In professional skin care, we hear and talk a lot about age management, acne and sensitive skin, but there’s a new kid on the block that is rising fast in our client populations: medically compromised skin. This term refers to reactive skin caused by a combination of illness, medications, stress and lifestyle. Let’s break it down.
Illness and Medications
Medically compromised skin starts with disease or illness, and then all the medications prescribed to treat it. In the U.S., unfortunately, we are experiencing a health crisis right now.
In fact, as you are reading this, I am sure someone from your circle popped into your head. Sadly, we all likely know someone suffering from illness; if not, we certainly have them as clients.
The CDC reported this year that 6 in 10 Americans have some sort of chronic illness or disease, like diabetes, stroke, Alzheimer’s, lung or kidney disease, to name a few. Further, 4 in 10 Americans have two or more of the leading causes of death (heart disease or cancer).1 In 2022, we saw an increase in cancer by 8% to 300%, depending on the type of cancer.
The bottom line is that a lot of people are dealing with some sort of health crisis, and most of them are prescribed multiple medications.
With that in mind, polypharmacy is defined as, “The increase of risk of adverse reactions to medications.” According to U.S. Pharmacist, patients taking five to nine medications have a 50% chance of an adverse drug reaction, increasing to 100% when taking 20 or more medications.2
Cutaneous adverse drug reactions (CADR), also known as toxidermia, are skin manifestations resulting from systemic drug administration. They are a common public health problem affecting about 10% of hospitalized patients.3 Another study noted that in that in a group of 97 patients, 46.4% of them had a cutaneous reaction,4 and PubMed notes that pharmaceutical companies report the incidence of reactions are 1% to 3% of multi-medicated patients.5
CADR or urticarial toxidermia typically presents in two different ways. It can be immediate, within one to two hours after the start of the treatment, or it can be delayed, which usually occurs several days after the drug administration. Medications most known to cause adverse cutaneous reactions are:
- Antibiotics,
- Non-steroidal anti-inflammatory drugs (NSAIDs),
- Anti-seizure drugs,
- Allopurinol (for gout),
- Diuretics (for heart, kidney, liver failure,high blood pressure),
- Statins (cholesterol-lowering),
- Blood thinners (for heart, blood clots),
- Vasodilators (for heart, blood pressure),
- Cytotoxic drugs (anti-cancer medications),
- Immune-modulating drugs (anti-cancer medications).
Common Presentations
Hives, urticaria and pruritis are among the most common CADR reactions. The medication causes an allergic reaction, and CADR most commonly presents as skin rashes, itching or reactive skin.3
Allergic reactions start in the immune system as a chain reaction while the body is defending itself from the foreign object or medication. This response produces antibodies called immunoglobulin E (IgE) specific to the drug being given. The antibodies then travel to the cells that release chemicals and trigger an immediate allergic reaction, which causes symptoms in the nose, lungs, throat, sinuses, lining of the stomach or on the skin. This type of reaction usually occurs within hours of taking the medication.
Medications that cause the expansion of T cells usually result in a more delayed immune response of itchy rashes that can occur days to weeks after exposure to the drug. This sometimes makes it more difficult to link the cause.
Another reaction related to medications is photosensitivity, in which the person is sensitive to the sun. They need to know this so they can protect themselves from a sunburn and potential skin damage. So, avoiding sun exposure and educating your client on safe and proper SPF is key. You should also avoid using certain spa equipment, such as LED and laser devices.
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Becky Kuehn is the founder of Oncology Spa Solutions and the author of the "Life-Changing Esthetics" course. Her mission is to find ways to help with the devastating side effects of cancer treatments and deliver help to those in need.
