Restoring the Moisture Barrier: Proper Epidermal Hydration for Oncology Clients

Written by Melissa Montalvo and Karym Urdaneta, Pink Horizons Botanical Skin Care™

One of the greatest contributors to aging is environmental damage. Whether one is exposed to nature's elements or relentless air pollution, the skin is constantly trying to protect itself. Without proper care, aging accelerates and the risk for potential skin disorders increases. Maintaining the skin's barrier function is of the utmost importance to defending it against free radicals, transepidermal water loss (TEWL), inflammation, and infection – all of which contribute to accelerated aging.

The average person will find that maintaining the skin's moisture barrier is an ongoing challenge that takes discipline and vigilance. Now, imagine being exposed to bouts of radiation therapy and bombarded with cytotoxic drugs. A day in the life of a client undergoing oncology treatment can leave traumatic effects on the skin – posing a stark challenge to cope with inherent environmental challenges. Taking preemptive measures by creating a straightforward plan of management that focuses on gentle treatments, comfort level, safe and nutritious products, and a temperate reminder to supplement the body internally can greatly reduce a client's recovery time and lessen the overall stress involved with such a difficult experience.

ingredientsA Compromised Stratum Corneum
It has long been known that the skin's outermost layer, the stratum corneum, contains cells made up of structural proteins that keep the skin hydrated by not only absorbing water but by also preventing water evaporation, thus forming the skin's moisture barrier. Working in unison with the acid mantle, the moisture barrier serves as the skin's single most important defense against not only accelerated aging, but severe skin disorders. The National Cancer Institute warns that skin changes can occur just a few weeks after radiation therapy begins and can have lasting effects even after therapy treatment is over. This leaves the skin more vulnerable and sensitive to the sun and maintaining the moisture barrier becomes increasingly more difficult. On the same hand, chemotherapy reduces the amount of oil that the glands secrete, creating an extra challenge to keep the skin's natural barrier hydrated.
The skin's barrier function is regulated by the pH of the acid mantle. Skin becomes more vulnerable during and after therapy treatments due to a compromised immune system which directly affects the skin's antimicrobial defense system. It is crucial to keep the skin at a well-balanced pH of between 4.5 and 5.5 in order for the acid mantle to protect the stratum corneum from bacterial and fungal infections. Common skin disorders that occur as a result of pH fluctuation include xerosis (severe dryness), phototoxicity, pruritus (itchy skin), redness, hyperpigmentation, cracking, peeling, tenderness, lesions, edema, burning, and blistering.

A Tailored Approach
Raj Anderson, a licensed medical aesthetician with advanced training in oncology aesthetics as well as oncology massage, practices at Boca Raton Regional Hospital's Davis Therapy Centers providing both inpatient and outpatient services and follows essential guidelines and principles that lend to successful treatment of her clients. Her experience with providing oncology spa services has given her insight into the most effective methods of treatment for maintaining the skin's moisture barrier, thus assisting her clients to preserve quality of life during the healing process. Anderson advises that good hydration and nutritional topical skin care products are necessary for any pre- and post-treatments and of course, "supporting the protective barrier by keeping the skin well hydrated before surgery is vital to its healing and recovery." She insists that nothing should be applied within the first two hours of radiation treatment as it could interfere with its effects. Furthermore, skin care professionals should avoid excessive rubbing or pulling on the skin and be gentle when removing products.

oncology-clientProduct Selection
Skin care professionals should always select gentle and safe skin care products taking into account the client's preexisting skin allergies. Use products high in natural moisturizing factors (NMFs) such as jojoba, sesame, calendula and sweet almond oil. No alcohol based products, perfumes or abrasive physical exfoliants should be used. recommends the use of a heavier weight moisturizer, particularly one that is aloe based, and more frequently than usual. It is of critical importance for clients to protect their skin from the sun, using products that block both UVA and UVB rays. Here is a list of general product guidelines: products should be free from toxic chemicals; gentle, mild and non-irritating; anti-inflammatory; moisturizing and hydrating; hypoallergenic and non-comedogenic; fine, certified natural oils; certified organic essential oils diluted to very low percentages (less than or equal to 0.5 percent); and a safe broad spectrum sunscreen with a minimum of SPF 30.

Unique Circumstances
The effects of radiation and chemotherapy can be reduced significantly with proper care. Understanding the needs of oncology clients allows one to guide them confidently with a plan that will help them to make the transition and overall experience less traumatic. Andersen takes note that a healthy body can help to support a speedy recovery. Therefore, it is important to remind clients that internal nourishment and adequate hydration is crucial to their skin's health and overall healing process. Anderson insists that oncology clients must be aware that dehydration produces crystallization of lipids on the skin, causing a rough, dry stratum corneum. Oncology aesthetic treatment services should be specifically tailored to address each individual's needs, reactions to the cancer therapy and medical history. She also advises skin care professionals to initiate a spa treatment plan, using a gentle approach, that includes the hair and scalp which is part of the body's defense system to clients prior to their oncology therapy. This, along with a compassionate customer care approach, is essential for providing these special clients with the most effective treatment possible.

Andersen, Raj. Personal Interview. June 24, 2013., "Skin Care."; accessed on June 5, 2013.
National Cancer Institute, "Radiation Therapy and You."; accessed on June 3, 2013.
National Cancer Institute, "Side Effects and Ways to Manage Them."; accessed on June 3, 2013.

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