Serious Skin Care for Women of Color

During and After Breast Cancer Treatment

Most women realize that when going through treatments for breast cancer they are likely to experience hair loss and nausea, but few are counseled on the extent to which their skin may become affected by not only radiation (if that is a part of their regime), but also chemotherapy. Women of color are particularly susceptible to this oversight, because many wrongly assume their skin will not be as severely involved due to increased levels of pigment or melanin.

The amount of melanin among women of color can vary dramatically and depends greatly upon a woman’s heritage. Skin tones include everything from light brown to ebony hues, so it’s easy to see that assuming a “one size fits all” plan for keeping skin as healthy as possible during treatment, just doesn’t work!

The melanin in dark skin is made in cells known as melanocytes. These cells, which are contained in the upper layer of the skin, are very reactive. Melanocytes often produce more melanin when stimulated by sunlight, inappropriate skin care products or cosmetics, irritating topical medications, some oral medications, and a wide variety of medical conditions. Because of the reactive and unpredictable nature of melanin, women of color are more likely to suffer from problems such as dark marks, blemishes and other skin discolorations.

A better understanding of how treatments can affect your skin

Since chemotherapy involves the use of drugs to destroy rapidly dividing cancer cells, it also affects normal cells that grow rapidly, such as skin cells. It is not uncommon for rashes and dry skin to be common side effects of chemotherapy. Although the melanin in dark skin provides some protection from the damaging effects of the sun, and keeps skin looking younger longer – it is also responsible for skin that is prone to scarring. Radiation can cause the skin around the nipple and areola to become very dark with treatment. It is not uncommon to have black spots in the area of sweat glands and hair follicles. These will usually fade with time, but can be a source of distress for women undergoing treatment.

Although black women are prone to excessive facial oils, they may have dry, ashy body skin, which is easily irritated by plucking, squeezing blemishes or shaving. Even minor skin irritations can result in dark spots, so it’s not uncommon for African-American women to experience less than desirable side-effects from both chemotherapy and radiation treatments. One recent study observed that 90% of all women undergoing radiation treatment for breast cancer developed radiation-induced dermatitis, which makes this a major concern for women of color.

African-Americans also often experience skin discoloration from medications taken for high blood pressure, diabetes and heart disease. Additionally, dark skin reacts differently (and often more severely) to common conditions like acne, eczema, psoriasis and dandruff.

At a time when skin reactions are more likely, it’s a good idea to understand some of the contributing factors:

• having chemotherapy before or at the same time as radiation
• being overweight
• having other health problems such as diabetes
• having sun damaged skin
• smoking

Breast surgery may also put women of color at increased risk for keloids. Most injuries or wounds heal with normal scars. However, when abnormal scars do develop in individuals of African, Latina and Asian descent, one of the most common types is keloidal scarring. These scars are more likely to occur in individuals with a family history or genetic susceptibility. Keloids are unique because they overgrow the boundaries or margins of the original wound. Although keloids have been seen in people of all races, individuals with skin of color are affected more often than those of European descent.

In order to prevent or minimize potential skin problems, it is particularly important that African-American women (and all women of color for that matter) having chemotherapy and/or radiation talk to their oncologist(s) about the risk of developing a skin reaction. As an additional precaution, it is probably a good idea to seek a dermatologist to discuss any preventive measures they may know about.

Caring for the skin you’re in

Nurturing your skin is very important all the time, but particularly crucial during treatment for breast cancer. A key essential is to avoid irritants that may stimulate the production of excessive melanin. Ingredients in soaps, cleansers, toners, moisturizers, astringents, anti-aging products, and anti-acne agents are all possible irritants. Women of color are advised to avoid:

• Cleansers, toners or astringents containing alcohol, propylene glycol, fragrance, or dyes
• Products containing essential oils (concentrated oil extracts from plants)
• Moisturizers containing fragrance, lanolin, dye, alcohol or propylene glycol
• Sunscreens containing fragrance, oil, PABA
• Make-ups containing oil
• Alpha-hydroxy acid in high concentrations or at certain pHs
• Detergents and fabric softeners containing fragrance, dyes, or preservatives

Sadly, until quite recently, many African-American women were not properly counseled on treatment choices when it came to mastectomy vs. lumpectomy and radiation therapy. As a consequence, few women of color were opting for lumpectomy and radiation. Fortunately, studies have now been done that show the cosmetic results at three and five years after completion of therapy. Although significantly fewer black patients had an excellent-to-good cosmetic result at three years compared with white patients, the good news is that the results were not significantly different at five years. These results helped to show that appropriately selected black patients with early stage breast cancer have excellent local control after conservative surgery and radiation therapy and should continue to be offered breast preservation as an alternative to mastectomy.

Your skin during radiation therapy

There is evidence that the following activities can help to reduce the severity of skin reactions while undergoing radiation treatments:

• Washing your skin with a mild soap or cleansing agent
• Moisturizing with a light moisturizing cream – (your doctor or nursing staff should be able to give you good suggestions and/or recommendations)

Based on the experience of other women receiving radiation therapy for breast cancer, as well as the observations of health care professionals, it is also advised that you:

• Wear sun protective clothes or use sun screen over the treatment area when in the sun
• Avoid irritants: it’s important to protect the skin in the treatment area from damage from abrasion, chemicals (such as perfumes, deodorants, hair dyes) and extremes of temperature during your course of radiotherapy
• Keep skin folds dry

African-American skin may appear more tan-colored and less red than white skin when it is radiated. Doctors recommend that skin receiving radiation therapy, regardless of whether it’s black or white, be protected from prolonged exposure to the sun.

Let the sunshine in … but don’t think it can’t damage darker skin!

Women of color need to remember that wearing a sunscreen is just as important for them as for their Caucasian counterparts! For most dark skinned women, a sunscreen with an SPF 15 is sufficient, but if you have certain medical conditions, such as lupus, or take some medications, or have dark marks or skin discolorations, you may need a sunscreen with an SPF 30. It is important to use broad-spectrum products containing ingredients that protect the skin from both UVA and UVB rays.

Sunscreen should be applied 20 minutes before exposure to the sun to allow the skin to absorb the product and create a protective shield. It should be used generously on any exposed skin, like the face, neck and hands, and reapplied after vigorous exercise or swimming even if the product is labeled “water proof”. Another point to remember is that the sunscreens used in makeup foundations wears off after only a couple of hours, so it’s best to apply sunscreen separately, under makeup, or in moisturizers that say SPF 15 on the label.

Make sure you are in the know when it comes to checking your skin

Skin health for all women involves regular skin self-examinations. For women of color this becomes particularly important, because although darker skin is less susceptible to skin cancer, it is also true that those from African-American, Asian, Latino and Native American backgrounds usually have higher morbidity and mortality rates for several types of skin cancer than their white counterparts. This lower survival rate is a direct result of late detection or misdiagnosis. There simply isn’t enough research on darker skin, so there is very little literature available to healthcare professionals to help educate them on the different ways skin cancer can manifest itself in people of color. For this reason, it is of the utmost importance that women of color choose physicians who are familiar with the unique characteristics of darker skin. This can literally make the difference between life and death.

The National Cancer Institute recommends these steps for checking skin for signs of cancer. After a bath or shower, use a full-length or hand-held mirror to check all areas—including hands, feet, nails, back, scalp, buttocks and genitals.

• Look at the front and back of your body in the mirror, then raise your arms and look at the left and right sides.
• Bend your elbows and look carefully at your palms, your forearms, including the undersides, and your upper arms.
• Examine the back and front of your legs. Also look between the buttocks and around the genital area.
• Sit and closely examine your feet, including the soles and the spaces between the toes.
• Look at your face, neck and scalp. You may want to use a comb to move hair so that you can see better.

Malignant melanoma is the most dangerous and deadly form of skin cancer in people of color. Although it is often curable if discovered early, many cases aren’t discovered until it is too late to effectively treat the disease. Unlike other skin cancers, melanoma has great potential for metastasizing (spreading), and once it reaches other parts of the body, it is very difficult to treat. There are two main reasons for late detection, firstly, because the melanomas on dark skin often occur on less sun-exposed areas (feet, palms, nails); and secondly, they are sometimes misdiagnosed as plantar warts, fungus on the palm, or dark nails. Melanoma in non sun-exposed skin (especially the feet, palms, nails) is the most common seen in Asians, Native Americans, African and African-Americans.

Acral Lentiginous is one of the most common forms of melanoma in people with dark skin, especially Asians and African-Americans. This form of melanoma tends not to affect Caucasians. It is usually seen as a black or brown discoloration on the palms of hands and feet, or under the surface of nails, and is one of the least diagnosed because of its odd location. Acral Lentiginous spreads superficially before tumors begin penetrating deeper organs.

Squamous cell carcinoma is the second most common form of skin cancer affecting over 200,000 people a year in the United States. Fairer-skinned and lighter-eyed individuals are at a higher risk for squamous cell carcinoma, but anyone with a history of long sun exposure is at risk. People with darker skin are at much lower risk of developing this cancer, but it does account for more than 66% of the incidences of cancer in people of color.

This cancer can occur anywhere on the body. However, it is most common in areas with the greatest exposure to sunlight. Areas often overlooked during suntan lotion application (like ears and lips) are especially vulnerable. Skin injuries like burns, scars, and long-standing sores are known to sometimes cause squamous cell tumors. They also occur on sites previously exposed to prolonged X-rays or certain chemicals. Medical conditions suppressing the immune system over an extended time period can increase the risk of squamous cell carcinoma as well.

Skin care during treatment for breast cancer, particularly for women of color, is yet another area where more study needs to be done in order for reliable information to be developed. As more women become better informed as to whether or not breast sparing surgeries, chemotherapy, and radiation are appropriate for them, the need for this information is going to become even more pressing. Hopefully women of color will begin sharing their stories about what has helped them treat skin that has been compromised by their choices, so that individuals facing treatment decisions will at least have some idea of what works and what doesn’t.

Our skin is our largest organ, so it stands to reason it is going to be affected in significant ways when we are dealing with something as profound as breast cancer and the accompanying treatments. Making sure to provide your skin with a little more TLC during and after your treatments is just one more step in the right direction for regaining your overall health, no matter what color skin you’re in!