Hair loss, skin problems & nail changes

The hair and skin can be significantly affected by ongoing treatment for secondary breast cancer. The following information may help you to manage and find different ways of coping with these symptoms.

In this section:

Hair loss & hair thinning

During treatment for cancer, some people experience hair thinning or hair loss. This can include the eyebrows, eyelashes and pubic hair.

Treatment targets healthy as well as cancerous cells. This means that healthy cells of the hair follicles can also be damaged, causing hair to fall out.

With longer term treatment, or repeated cycles of various different chemotherapies, there is the chance that hair loss may be permanent, or hair re-growth may only be partial. Though this is not the case for everyone, it can be a real concern for women living with secondary breast cancer.

In some cases, treatment may cause hair to become thinner or more brittle, rather than falling out completely. This can happen with hormonal therapies such as anastrazole (Arimidex), exemestane (Aromasin) or letrozole (Femara).

Many women find hair loss amongst the most difficult of side effects to cope with. Hair can be a huge part of a person’s image and their sense of self. Losing it can not only affect how a woman feels about herself, they may also find it a distressing ‘sign’ of their illness to others. Some women, on the other hand, see hair loss as a sign that their treatment is working and do not feel so distressed. There is no right or wrong way to feel.

Some women choose to wear a cold cap when undergoing chemotherapy treatment. This is a cap you wear to cool the scalp in order to reduce the flow of blood to the hair follicles. This means that less of the chemotherapy drug reaches them and can help to reduce hair loss. This can be uncomfortable to wear as it can feel heavy and very cold on your head and must be worn for a prolonged period of time. Your doctor (or, if you have one, your breast cancer nurse) will be able to advise you further if this is an option you are considering. Breast Cancer Now also have a range of information on scalp cooling.

There are lots of things which you can do to manage hair loss in the longer term.

Things you can do to prevent further hair loss

  • Avoid washing your hair for 2 days after you have had your treatment.
  • Try not to wash your hair too frequently (no more than twice a week).
  • Wash your hair with luke warm water and use a gentle, unscented shampoo and conditioner.
  • Try gently massaging your scalp. This may encourage blood flow to the hair follicles.
  • Gently brush your hair with a wide tooth comb or soft hairbrush and avoid tying it back with hairbands if possible.
  • Avoid excess heat on your hair e.g. hair dryer, straighteners, curlers, heated rollers etc.
  • Avoid using strong chemicals or on your hair such as hair dyes, hair spray, relaxers, perms etc.

Things you can do if hair loss is permanent

  • Seek advice from a dermatologist. These are doctors who specialise in skin and some are experts in hair loss. You can ask your GP for advice on how to be referred or visit bhns.org.uk. Other non-medically trained professionals, known as trichologists, also specialise in hair loss and may be able to offer further information and advice.
  • Look after your scalp. The skin here is very sensitive so it is important to use a high factor sun protection and keep it covered when out in the sunshine. To prevent it from becoming dry and flaky, keep it well moisturised using an unscented moisturiser or natural oils (e.g. olive or almond oil). It is also important to keep your head warm and covered in cold weather too, since heat is lost from the scalp.
  • Speak to others in your situation. Breast Cancer Now’s Living with Secondary Breast Cancer meet-up groups include discussions relating to coping with hair loss as well as a practical session on eyebrows & eyelashes and hair & scalp care.
  • Experiment with a different look. You may decide that you would like to explore the option of wearing a wig or other headwear alternatives. Your hospital may have a service to support women through hair loss as a result of cancer treatment and they may be able to offer information, practical advice and even the opportunity to try on some wigs. Alternatively, your local cancer information centre will be able to direct you to services in your area.

Further information

Breast Cancer Now & Living Beyond Breast Cancer have a range of further information and practical advice for preparing for and coping with hair loss.

The charity Cancer Hair Care also have a wide range of information and support on their website.

Dry & itchy skin

Treatments used in secondary breast cancer can affect the skin in many different ways. You may find that it becomes sore, red, dry, more prone to spots or more sensitive to sunlight.

Dryness and itching are two commonly experienced side effects of treatments used in secondary breast cancer. Both can cause significant discomfort, distress and disruption to sleep and daily life. There are lots of different things that can be done to ease these symptoms.

Your doctor (or, if you have one, your breast cancer nurse) may also be able to prescribe or recommend a range of moisturisers or creams, depending on the cause, so it is important for you to let them know if these symptoms are bothering you.

Tips for coping with dry skin

  • Avoid washing with very hot water.
  • Gently pat your skin dry after showering or bathing and avoid scrubbing.
  • Regularly moisturise (at least twice a day) using a fragrance-free moisturiser, especially after showering or bathing.
  • Try to avoid using other fragranced products (e.g. soaps and shower gels) on the area of dry skin.
  • Protect your skin from the hot and cold – wrap up in cold weather and keep covered up in the heat.

Tips for coping with itchy skin

  • Avoid using any fragranced products such as creams, shower gels or perfumes. Washing with a moisturising emollient cream (e.g. aqueous cream or Diprobase) can be a much gentler alternative.
  • Apply fragrance free and alcohol free moisturising cream to soothe the area.
  • Anti-histamine medications, which can be bought over the counter, can also help to ease the itching. Speak to your doctor breast cancer nurse first before trying these.
  • Try to keep your living space cool. Feeling overheated can irritate your skin more.
  • Wear loose fitting cotton clothing rather than woollen or made-made materials.
  • Avoid washing your clothing or bedding with highly fragranced detergents or conditioners.
  • Keep your nails short to reduce the likelihood of scratching.

If you are finding that you need to scratch, you may find some of the following helps to soothe and distract you;

  • Gently pinching or tapping the skin around the area of itching.
  • Applying a cool moisturiser.
  • Pressing with a cool flannel or cold pack.

It is important to seek medical advice if your symptoms worsen. If your skin becomes very red and painful or if you notice any pus, please contact your hospital immediately.

Nail changes

Treatments such as chemotherapy and targeted therapies can affect the way your finger and toe nails look and grow. You may find that they have become flaky and brittle or develop ridges and white or dark lines. They may at times fall off altogether.

In secondary breast cancer, as treatment is ongoing, your nails may not get the chance to recover. However, there are lots of things you can do to manage these changes and protect them from further damage.

Should your nails become sore, swollen or painful to touch at any time, it is important that you contact your doctor (or, if you have one, your breast cancer nurse) as this may be a sign that you are developing an infection which needs to be treated.

Tips for coping with nail changes

Moisturise. Keep your hands and feet well moisturised and try using a nail-strengthening cream. Try moisturising the nails themselves with nail oils.

File. File your nails rather than cutting them. It is also a good idea to file them in one direction, rather than backwards and forwards, to prevent any further splitting. 

Take care of your cuticles. Keep your cuticles well moisturised and avoid cutting them.

Cover up. If you feel unhappy or self-conscious with the appearance of your nails, try painting them with nail varnish (avoid this if your nails are sore or splitting). Avoid wearing false nails as these can cause further damage.

Protect. Wear gloves to protect your nails when doing household tasks and make sure your shoes are comfortable and fit correctly.

Disclaimer: on this website you will find self-management advice to help you to manage a range of mild symptoms and side effects of secondary breast cancer and its treatment. Please ONLY use this advice if you are currently participating in the LIBERATE study. Otherwise, please follow the advice of your own healthcare team.

Page last updated: April 2020