# Skin and nail care during chemotherapy and targeted therapy

Source: https://onco.cc/protocols/skin-and-nail-care-during-cancer-drug-treatment/  
OnCo record `skin-and-nail-care-during-cancer-drug-treatment` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Many cancer drugs dry the skin; some cause an acne-like rash, sore nail folds or red, painful hands and feet. Gentle washing in lukewarm water, a thick fragrance-free moisturiser, gloves for housework and careful nail trimming help; with some targeted drugs the team prescribes preventive creams from day one. Tell the team early about a rash or sore nails, and urgently about a rash with wheezing.

## Summary

The MASCC EGFR inhibitor guideline (2011, the most recent MASCC guideline on this that could be read) is the only graded source read in full. For acne-like rash it recommends prevention from the start of treatment: hydrocortisone 1% with moisturiser and sunscreen, plus doxycycline 100 mg twice daily (or minocycline 100 mg daily) for the first 6 weeks, on randomised data (systemic tetracyclines level II, grade A; topical regimen level II, grade C). For dry skin it recommends tepid bathing with mild moisturising soap or bath oil, regular moisturising creams, and avoiding extreme temperatures and direct sun (level III, grade B); thick occlusive emollients in a tub, avoiding alcohol-containing lotions, retinoids and benzoyl peroxide. For fissures, protective footwear and avoiding friction (level III, grade B). For paronychia, dilute bleach soaks (level II, grade A), comfortable shoes, careful nail trimming and gloves for cleaning. For hand-foot syndrome, a 2026 comparison of six guidelines found five of six advise avoiding chemical and physical stress to the hands and feet and using alcohol-free moisturiser; only ESMO, BC Cancer and eviQ recommend oral celecoxib for capecitabine. NCI's patient booklet (2023) gives matching ungraded advice. The ESMO 2021 dermatological toxicity guideline could not be read.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: skin care on chemotherapy; EGFR inhibitor rash care; acneiform rash prevention; paronychia prevention; hand-foot syndrome skin care; nail care during chemotherapy; dry skin on targeted therapy

## Connected records

- protocols: [Sun protection during and after cancer treatment](https://onco.cc/protocols/sun-protection-during-and-after-cancer-treatment/)
- drugs: [Afatinib](https://onco.cc/drugs/afatinib/), [Capecitabine](https://onco.cc/drugs/capecitabine/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [Erlotinib](https://onco.cc/drugs/erlotinib/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [Gefitinib](https://onco.cc/drugs/gefitinib/), [Panitumumab](https://onco.cc/drugs/panitumumab/)
- terms: [Hand-foot syndrome and hand-foot skin reaction](https://onco.cc/terms/hand-foot-syndrome/), [Rash and skin toxicity (acneiform rash, paronychia)](https://onco.cc/terms/rash-skin-toxicity/)

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