How Metastatic Breast Cancer Can Affect Your Skin and Nails

Medically Reviewed by Stephanie S. Gardner, MD on March 15, 2022
Written by Sarah Ludwig Rausch
5 min read

If you’re being treated for metastatic breast cancer, you might notice some changes in your skin and nails. These effects aren’t from the cancer itself. Most of the time, they’re caused by certain cancer treatments.

Skin and nail changes can happen to anyone being treated for breast cancer. But when you’re having treatment for metastatic breast cancer, these side effects are more likely. This is because metastatic breast cancer usually requires long-term treatment, giving these changes more time to develop.

Here’s a look at what causes skin and nail changes, the symptoms to watch for, how to help prevent these changes, and how to manage them if they appear.

Skin and nail changes are usually caused by specific types of cancer treatments. These include radiation, some types of chemotherapy, and certain hormonal and targeted therapies. If you’re on more than one treatment that causes skin and nail side effects, your chances of having them are higher.

Keep in mind that not all breast cancer treatments cause skin and nail changes. And not all people experience the same effects, either. Ask your doctor or pharmacist if you need more information on the side effects of your treatment.

External beam radiation therapy (EBRT) is the most common type of radiation used for women with breast cancer. One of the main side effects of EBRT is skin changes in the area that’s been treated. This is similar to a sunburn, with redness, peeling, and skin darkening.

Internal radiation, called brachytherapy, is used less often to treat breast cancer. It can cause bruising and redness in the treated area.

Radiation may also make your skin more sensitive to touch. This is because it affects your skin’s nerve endings, just like a burn does.

Radiation has more of an effect on your skin, but it can cause your nails to look darker, too.

Along with cancer cells, chemotherapy kills cells that help your nails grow and your skin stay hydrated and soft. This can lead to dry and sensitive skin.

Long-term treatment with chemotherapy for metastatic breast cancer can also cause you to have a low blood cell count. This increases your risk for skin and nail infections. Even a small infection like this can be serious when your immunity is already low. If you notice signs that you have an infection, such as red, painful skin or nails that are warm when you touch them, call your doctor right away.

The types of chemotherapy used to treat breast cancer that may lead to skin and nail changes include:

  • 5-fluorouracil (5-FU)
  • Capecitabine (Xeloda)
  • Cyclophosphamide (Cytoxan)
  • Daunorubicin (Cerubidine, DaunoXome)
  • Docetaxel (Taxotere)
  • Doxorubicin (Adriamycin)
  • Ixabepilone (Ixempra)
  • Liposomal doxorubicin (Doxil)
  • Mitoxantrone (Novantrone)
  • Nab-paclitaxel (Abraxane)
  • Paclitaxel (Taxol)

Tamoxifen, a hormone therapy, and some targeted therapies can cause skin and nail changes. You may see more severe effects from targeted therapies than radiation or chemotherapy.

The targeted therapies used to treat breast cancer that may cause skin and nail changes include:

  • Everolimus (Afinitor)
  • Lapatinib (Tykerb)
  • Neratinib (Nerlynx)

Your skin and nails can also be affected by other treatment-related issues. For instance, if your treatment causes vitamin deficiency, this could change your skin and nails. Or if you pick up an infection because your treatment has lowered your body’s ability to fight off illness, the infection could affect your skin and nails.

Symptoms like itching or dry skin may be from your treatment, but they could also be from other common causes, too. Dehydration, heat, cold, or not getting enough nutrition can all cause dry skin. Allergies or other illnesses are among the things that can cause Itching.

The skin changes you have will depend on the treatment you’re getting. You may notice symptoms such as:

  • Redness
  • Rash
  • Dryness
  • Thin or delicate skin
  • Blistering or peeling
  • Itching
  • Acne
  • Burning
  • Pain
  • Soreness
  • Sunburn easily
  • Darker or lighter areas of skin
  • Painful sores
  • Swelling
  • Crusty or flaky skin
  • Dome-shaped growths called keratoacanthoma

Changes in your nails can affect your fingernails, toenails, or both. You might only experience changes in one or two of your nails, or they could all be affected. You may notice symptoms such as:

  • Nails that look bruised or discolored
  • Weaker nails that seem thin or brittle
  • Changes in nail thickness
  • Unusual spots, pits, marks, ridges, or lines
  • Dry or frayed cuticles
  • Nail infections
  • Painful fingers, toes, or nail beds
  • The nail plate lifting off or falling off the nail bed
  • Ingrown nails

It may be reassuring to know that, for most people, skin and nail issues start getting better once you’ve stopped the treatment that’s causing them. This may take a few weeks or months.

In the meantime, here’s what you can do to help keep these changes from happening and manage your symptoms if they do begin.

For Skin:

  • Make sure you’re eating a healthy diet and drinking eight to 10 glasses of water every day.
  • Use mild, unscented soap and skin products. Ask your doctor or nurse what they recommend.
  • Keep your skin moisturized. The best time to slather on creams or lotions is right after you get out of the shower and pat your skin with a towel.
  • Don’t take hot baths or showers, which dry out your skin. Try to keep them short.
  • Use sunscreen and lip balm with sun protection when you’re outside. Wear loose-fitting clothes that cover your skin and a hat to protect your head. Try to stay out of the direct sunlight as much as you can.
  • Try not to scratch. It can be tempting when your skin is itchy, but scratching can lead to painful sores and even infection.
  • Use a cool washcloth or an ice pack to help relieve itchy skin.
  • Stop shaving or shave less often if your skin is sensitive.

For Nails:

  • Use moisturizer, olive oil, or vegetable oil on your cuticles. Don’t cut or pull them.
  • If your toenails are bothersome, buy shoes with more room in the toe box.
  • Keep your nails clean and cut short.
  • Put on gloves when you clean, wash dishes, or garden.
  • Avoid manicures and pedicures and don’t use artificial nails.
  • Let your doctor know if your nail(s) come off. Keep them clean and protected with a bandage.

You may want to keep a log of skin and nail symptoms when you start a new treatment. You can track how long you’ve had the symptoms, what they’re like, how uncomfortable they are, and how much they are bothering you. Knowing these details can be helpful to both you and your doctor.

Talk to your doctor if any skin or nail symptoms are bothersome or serious. They may be able to prescribe medicine to treat the side effect, lower your treatment dose, or change the frequency of your doses.

Call your doctor right away if you have symptoms of an allergic reaction, such as swelling, severe rash or itching, or a burning feeling close to where your IV was inserted.