Side Effects
Preparing for and Managing Side Effects from Chemotherapy and Radiation
Going into chemotherapy and/or radiation can be a frightening, nerve-wracking experience. As with many things in life, it’s the fear of the unknown that scares us the most, so we’ve put together a list of common side effects. This is not a comprehensive list, but deals specifically with our area of specialty—the skin, hair and nails. You may experience some of these symptoms, or none of them. They may be severe, or very mild. It depends on your particular type of treatment, as well as on your body chemistry. According to the American Cancer Society, “Every person doesn’t get every side effect, and some people get few, if any.”
We hope that by giving you this information, we can help you prepare for what may occur. Once you know what to expect, you can begin conscientious self-care by stocking up on non-toxic personal-care products, adjusting your habits to accommodate the changes your body will experience, and above all, taking the time to truly nurture and express compassion for yourself.
(Note: There are over 90 different chemotherapy drugs. We have listed some below that may be responsible for certain side effects, but be sure to ask your doctor or specialist nurse about specific side effects of your own treatment.)
ACNE (rash-like)
- Some common chemotherapy drugs can increase the activity of oil glands in the skin and lead to increased acne
- Skin can form pimples that are papular and pus-filled
- It is important to not treat it with harsh acne medications as it can burn or damage the skin since it is so sensitive
- Do not squeeze the pimples as it can spread bacteria
- Speak to your dermatologist regarding options
- This can also be confused with what may be a rash (see below under ‘Rash’)
DRUGS THAT CAUSE IT: steroids (prednisone, dexamethasone or decadron), Cetuximab (Erbitux),more drugs under ‘Rash’
DRY EYES
- Excessive tearing
- Eyes feel overly dry, gritty, or itchy
- Sensitivity to light
- Difficulty wearing contact lenses
- Blurred vision
- Need to blink constantly
- Hard to open eyes after sleeping
- Wear sunglasses to protect your eyes from environmental factors and the wind
- Read our post on How to Bring some Comfort Back to your Dry Eyes During Treatment
DRUGS THAT CAUSE IT: Some medications like isotretinoin and tretinoin, cytarabine, fluorouracil (Adrucil, 5-FU, 5-Fluorouracil, Efudex), and medications to reduce side effects
DRY LIPS
- Dry lip syndrome
- Cracked lips
- Often occurs simultaneously with dry mouth syndrome
- Read our post on How to care for Your Lips During Treatment
- Read our post on The Dangers of Lead in Our Lipsticks and Glosses
DRUGS THAT CAUSE IT: fluorouracil (Adrucil, 5-FU, 5-Fluorouracil, Efudex), many others
DRY MOUTH (Xerostomia)
- Occurs when the salivary glands don’t produce enough saliva
- Can be caused by radiation when salivary glands are exposed
- Dryness and elevated acidity in the mouth; may lead to tooth decay
- Thick or stringy saliva
- Change in your ability to speak clearly
- Drink plenty of water and avoid beverages that are dehydrating like caffeine
- Read our post on Dry Mouth and Tips to Bring Some Relief
DRUGS THAT CAUSE IT: radiation (to exposed salivary glands); chemo drugs include Accutane, Acrylin, Ala-cort, Alkeran, Amifostine, Arimidex, Azacitadine, Kidrolase, Lanacort, Lapnitib, Lenalidomide, Leustatin, Mercaptopurin, Mylocel, Octreotide, Oxaliplatin, Proleukin, Retinoic Acid, Streptoizocin, Toxal, Thioguanine, Vectibix, Xeloda, Zanosar, Zevalin, Zolina Zorneta
HAND AND FOOT SYNDROME (Palmar Plantar Erythrodysesthesia or PPE)
- Hands and feet become red, inflamed and irritated
- Caused by chemo medications leaking out of small blood vessels in the palms of the hands and soles of the feet
- Cracking and peeling may occur
- Excessive dryness of the skin
- Hands feel numb, lose feeling in the fingertips
- Tingling sensations
- Read our post on How to Alleviate Hand and Foot Syndrome Side Effects
- Read our post on Chemotherapy and Sore Feet: Some Tips That May Help
DRUGS THAT CAUSE IT: Can occur with several types of chemotherapy or biologic therapy drugs used to treat cancer; examples include bleomycin (Blenoxane), capecitabine (Xeloda®), dactinomcin (Actinomycin D, Cosmegen, Act D), daunorubicin (Cerubidine, Daunomycin, Rubidomycin, DNR), continuous-infusion doxorubicin, docetaxel (Taxotere), epirubicin (Ellence), etoposide (VePesid, VP-16, Etophophos), 5-Flurouracil (5FU), idarubicin (Idamycin), high-dose Interleukin-2, irinotecan (Camptosar), mitoxantrone (Novantrone, DHAD, DHAP), oxaliplatin, paciltaxel (Taxol), plicamycin (Mithracin), procarbazine (Matulane), topotecan (Hycamtin), valrubcin (Valstar), vinblastine (Velban), vincristine (Oncovin), vinorelbine (Navelbine)
HAIR LOSS OR THINNING (Alopecia)
- Hair loss may include scalp, facial, eyelashes, eyebrows and body hair
- Radiation may cause loss of hair at the treatment site
- Some people experience hair loss, others don’t-it depends on the drugs and dosages used
- Usually begins within 2 weeks of starting chemo and may worsen 1-2 months after the start of therapy
- Hair often comes out in clumps rather than in an even pattern
- Read our post on Hair Loss and How to Deal with Hair Changes
- Read our post on Safe, Non-Toxic Shampoos to use During Treatment
- Read our posts on Choosing, Caring and Styling Wigs and Tying Scarves
- Read our post on Hair Re-growth After Chemo: My Hair is Coming Back Curly
- Read our post on Perming or Coloring: Safe During Chemotherapy?
- To find A Wig Salon near you, click here.
DRUGS THAT CAUSE IT: All chemotherapy drugs have the potential to cause at least some hair loss; drugs known to cause the most extensive include cytoxan, taxol, taxotere, and adriamycin; also the regimens AC (Adriamycin and Cytoxan) and ACT (Adriamycin, Cytoxan, and Taxol)
INFECTION (increased risk)
- White-blood-cell count can decrease, hampering the immune system and lowering the body’s ability to fight off infection
- Infections can be serious for cancer patients; different germs, bacteria and viruses may all be factors
- Fever of 100.5˚ is often the first sign
- Other signs include fatigue, sore throat, shortness of breath, redness, pain, swelling, or a sore/wound that doesn’t heal
- Avoid large crowds of people who are sick and do not share drinks, foods or personal items to avoid spreading bacteria
- Read our post on How to Keep your Personal Care Products Bacteria-Free
- Read our post on How a Trip to the Spa Can Help your Immune System
- Read our post on How to Protect Yourself During Low-Blood-Count Days
- Read our post on Cleaning Your Make-up Bag: What to Toss and What to Keep
DRUGS THAT CAUSE IT: 2-Cholrodeoxyadenosine (2-CDA; Cladribine, Leustatin), CCNU (Lomustine), cis-platinum (Platinol), fludarabine(Fludara), hydroxyurea (Hydrea), irinotecan (CPT-11), methotrexate (MTX), semustine (Methyl-CCNU), topotecan (Hycamtin), vinblastine (Velban)
MOUTH FISSURES OR ULCERATIONS (Oral Mucositis or Stomatitus)
- Particularly common with patients who have head and neck cancers
- Fissures may appear at the corner of the mouth
- Ulcers (painful swellings with white centers) may appear anywhere inside the mouth including gums
- Pain can make it difficult to eat, chew, and swallow
- Read our post on How to Care for Mouth Fissures and Ulcerations
DRUGS THAT CAUSE IT:bevacizumab (Avastin), busulfan (Myleran), bleomycin, bortezomib (Velcade), busulfan (Myleran), capecitabine (Xeloda), carboplatin (Paraplatin), cetuximab (ERBITUX), chlorambucil (Leukeran), cyclophosphamid, cytarabine, daunorubicin, doxorubicin (Adriamycin), erlotinib (TARCEVA), etoposide (Etopophos, VePesid), fluorouracil (Adrucil), geftinib (IRESSA), idarubicin, ifosfamide, imatinib (Gleevac), melphalan (L-PAM; Alkeran; L-Sarcolysin), mechlorethamine (Nitgrogen Mustard), methotrexate, oxaliplatin (Eloxatin), paclitaxel (Taxol), panitumumab (Vectibix), sunitinib (Sutent), streptozocin (Zanosar), temozolomide (Temodal), thiotepa (Thioplex), vinblastine (Velban)
NAIL CHANGES
- Skin on fingertips may split open
- Nails can become brittle, darken in appearance, become black, or fall off
- Nails can form horizontal depressions on the nail bed or white, horizontal discolorations; stripes
- In severe cases, may disrupt daily activities
- Read our post on Nail Changes During Treatment
- Read our post on Choosing Natural Nail Polish over Toxic Formulas
- Read our post on Manicures During Chemotherapy: How to Stay Safe and Avoid Infection
- Read our post on Pedicures: Are they Safe during Chemotherapy?
DRUGS THAT CAUSE IT: bleomycin, busulfan (Myleran), carboplatin (Paraplatin), chlorambucil (Leukeran), cisplatin (Platinol), cyclophosphamide (Cytoxan), daunorubicin, decarbazine (DTIC), doxorubicin, fluorouracil, ifosfamide (Ifex; Isophosphamide), mechlorethamine (Nitgrogen Mustard), melphalan (L-PAM; Alkeran; L-Sarcolysin), methyl CCNU (Semustine), oxaliplatin (Eloxatin), streptozocin (Zanosar), temozolomide (Temodal), thiotepa (Thioplex)
PHOTOSENSITIVITY
- Enhanced skin response to sunlight
- Redness, swelling, blistering, peeling
- Itchy rashes
- Exaggerated sunburn
- Read our post on How to Protect Yourself from the Sun During Treatment
- Read our post on Sun Protection Tips You May Not Have Thought About
DRUGS THAT CAUSE IT: capecitabine (Xeloda), cladribine (Leustatin), clofarabine (Clolar), cytarabine(ara-C, cytosar-U), floxuridine (FUDR), fludarabine(Fludara, 2-fluora-ara-AMP), fluorouracil (Adrucil, 5-FU, 5-Fluorouracil, Efudex), gemcitabine (Gemzar), hydroxyurea (Hydrea), mercaptopurine (6-MP, Purinethol), methotrexate (Amethopterin, Folex, Folex PFS, Mexate, Mexate-AQ, MTX, Abitrexate, Rheumatrex), nelarabine (Arranon), pemetrexed (Alimta), pentostatin (Nipent), thioguanine (6-TG, 6-Thioguanine, Tabloid), vinblastine (Velban)
RADIATION BURNS
- Damage to the skin caused by exposure to radiation
- Skin is red, raw
- Burns, feels hot
- Skin starts to slough off, and may turn black
- Can be very painful
- Blisters may form, or open sores on the area of treatment
- Sores can be oozing at times
- May feel too irritated or raw to touch
- Shooting pain from the inside
- Read our post on What to Expect from Radiation Treatments
- Read our post on Products to Soothe and Calm Radiation Burns
- Read our post on What Foods Can Reduce Skin Damage from Radiation
RASH (Tarceva Rash or other)
- Occurs within the first few weeks of treatment
- Develops in the face, neck, chest, back, and scalp
- Looks like pimples or red bumps; redness
- Can be like a sunburn-red and hot/flushing
- Itchy, dry skin that flakes
- Sores
- Tender, irritated skin
- Read our post on Tarceva Rash During Treatment
DRUGS THAT CAUSE IT: aminoglutethimide (Cytrdren, Elitpen), bevacizuman (Avastin), bleomycin Blenoxane), bortezomib (Velcade), cetuximab (ERBITUX), cisplatin (rare—Platinol, Platinol-AQ), cytarabine (Ara-C), dactinomcin (Actinomycin D, Cosmegen, Act D), daunorubicin (Cerubidine, Daunomycin, Rubidomycin, DNR), docetaxel, epirubicin (Ellence), erlotinib (TARCEVA), erbitux, fluorouracil (Adrucil, 5-FU, 5-Fluorouracil, Efudex), geftinib (IRESSA), idarubicin (Idamycin), imatinib (Gleevac), L-Asparaginase, methotrexate (Folex, Folex PFS, Mexate, Mexate-AQ, Abitrexate, Rheumatrex), mitoxantrone (Novantrone, DHAD, DHAQ), paclitaxel, panitumumab (Vectibix), plicamycin (Mithracin), sorafenib (Nexavar), sunitinib (Sutent), tamoxifen (Nolvadex, taxomifen citrate), valrubcin (Valstar), 2-Cholrodeoxyadenosine (2-CDA; Cladribine, Leustatin)
SCARRING (from radiation or surgery)
- Scar tissue remains on damaged tissue after it heals
- The amount of scar tissue depends on the size, depth, and location of the wound
- Surgery can leave scars at the incision points
- Chemotherapy and radiation can leave scars in the skin from wounds, burns, and acne and/or skin rashes
- Radiation can also leave hardened, stiff tissue known as radiation fibrosis
- Read our post on How to Take Care of Scars after Treatments and Surgery Are Over
SKIN TENDERNESS/DRY SKIN/ITCHY SKIN
- General itching
- Dry and flaky skin
- Bleeds easily if rubbed too hard or scratched
- Redness or rashes
- Peeling; feeling of tightness
- Thin or fragile skin
- Read our post on Tips for Men’s Shaving Routine During Treatment
- Read our post on Natural Alternatives to Irritating Colognes and Perfumes During Treatment
- Read our post on The Dangers (and Alternatives) to Petroleum Based Moisturizers
- Read out post on Changing Your Bathing Habits During Treatment: Your Skin Will Thank You
- Read our post on Foods that can Boost Skin’s Hydration Naturally
- Read our post on Dry, Itchy Skin: Toxin-free Tips to Calm and Hydrate Your Skin
- Read our post on Harsh Ingredients To Avoid During Chemotherapy
DRUGS THAT CAUSE IT: Most of them
SKIN TONE CHANGES
- Blotchy skin
- Hyperpigmentation (darkening of the skin, overall or only in places)
- Skin may appear ashy and dull (due to low white-blood-cell count)
- Can occur particularly in areas of pressure, such as underneath tape or dressings
- Some chemo drugs (fluorouracil, vinorelbine) given intravenously can cause darkening of the venous pathways up the arm
- Usually occurs within 2-3 weeks after starting treatment; typically goes away within 10-12 weeks after stopping
- Read our post on The Benefits of Mineral Make-up for Compromised and Sensitive Skin
- Read our post on How to Deal with Blotchy Skin and Fake the Glow
- Read our post on How to Deal with Hyperpigmenation After Treatments are Over
- Read our post on Hydroquinone: Lightening the Discloloration Isn’t Worth the Cancer Risk
DRUGS THAT CAUSE IT: bleomycin, busulfan, cyclophosphamide, cisplatin, docetaxel, etoposide, hydroxyurea (Hydrea), ifosfamide, methotrexate (MTX), prednisone (Apo-Prednisone, Orasone, Deltasone, Predisone), thiotepa
LOSS OF TASTE (Dysguesia)
- Sometimes described as “metal mouth”
- Bitter taste, or loss of taste
- Decreased ability to taste sweet foods; lower tolerance for bitter foods
- Can interfere with you getting the nutrition you need
- Starts a week or two after the beginning of treatment
- It’s estimated that about 50% of patients getting chemotherapy experience taste changes
- Read our post on The Miracle Fruit and Reviving Taste Buds During Chemotherapy
DRUGS THAT CAUSE IT: bleomycin (occasionally), cyclophosphamide (Cytoxan, Neosar, Endoxan), paclitaxel (Taxol, Abraxane), rituxin (Rituximap), sunitinib (Sutent), vincristine (Oncovin, Vincasar PFS, leurocristine)
For more information on side effects, click on any of the resources below.
Cancer Help, Chemocare, Caring, Oncology Channel, Care First Stay Well Solutions Online, Candlelighters

