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Sometimes the 36-year-old cancer patient lets herself remember when she had the energy to "run around with her kids like a maniac" and stay up until the early hours of the morning. That was before a recurrence of Hodgkin's disease forced her to begin the chemotherapy treatment that left her nauseated, fatigued, somewhat dispirited, and bald.
Before chemotherapy, Sharon (who asked that her last name not be used) had beautiful jet-black hair. Now she keeps a strawberry blond wig handy for those times she says she "needs a good laugh" to help her "escape" from the side effects of chemotherapy, as well as the reality of having cancer.
"The wig has bangs coming down. I never used to wear bangs." she says "Sometimes I put on long, dangling earrings with the wig and some cosmetics that they gave me when the hospital made me up. It's pretty funny because I'm not the kind of person that used to use all this stuff."
Her mother, Dorothy (who asked that her last name not be used) helped coax Sharon from her hospital room to the "Look Good....Feel Better" workshop at North Shore University Hospital, Manahasset, N.Y., where she was receiving her treatment. Dorothy says her daughter was quite skeptical and felt she didn't want to be bothered with having anyone teach her individualized skin care and makeup techniques, or how to work with wigs, turbans and scarves.
But once they started working on her, "Sharon got such a kick out of it and laughed for hours afterwards. The thing a mother looks for is her child's happiness." says Dorothy. "While having your child having cancer is not happy thing, for those moments, Sharon's smile was my smile, too."
The notion that it's hard to weather going through an arduous course of radiation or chemotherapy treatment without looking good and feeling good about oneself has gained scientific respect, according to Julia Rowland, Ph.D, director of psycho- oncology research, Georgetown University Medical Center, Washington, D.C.
"Looking good despite what we may be going through can help one take control again and can be a critical component to the healing process by providing powerful psychological benefits," says Rowland.
The "Look Good....Feel Better" course, available to Sharon and others around the country, was developed jointly for national use by the Cosmetic, Toiletry, and Fragrance Association (CTFA) Foundation, the National Cosmetology Association, and the American Cancer Society nearly three years ago. It's an attempt to help patients learn to minimize the side effects of cancer drugs and radiation treatment, which can cause changes in hair, complexion, and nails.
"Look Good...Feel Better" teaches hands-on beauty techniques in group or one-on-one makeover workshops conducted by specially trained, volunteer cosmetologists in hospitals, community centers, and salons.
According to Carolyn Deaver, vice president, CTFA Foundation, the program is also operating in Australia and will be launched in Canada this year. Though the current program is geared for women, a similar program for men undergoing cancer treatment is expected to be developed.
If a patient is unable to attend a makeover workshop, there is a video and brochure available free of charge, which can be used at home.
Here are some of the problems that these programs and pamphlets tackle.
Drugs capable of killing cancer cells can also attack normal cells. This accounts for many of chemotherapy's unpleasant side effects.
Hair loss, although temporary, and not always a side effect of chemotherapy, is often cited by patients who experience it as the most devastating cosmetic side effect of chemotherapy.
"Every time I pass a mirror and look at my bald head," says 43-year old Corrine Wenze of South Farmingdale, N.Y., "it's a constant reminder of my disease. Even when I look at babies I cringe because they remind me I have only about six loyal strands of my own hair."
Wenze says that when she first found out she had breast cancer she "wallowed very well by playing video games for nearly a month. I wanted to fall into a hole and disappear. I didn't believe I could have cancer."
She continues, "You know the surgeon sent me home without my breast and then sent me through cancer treatment. It wasn't until I went to the "Look Good....Feel Better" program that I picked up. They made me feel more cared for by caring for me and then showing me how to care for myself."
Rowland says losing one's hair is often the first overwhelming confrontation patients have with their illness. Until that point, they might have easily hidden their disease from everyone, including themselves.
According to cosmetologists, the best time to start looking for a wig is before the first chemotherapy treatment. Synthetic wigs are the easiest to maintain because they don't need to be set and are not affected by humidity like natural hair. They're also less costly than natural hair wigs.
Bijan Safai, M.D., chief of Memorial Sloan-Kettering Cancer Center's dermatology service in New York City, says that in most cases patients' hair begins to grow back within a few weeks after their chemotherapy treatment ends. But if a wig does not fit right and exerts excessive pressure at certain points, the hair follicles at those points will die and hair will never grow back. So he recommends wigs that don't need to be glued or taped down and don't require elastic bands that hold them tightly against the scalp.
Frequently, the cost of a wig is reimbursable by third-party payers if it is prescribed as a "cranial prosthesis" by a physician. Other options cancer patients can consider are brightly colored scarves, turbans, or hats.
William Cahan, M.D., senior attending surgeon at Memorial Sloan- Kettering, says many of his male patients choose to wear hairpieces close to their natural hair color and style while undergoing cancer treatment. However, some prefer to have fun wearing hats such as French berets and beanies with propellers. Like Sharon choosing to wear a strawberry blond wig, these men seem to get through their treatment by self-kidding.
Chemotherapy is easier on the skin than on the hair. Even so, whatever a person's skin type, chemotherapy will make skin drier because the drugs interfere with oil and sweat glands. Keeping skin as moist as possible during treatment is important to keep it looking young and healthy. Moisture can also prevent cracking and chapping, which can lead to infection in the cancer patient, whose immune system is suppressed.
Cancer patients are advised never to pull, tug or scrub the face too hard. Overzealous cleansing can strip away the remaining natural oils. Soap-free face cleansers that gently cleanse makeup and oil without drying skin are preferable. Safai recommends using an antimicrobial soap, however, to effectively clean areas like the armpits and genitals, which are prone to infection.
Moisturizing day and night can slow down the skin's loss of moisture by leaving behind a filmy deposit of oil. The oil not only helps retard the moisture evaporation, but it also makes the surface of the skin softer and more pliable. This may be especially important for hands and soles of the feet, which may become sore and blistered. Rubber gloves should be used when doing household chores.
Cancer patients are advised to moisturize with products containing sunscreens with a sun protection factor (SPF) of at least 15 because people undergoing chemotherapy may be more sensitive to harmful ultraviolet rays. (For more on sunscreens, see "Cool Tips for Summer Safety" in the June 1992 FDA Consumer.)
Dry, chapped lips can be helped with nonpigmented lip balms or petrolatum-based products, according to Harley Haynes, M.D., a dermatologist with Brigham and Women's Hospital and Harvard Medical School. He recommends using lipsticks only when lips are in good condition. Chemotherapy may also affect nails, retarding their growth and, in many cases, causing them to become thin and brittle and develop horizontal grooves.
It's not a good idea to cover the nails with acrylics or other types of wraps, says Haynes, since these materials can trap bacteria that may cause infection. Instead, the nails can be clipped short and moisturized with lotions. A light-color nail polish will camouflage any nail imperfections. But to prevent nails from drying out, only non-acetone-based nail polish remover should be used.
Cancer patients who have professional manicures should bring their own implements to guard against infection. Cuticles should be pushed back rather than cut.
Radiation treatment, unlike chemotherapy, affects only the skin that is irradiated or close to the point of irradiation. Its most common effect is brief, intense sunburn-like reaction that causes blistering, says Alan Lorincz, M.D., professor of dermatology, University of Chicago, Pritzer School of Medicine.
Sometimes, however, a chronic skin condition may occur in which the treated skin thins and loses elasticity and may become lighter or darker. This skin needs to be treated especially gently with emollients and sunscreen products with a high sun protection factor. It can be expected to be more susceptible than the rest of the person's skin to chronic irritation and breakdown.
During chemotherapy and radiation treatment skin will, in general, become more sensitive to allergens or irritants. So cancer patients are advised not to share any of their hygiene products with anyone else and not to use old products that have changed in appearance, odor, or texture.
In general, it's not a good time to experiment with new brands of products, unless products usually used become irritating. Some cancer patients, however, want to experiment with cosmetics to try to camouflage certain facial effects of cancer treatment, such as skin discolorations, blotchiness, dark circles under eyes, or loss of eyebrows and lashes. Experts advise trying out only one product at a time for several days before starting a second new product.
After taking the necessary precautions (see next section), cancer patients will find that cosmetics can be important tools, says Rita Davies, a volunteer cosmetologist with the American Cancer Society.
Foundation and concealer are good for evening out skin tone. Eye crayons applied in a feathery motion can give the appearance of lashes, and brow powders can create natural-looking eyebrows. Mascara that has a wand with a little comb can help give body to the remaining eyelashes.
Cosmetics can give a lift not only to the face, but to a cancer patient's outlook on life. As Rowland says, "I think we underestimate the impact of outward appearances. If we put on a costume we feel differently about ourselves. Similarly, cosmetics are a way to fortify the self during chemotherapy or radiation."
Though cosmetics generally have a lengthy safety record, this does not mean that a consumer should assume the products they're using are absolutely free from risk, says John Bailey, Ph.D., of FDA's division of colors and cosmetics technology. He reminds shoppers that the law does not require pre-market approval of cosmetics products by the agency, although "untested" products must be labeled as such.
Individual cosmetics companies are responsible for ensuring that their products are safe for use by the consumer and have a great deal of freedom in how they formulate their products. (See "Cosmetic Safety:More Complex Than at First Blush" in the November 1991 issue of FDA Consumer.)
When purchasing cosmetics, he says, it is very important to read the label for a description of the product, including its ingredients, and any warning statements about the use of the product. Besides reading the product label, Bailey advises consumers to exercise good judgment in purchasing and using cosmetics products. For example, old products, or products that are inadequately preserved, may become contaminated with microorganisms. Never purchase a product that doesn't look or smell right and don't share cosmetics with other people or "wet" products with saliva.
Persons undergoing medical treatment, such as chemotherapy, should consult their physicians if they have experienced allergic reactions to cosmetics in the past, or if they notice any unusual reaction after use.
Cheryl Platzman Weinstock is a freelance writer in Long Island, N.Y.
U. S. Food and Drug Administration
FDA CONSUMER, July/August 1992
Hypertext updated by dms/kwg 2002-MAR-07