure to use green henna, which is 100% henna plant without any additives. Make sure to cover your entire palms and soles of the feet. This will dye your hands and feet a dark brown or red, and the color will stay for around two weeks. Use plastic gloves or socks to make sure you do not stain your clothing or furniture, because stains are permanent. 
Over-the-counter options

Try exfoliant creams containing urea (such as Eucerin 10% urea), salicylic acid, or ammonium lactate, which can be purchased over-the-counter or provided by your doctor.

Keeping your skin moisturized throughout the day is important. Look for fragrance-free, alcohol-free options. Products made for eczema are often good choices.

Some COLONTOWN members recommend products like: Aquaphor, Aveeno, Bag Balm, Cerave, Cetaphil, Eucerin products (including Eucerin Repair Foot Cream with 10% urea), Udderly Smooth, Sween 24, CV Skinlabs, Neutrogena Anti-Itch Moisturizer, Reconval B6, or O’Keeffe’s Working Hands.

Some have had luck with oils such as coconut or almond, or CBD creams with menthol added.

Members recommend haircare products for itching, psoriasis or eczema such as Nizoral brand, Selson Blue, Head & Shoulders.

Here are some moisturizing and cleansing ingredients that COLONTOWN members commonly recommend:

  • Calamine 
  • Calendula used for chapped or cracked skin
  • Lanolin nipple cream
  • Coconut Oil
  • Almond Oil
  • Vitamin E oil
  • CBD creams with menthol added
  • Creams with 10%+ urea, salicylic acid or ammonium lactate
  • Products formulated for eczema

And remember that larger stores may have generic store brands of some of these products that can be more economical.

Take care when choosing showering products. It’s best to stay away from fragrances, shower in cooler water, and take shorter showers. Moisturize immediately after you pat your skin dry. Products such as oatmeal-based cleansers, Nivea or Cetaphil wash might be good choices, according to many COLONTOWN members.

If you’re feeling pain, try ibuprofen (Advil) or naproxen (Aleve). Before taking any medications including over-the-counter remedies, chat with your doctor.

Check in about taking Vitamin B6 (pyridoxine) as it may help prevent HFS too. One important note, vitamin B complex found in multivitamins can interfere with capecitabine, so make sure to chat with your doctor before taking any vitamins or over the counter medications or supplements.

Prescription options

Some recent data suggests using a topical gel arthritis pain reliever diclofenac (Voltaren) might help prevent or treat HFS. Talk to your doctor about using this as a possible preventative measure.  

Topical anti-inflammatories are often a good treatment for HFS. Prescription corticosteroid creams such as clobetasol or Ultravate work for many patients. 

Lidocaine and other topical pain relievers can be used in the form of a cream or a patch placed over painful areas on the palms and soles.

When might side effects go away?

Symptoms of HFS typically subside and eventually go away completely following the end of chemotherapy or targeted treatments.

If HFS is seriously affecting your everyday life, speak to your doctor about whether they recommend a lowered dose of chemotherapy. In severe cases, chemotherapy may need to be stopped temporarily or permanently to allow your skin to heal. Letting HFS go on without addressing it may lead to skin infections, so manage this side effect as actively as you can.

You can find additional information regarding HFS along with patient experiences by joining COLONTOWN. Try searching for terms such as “skin” or “hand foot syndrome” to find specific suggestions. Join COLONTOWN here.

Skin cracking & nail issues

What are the symptoms?

Painful cuts and cracks that range in severity can form on the hands, feet, around the nails and even areas like the vulva or perineal area. These can sting and be very annoying and painful, and if left untreated, can lead to infection.

Cracks in the skin or nail beds can also lead to infections so it is really important to monitor them for signs of infection such as heat, swelling, redness, and pus. If you notice this, let your care team know immediately so they can help prevent it from getting worse.

What can cause it?

Dry, itchy, cracked and even bleeding skin can be seen alongside the EGFR rash side effect, or simply on its own.

What might it look like?

Your nails may become brittle, nail beds may change colors and your nails may have waves, lines, or indentations. Nails can separate from the nail bed, causing you to lose all or part of a nail, and nail growth can slow.

How do I treat or prevent it?

We might sound like a broken record, but gentle skin care and moisturizing is the best way to prevent or reduce the impact of skin and nail bed cracks.

Try liquid bandage or a clean, new tube of super glue to close cuts on hands and feet. Make sure to do this in an area with good ventilation, and be sure to not glue your fingers together. Once dry, protect your hands and feet with cotton gloves.

You may also ask for a prescription for a topical steroid called clobetasol propionate ointment from your doctor. This cream is used to treat eczema and psoriasis. It reduces swelling, redness, itching and rashes caused by these skin conditions. It’s a type of topical steroid medication (cream). Some people report it helps with cracks in hands and feet.

When might side effects go away?

In time, these problems should grow out if you stop treatment, but this can take a year or more.

Your skin has gone through a lot, so be gentle with it and patient with the recovery process. Keep notes on how you’re recovering, and keep your care team up to date. If you have any questions about your recovery, work with them to find a solution that is right for you.

Dryness & itching

Your skin goes through a lot in life — from teenage pimples to earning wrinkles with time. Cancer treatment can cause new and frustrating side effects, including dry and itchy skin. This can be particularly uncomfortable and frustrating.

What can cause it?

Oxaliplatin is one of the most commonly used drugs for CRC. Most people will take it at some point if they’re on a chemotherapy regimen. When we think about oxaliplatin side effects, most people think of neuropathy and cold sensitivity, but it can also cause dry, itchy and sensitive skin.

Irinotecan is another common medication used to treat metastatic CRC. Although it is mainly known for causing diarrhea, it can also cause relatively mild skin problems, including dry, itchy, and sensitive skin.

Trifluridine and Tipiracil (Lonsurf) is reported to cause itching, redness and rash in some people who take it. Please notify your care team if this happens so they can help determine if this is an indication of an allergic reaction or an expected side effect. 

How do I treat or prevent it?

Our recommendations go back to the gentle skin care routine and healthy skin habits – don’t scratch, reduce exposure to hot water, treat your skin gently and moisturize often with unscented products for dry or eczema-prone skin.

If the itching is really bothering you, ask your care team about other OTC or prescription things that could help. Some find topical corticosteroids or diphenhydramine (Benadryl) creams to be helpful for itching.

As we mentioned above, some people experience cold sensitivity on oxaliplatin. So take care to avoid applying cold moisturizers if you are experiencing that side effect. There are plug-in lotion warmers that can be used to gently heat your product before applying.

When might side effects go away?

Symptoms often lessen when treatment ends. Sometimes it takes a while for you to get back to where you used to be. Other times skin side effects may be something you deal with in the forseeable future. Your skin has gone through a lot, so be gentle with it and patient with the recovery process. Keep notes on how you’re recovering, and keep your care team up to date. If you have any questions about your recovery, work with them to find a solution that is right for you.

Weird things that happen

Cancer treatment impacts everybody and every BODY differently. It can cause some pretty weird things to happen to your skin, so know you aren’t alone if you’re left scratching your head. COLONTOWN members have reported the following (and numerous other odd reactions). They usually aren’t dangerous, but let your care team know if you experience them:

  • Changed fingerprints
  • Hair growth on face
  • Subcutaneous bleeding that looks like a rash but it’s a bruise
  • Black “ink” spots on skin and gums
  • Palms and feet turning grey

Our advice is always to let your clinical team know about any changes you notice. They can help you decide if they need direct attention or not.

How to talk to your care team

It can be hard to talk about skin rashes. They might be in a sensitive spot, or look a bit odd to you. However, learning to describe your concerns in detail will help your care team address problems more quickly and accurately. 

And importantly, if you’re able to manage your rashes better, you have a better chance of completing treatment on schedule. 

Here are some ideas to help you get your points across effectively:

Get comfortable with sharing

Show your partner, your family members, or your BFF. Some problems are in places you can’t see well, and having help monitoring issues is important. Plus, you can practice getting comfortable sharing with your care team. 

Take pictures

It can be helpful to have a picture of your skin before you notice a problem. Then, later photos can show any changes or progression of rashes, moles or other concerns. This is especially important for people with dark skin, as doctors may find it more difficult to notice skin changes. Try taking some pictures from further away and up close, including a quarter or something else for size reference.

Think about when you noticed the problems starting

Sometimes side effects can be subtle at first. If a rash seems to be spreading, outlining the rash with a pen for later comparison can help to show how much and how fast a rash has spread.

Keep track of where on your body you find problems

Face, scalp, chest, stomach, back, arms, legs, hands, feet, or nails? On your buttocks or your groin? On your penis, vulva, anus, or peritoneum (the area between your anus and genitals)?

Learn language to describe how it looks

Has your skin changed colors — red, gray, black or other colors? Is it blotchy, or are there dots or areas of different colors? Are there bumps, blisters or swelling? If so, how large? Do they appear to be filled with fluid or are they more solid?

Describe how it feels

Is it painful or tender? If so, what makes it hurt? Does it burn or itch, feel raw, or hot? Is it numb or tingling? Does anything make that better or worse? 

Describe the texture

Is your skin tight, flaky, scaly, peeling? Is your skin feeling thicker than usual? Is it oily? Dry or moist? Cracking? Are your nails changing texture?

Have the skin issues made it hard for you to do daily activities?

Are there any changes in how you walk, grab objects, button your shirt, etc?

Have you changed skin care routines recently?

If so, how do you think that has affected things?

Have you experienced a different environment?

Have you been in especially hot or cold environments, or in the sun without protection? What temperature do you use for showering?

Are you taking your care team’s advice?

Are you taking your medications as prescribed? Are they working well for you in general? If you’ve stopped, how long ago?

Anything else you’ve noticed out of the ordinary?

Review your journal and notes and compare how your side effects have evolved over time.

Skin treatments and spas

Here are some suggestions on living an active life despite skin changes.

Many of us find spa and skincare treatments relaxing and rejuvinating. During treatment, we want continue our routines and feel as normal as possible. We also want to look like ourselves. So what spa treatments are safe, and which should you avoid?

The first rule of thumb is to involve your care team in lifestyle decisions too. COLONTOWN members have some tips for using spa treatments, makeup, and other fun things:

  • Let your aesthetician or nail technician know you are taking treatments for cancer. Some may be certified for oncology, so take a look around to see what your options are
  • When it comes to hair removal, avoid waxing because your skin may peel. If this is really something you want to pursue, threading may be an option. You can also try gentle electric razors
  • Ask for gentle products
  • If you are getting a manicure or pedicure, bring your own sanitized tools. Your immune system may be more sensitive. Do not cut your cuticles, because it can expose you to infection. Do not use fake or gel nails, in part because you can’t monitor your real nails for health issues
  • Try makeup designed for sensitive skin. “Non-comedogenic” products are intended to not clog pores. You may have to try several brands to find one that works for you
  • Green tinted makeup can offset redness. Often you can find this in a palette with orange and red tints too
  • Experiment with tinted moisturizers with SPF built in
  • Use extra care to reduce sun exposure and do not use tanning beds
  • As you go through treatment. your skin may become less likely to have rashes or other issues. The middle of your chemo cycle is the worst time to get any skin or nail treatments. If you really want to get a treatment done, aim to do it within a few days before your next round of chemo

Managing mental health

Skin is one of the first things may people notice about us — it’s our wrapper and how we present ourselves to the world. So the impacts of treatment on skin can be pretty distressing, because you may feel it changes the way others see you. Sometimes seeing rashes, bumps or irritation when you look in the mirror can be surprising and really impact our mental health and outlook on things. If this happens to you, you’re not alone.

It is not vain to want to feel and look good. Many COLONTOWN members have experienced these feelings. It’s important to stay in communication with your care team about how you are feeling — not just physically, but mentally and emotionally as well. Many people with cancer find they need some extra help through mental health medications, someone to talk to in the hospital, or support groups. The COLONTOWN community groups are here to lift you up, lend an ear, and provide suggestions on what has helped them. Join here.

Looking for additional mental health resources? 

Here’s a page from CRC101 (our complete guide for colorectal cancer patients and caregivers) on managing it all:

How do I handle all these new emotions?

As treatment ends and beyond

After you finish treatment, you may expect your skin to quickly return to normal. While some skin issues will resolve soon after you complete treatment, others may hang around for a while longer. 

And even when those rashes resolve, you may find your skin has changed significantly. For example, you may be more sensitive to the sun, or find yourself having allergic reactions to creams you’ve used for years. It’s important to be patient, keep track of your side effects, and learn to get used to the new skin you’re in.

Living with long term impacts

Going through cancer treatment, whether it’s shorter or longer term, causes changes to your body. Not everyone will experience long-term impacts to their skin, but here are a few to watch out for:

  • Sun sensitivity may continue for several months. Using dermatologist-recommended sun protection is smart at any time
  • Your skin and hair may continue to be dry, flaky and itchy for months. Keep up with your skincare and moisturizing routine
  • Nails take months to a year to grow out — so you may see lines, ridges, cracks, discolorations and brittleness for some time to come. Your nail bed color may be different as well, and you could lose nails after treatment is complete
  • Although it is not well-documented in published research, some COLONTOWN members have found they developed new skin reactivity to products such as bandages, dressings, medical cleansers, surgical tapes, certain skincare products or sunscreens during and even after treatment
  • Take note of any new redness, itching or irritation from these products and alert your care team as soon as possible to get it treated

Looking for additional resources? 

Take a look at this booklet on skin problems and solutions from FightCRC.

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