Skin Care and Diseases

Dry skin treatment following treatment

05/21/2001 08:42PM

Question:

My husband was diagnosed with neuroendocrine tumors in June, 2000. Since that time we have found these tumors are in his liver, pancreas, lymph nodes and bones. He has received radiation treatment in January, chemotherapy in February and March, Sandostatin injections in October, November, December, and January, and again this month. He is taking Dilaudid for pain. The question I have deals with the occurrence of very dry skin all over his body. He has tried various lotions but they are not really changing anything. Is there anything available by prescription or over the counter that will help him to restore moisture to his skin.

Answer:

Although certain chemotherapy agents and radiation may cause dry skin, based on the available information I am unable to determine if they contributed in this case. Dry skin is not a know side effect of either of your husband`s current medications. Sandostatin may occasionally cause other dermatologic side effects including injection site pain, flushing, edema (swelling), itching, and rash. I will forward this question to the dermatology division for further insight.
Dermatology consult
Your husband sounds like he has acquired ichythosis or fish skin. Ichythosis is manifested as very dry skin with large scales that resemble fish scales, hence the name. It can be rather uncomfortable. Multiple endocrine neoplasia and other neuroendocrine tumors are not associated with very dry skin or ichythosis to my knowledge.
You mention that your husband does have tumors in the pancreas. It is possible that these tumors have interfered with the function of his pancreas. Or that radiation to the abdominal area caused damage to the pancreas. If his pancreas is damaged by any cause, he might not digest and absorb his food normally. He might develop an essential fatty acid deficiency which is manifested as ichythosis. Your doctor can do many tests to determine if your husband is absorbing his food. If he is not absorbing his food adequately, then it is possible to administer these essential fatty acids by intravenous route. If this idea were correct, his skin will return to normal.
There is another syndrome caused by tumors in the pancreas in which the alpha cells produce a hormone. The skin develops a dry, scaly appearance. This syndrome is called necrolytic migratory erythema. Your doctor can test for it by determining how much gastrin is in his blood.
If none of these causes are correct, then there are several ways to minimize the effects of dry skin. What is making the skin dry is absence of water. So daily soaks in a very pleasant bath is very helpful. After soaking for 15-30 minutes keeping the water feeling pleasant, the person pats his skin dry.
There are two creams that can be applied to the moist skin. The first is vaseline applied in a very thin coat. It will trap the water in the skin and prevent it from evaporating. It is good for this problem but if too much is applied, the skin becomes greasy. It is important to apply the thinnest possible coat.
Another agent that can be applied is LacHydrin. It has agents that help hold water in the skin. It is used by those with dry skin. I still recommend the baths first and then the application of LacHydrin. You can try both agents and see which is preferable to your husband. You do need a prescription for LacHydrin that you can get from your family doctor.
It would be good to reapply either the vaseline or LacHydrin (not both) again before retiring.
I hope that these comments are helpful.

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Response by:

James J. Nordlund, MD
Professor
Department of Dermatology
College of Medicine
University of Cincinnati