Advanced Skincare FAQs with Dr. Sauder

As a general rule, keep your skincare routine as simple as possible – no serums, acids, toners, etc.

Historically, the point of toners was that cleansers would strip the essential oil off of the skin, because they were quite strong, and the point of toners is to replenish.  If you use a neutral based cleanser followed by a moisturizer, you do not really need that toner.

Serums are very nice, but they tend to have a lot of added ingredients, like retinol. However, some of the ingredients can be helpful like niacinamide, which is an anti-inflammatory.

Simple rule:  Gentle cleanser.  Good moisturizer.  Great sunscreen. 

The type of base (or “vehicle”) you a product is in—ointment, gel, lotion, or cream—affects how well it works. These terms describe different chemistries, but they can be compared by their viscosity, or thickness. In terms of eczema, the strongest vehicle, from a moisturization standpoint, is an ointment. The issue with an ointment is that it might not be cosmetically pleasing as it can be quite greasy and sticky.

The next best thing is a cream. They are rich, thick, and have a bit of weight to them when you actually scoop them up or put them in your hand. However, they might not rub in quite as nicely as a lotion, which people tend to gravitate to because pump dispensers make application easier and quicker. Lotions contain lots of water and very little oil. Because the amount of oil drops as you move from an ointment to a cream, then to a lotion, oil, or gel, these later products can actually be dehydrating rather than hydrating.

Yes! People going through cancer have skin that is equivalent to eczema. People with eczema have a higher propensity to developing allergies to a product they are using. Even outside of cancer, people come to my clinic experiencing allergies, and I say to them: “I think you are reacting to xxx product” … and they say: “That product? I’ve been using it for the last 20 years.”.

That is exactly right. No one is born with allergies in their skin. We all need to be sensitized to products first and certain treatments can make your skin more sensitive, and therefore make your skin have a greater ability to be sensitized to an allergen. You can use something a million times, and the million and one time, you become allergic to it.

Key signs you are allergic to something:

• If things are getting worse rather than better, when using a product
• If things are red, itchy, scaly, especially in the areas where you are applying the product

I also recommend the website www.producteliminationdiet.com . It’s a wonderful resource and Dr. Skotnicki is fantastic dermatologist. I learn so much from her all the time.

I feel that way too, and I know these products inside and out. Every time I go, I discover new products that I was not aware of.

In general, you want to treat your skin like a person who has eczema – but you don’t necessarily need to get products for “eczema”.

Key words to look for are:

• hypo-allergenic
• fragrance-free – not scent-free (there is actually a difference)
• PH balanced or PH neutral product

There are lots to avoid in the pharmacy or drugstore – especially the acne aisle. Over the counter and prescription treatments tend to be quite irritating . And, acne – or something that looks like acne – is the single biggest side effect that I need to manage as a dermatologist for people that have cancer.

So, you might see an acne-like rash on your skin, but it’s not a great idea to get a strong acne cleanser. Most of these cleansers have acids in them (salicylic acid, lactic acid, alpha/beta hydroxyl acids), which can be irritating to the skin and disrupt the skin’s PH and/or moisture barrier. 

The same caution applies to retinol products. The prescription‑strength form is a retinoic acid (the active acid version of vitamin A) that can cause significant dryness, redness, and irritation. Over‑the‑counter retinol is a milder, non‑metabolically active form, but it still tends to dry the skin, which is exactly what we want to avoid.

Cancer treatments can cause skin reactions that are worsened by sun exposure, regardless of skin pigmentation. Using sunscreen helps protect against harmful UV radiation and prevents these reactions.  

To protect your skin from the sun, it is recommended to apply sunscreen every day, all year round, regardless of the weather. This is because UVA rays are present throughout the year and throughout the day, and they can even penetrate windows. 

If you go outside and engage in physical activities, it’s important to re-apply sunscreen frequently and generously – at least once every 2 hours, and immediately after heavy sweating or swimming. 

When choosing a sunscreen, select one with SPF 30 or higher to protect against UVB, and make sure it is labeled “Broad Spectrum” or shows the UVA symbol to ensure UVA protection as well.  

Apply sunscreen about 20 minutes before sun exposure for maximum effectiveness, and if using a moisturizer first, let it fully absorb to avoid diluting the sunscreen. 

It’s crucial to remember that UVA rays are present year-round and can penetrate windows, while UVB rays are more intense and primarily cause sunburn. For this reason, sunscreen should be applied daily, even when indoors near windows, to protect skin that may be more vulnerable due to cancer treatments. 

If a product is labeled “mineral”, it almost always contains zinc, titanium, or both. Some brands also include chemical filters in mineral formulas, but these filters aren’t inherently bad. In fact, many are safe and well-tolerated. Mineral sunscreens offer excellent protection, though they can be harder to blend in, especially over larger areas of skin.

UV-protective clothing is very effective for sun protection and is strongly recommended for anyone spending long periods outdoors or swimming, since water can wash off or reduce the effectiveness of sunscreen. A wide-brimmed hat offers better coverage for the face and neck than a baseball-style cap. Keep in mind that UPF fabrics can thin and lose effectiveness over time, so they will eventually need to be replaced. 

For cancers other than skin cancer, the skin is not the intended target of radiation; it is more of an “innocent bystander” as the radiation passes through to reach deeper tissues. When the skin itself is not the target, regular moisturizing before, during, and after treatment is often encouraged to help support the skin barrier. Some cancer centres also follow protocols that include a topical steroid to reduce inflammation, and this does not interfere with the effectiveness of the radiation. 

Certain targeted therapies can cause severe acne-like eruptions, known as acneiform eruptions. In these cases, over-the-counter products are usually not effective, and medical intervention is required. 

For adults not on these specific medications, acne can still flare due to underlying tendencies, particularly when the body is under stress. If you notice acne while on treatment, it is important to discuss it with your physician or oncologist first to determine whether it is a treatment-related side effect.  

If it is not linked to your therapy and is a flare of pre-existing acne, your family doctor or dermatologist can provide targeted care. There are many effective interventions for adult acne, including prescription medications and specialized topical treatments, tailored to the type and severity of acne. 

Skin changes are common during cancer treatment and can significantly impact quality of life. About two-thirds of patients say the effects are worse than expected, and around half will experience a treatment interruption or discontinuation because of skin issues. 

If your skin reaction is affecting your cancer therapy and quality of life, see a dermatologist familiar with treatment-related reactions. Often, these skin conditions are a sign the therapy is working, so stopping treatment unnecessarily can be harmful. Proper management can help you stay on therapy while protecting your skin. 

Whether or not you are experiencing hair loss, it’s recommended to use an anti-dandruff shampoo twice a week. Massage it into the scalp and let it sit for 2–5 minutes. These shampoos are anti-inflammatory and soothing. 

If you still have hair and experience redness or itchiness despite using the shampoo, a prescription anti-inflammatory lotion (usually a topical steroid) can be used. Apply nightly until symptoms improve, then gradually reduce frequency. 

For a hairless but itchy scalp, continue the anti-dandruff shampoo and follow with a rich moisturizer, cream, or balm to soothe the skin. 

Tea tree oil has anti-inflammatory and anti-microbial properties, so it can help with scalp irritation. However, some people may develop an allergy to tea tree oil, and many tea tree shampoos contain fragrances that can also cause reactions, so it’s advised to monitor your scalp for any worsening symptoms. 

For chemotherapies that cause anagen effluvium (hair loss), using an anti-dandruff shampoo twice a week can help keep the scalp healthy. Minoxidil (5% foam, brand name Rogaine) may also be useful—applied twice daily for men and once daily for women. Vitamin supplements can be beneficial as well. For certain chemotherapy regimens, a scalp cooling cap can help reduce hair loss, and there is data supporting its effectiveness. 

Nail changes during treatment can range from general issues like brittleness, cracking, or Beau’s lines—often related to stress—to more specific reactions from certain medications, such as painful inflammation of the nail bed. These problems can be distressing and significantly impact quality of life.

To care for your nails, stick to the basics: use a gentle soap (bring your own to public restrooms if possible), moisturize regularly, and wear gloves to protect your nails from trauma.

For general issues like brittleness or breaking, over-the-counter nail-strengthening lacquers can help. High doses of biotin are best avoided during treatment, as they can interfere with some lab results. 

It depends on the type of treatment. With hormonal therapies, the skin may experience lasting changes. For traditional chemotherapy, the skin usually returns to normal shortly after finishing treatment and once any reactions have subsided.