Cancer Treatment and the Skin Barrier with Dr. Barbara Paldus of Codex Labs

Send us Fan Mail

Dr. Barbara Paldus of Codex Labs joins Skin Anarchy to explain how cancer treatments affect the skin barrier and what gentle supportive care can look like. This episode is educational only, not medical advice, and everything here should be run by your oncology team first.

What is the skin barrier?

Not one wall, but a living defense system. Dr. Paldus describes five interconnected barriers: physical, chemical, microbial, immunological, and neurosensory. "We go from the physical to the chemical to the microbial to the immunological and to the neurosensory." Each one, she notes, affects the others.

Why do cancer treatments affect the skin?

Because treatments target rapidly dividing cells, and skin renews constantly. Chemotherapy, targeted therapy, immunotherapy, hormonal therapy, and radiation each hit renewing tissue differently. "Any tissue in your body that is continuously renewing itself, like your skin or your gut, will be affected," Paldus explains, which can slow repair, reduce oil, and disrupt the microbiome.

What is radiation dermatitis?

The skin reacting within the area exposed to radiation, from mild redness and dryness to burning, peeling, tenderness, or breakdown, usually building gradually over sessions. "It may not happen during your first treatment, but it can happen maybe on the second or the third one," Paldus says, stressing the radiation team must monitor it.

What is hand foot syndrome?

Redness, swelling, tingling, and pain on the palms and soles during certain treatments. Because hands and feet face the most friction, heat, and pressure, symptoms can disrupt everyday life. "They can interfere with walking, putting on your shoes, exercising, cooking," Paldus notes, advising patients to report it early.

What skin symptoms during cancer treatment need urgent attention

Several warrant immediate care. Paldus lists rapidly spreading rashes, extensive blistering or peeling, severe pain, open or draining wounds, honey colored crusts, and fever or chills with a skin problem. "Any kind of swelling, especially facial swelling or lip and tongue swelling," plus trouble breathing, means emergency care.

What does a gentle skincare routine look like during cancer treatment?

As simple as possible: lukewarm water, brief showers, fragrance free cleansers that never leave skin tight, patting dry, and moisturizing within three minutes. "When you start cancer treatment, that is usually not the ideal time to experiment with multiple potent active ingredients." The keyword is monitor.

Is "natural" skincare safe during cancer treatment?

No, not by default. Paldus is direct that a natural label guarantees nothing, and that formulation matters more than any single word on a label. "Natural ingredients can irritate the skin, cause allergies, or interact with the treatment just as much as synthetic materials." She urges fragrance free products, patch testing on intact skin, and clearing any routine with the team.

How should you manage itching during cancer treatment?

Gently, and with a threshold for escalation. Mild dryness and itch can ease with moisturization, soft clothing, cool compresses, and short fingernails to limit scratching. "If it's persistent or intense, that can also be a reaction to medication," or a sign of deeper issues, Paldus cautions, meaning it needs medical evaluation.

What is the one thing to remember about skin care during cancer treatment?

That the skin is a system to support, not a surface to treat alone. Paldus frames supportive care as improving comfort and quality of life while staying coordinated with the oncology team. "The skin is a prote