Getting a breast cancer diagnosis can leave one with a sinking feeling in their gut. But having to go through treatment can sometimes be an even tougher battle.
Not only do women have to deal with losing their breast(s) as well as their hair temporarily, but they may also begin to develop severally dry skin, painful rashes, scarring, or hyperpigmentation from chemotherapy, radiation, and surgery — making it essential for them to adjust their skin care routine during breast cancer treatment.
And while people of all races are likely to experience these uncomfortable side effects, for black women, the increased levels of pigment in their skin may cause their bodies to react differently, requiring them to seek out specialized care. Thankfully, there are dermatologists who can help.
Dr. Tiffany Clay, an Atlanta-based board certified dermatologist, shares that one of the first things black people should do as soon as they know they'll have to undergo chemo and radiation is start prepping their skin before beginning their first treatment. "I would say just treat it like baby skin," she explains. "Use products that are gentle and moisturizing."
Dr. Clay recommends immediately switching to gentle, hypoallergenic cleansers like CeraVe Hydrating Facial Cleanser, Cetaphil Gentle Skin Cleanser, which can be used for the face or body, along with Vanicream Moisturizing Skin Cream for Sensitive Skin to help keep the skin hydrated.
Dr. Heather Woolery-Lloyd, a board certified dermatologist specializing in skin of color, recommends trying Dove Sensitive Skin Body Wash as well as Aquaphor Healing Ointment. "Put [Aquaphor] on all over as soon as you get out of the shower to lock in the moisture," she suggests. "But you could also use plain old Vaseline. I love shea butter [too] — anything that locks it in."
Dr. Woolery-Lloyd also explains that some people going through treatment may need to get used to taking shorter, quicker showers as well if their skin begins to react to heat or steam. "If your skin is changing and really, ultra sensitive, you just can’t tolerate it," she says.
The types of clothing detergents and fabric softeners you use can also cause potential skin irritation during treatment as well, Dr. Woolery-Lloyd explains. She suggests that it's best to swap super fragrant products for ones that are free of dyes and perfumes before you get started. The dermatologist recommends trying Tide Free & Gentle Liquid Laundry Detergent, or Cheer Free Liquid Laundry Detergent, as well as Downy Ultra Free & Gentle Fabric Conditioner.
Chemotherapy is known to make the skin become more dry and sensitive, but it can also promote accelerated photoaging of the skin — which naturally occurs from sun exposure — causing premature fine lines and wrinkles. However, Dr. Woolery-Lloyd has found that black women are usually less likely to deal with this side effect. "The melanin [in our skin] gives us some protection — some, not complete — from the sun," she says. Still, since the skin can generally become quite sensitive to the sun during both chemo and radiation, Dr. Clay says it's necessary to apply a broad spectrum sunscreen of at least SPF 30 before going outdoors to avoid a potential sunburn or any other type of damage. "You want to minimize how many ultraviolet rays are contacting the skin," Dr. Clay explains.
A widely-known effect of chemo is hair loss, which Dr. Clay finds to be her black patients' biggest concern. "They want to keep their hair," she shares. "They ask if they'll lose hair during [the process], depending on which type of treatment they have. They also want to know how to recover any hair that was lost after having chemo." And while she says that some dermatologists can offer platelet-rich plasma treatment (PRP) in their office — a procedure that helps to stimulate hair growth — she often just suggests that all patients need to do is maintain a protein-rich, well-balanced diet or take over-the-counter supplements, if needed.
"The hair needs protein to grow and to be healthy," Dr. Clay explains. "You can always supplement biotin ... it actually helps your proteins grow and become stronger. So it will definitely enhance the strength of that new hair that's coming out that might be a little bit thinner or more brittle."
The physician also adds that younger women tend to have an easier time with hair regrowth than women who are over 50. "As we age, our hair will naturally thin anyway," she says. "So they may not recover fully to that 100 percent of that full, thick head of hair they had before."
Once patients are ready to start radiation, many will find that it can be quite irritating and harsh on the skin. And in black women, the treatment can cause severe hyperpigmentation (darkening of the skin) as well as radiation dermatitis, an itchy rash that can leave behind painful marks.
To help even out the skin tone of breast cancer patients specifically, Dr. Woolery-Lloyd tends to skip using hydroquinone, which is often used to treat hyperpigmentation, and instead opts for more natural and gentle remedies. "My go-to would be azelaic acid that’s very effective and safe to use," she shares. She also recommends products that contain natural skin brighteners like green tea, liquorice, and vitamin C.
But while hyperpigmentation can be hard to prevent, Dr. Laura Scott, a Miami-based dermatology resident, notes that rashes from radiation can sometimes be avoided if patients are able to ask their oncologist or dermatologist for prophylactic topical steroids, a mild form of hydrocortisone. "There is some evidence that this may help prevent acute radiation dermatitis," she shares. Otherwise, Dr. Woolery-Lloyd suggests using an "occlusive emollient" like Vaseline or Aquaphor to help relieve any discomfort once the rash has developed.
Because black people have more pigment in their skin, they also tend to be more predisposed to other issues like keloids and hypertrophic scars, which can cause cosmetic concerns for patients requiring breast surgery. Thankfully, there are ways to minimize their appearance.
One solution Dr. Scott recommends is trying over-the-counter silicone sheets for flat, prominent scars on their breasts. As for those who are prone to keloid or thick hypertrophic scars, the physician says it's best to visit a dermatologist where they can provide steroid injections soon after surgery to prevent the marks from forming all together.
And while it's easy for black women to dismiss any skin-related issues they may be dealing with as they're fighting breast cancer, it's important for them to remember that their cosmetic concerns are never trivial. "I think we have to give these patients the freedom and the assurance that it’s OK to care about what you look like," Dr. Woolery-Lloyd asserts. "Even though cancer is very serious, there should be no shame in recognizing that how you look is a big part of a woman’s identity. It's OK to mourn that change, and there’s lots of ways to address it."