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Oncology Esthetics: Hair Removal during Cancer

Written by Morag Currin on August 2nd, 2018.      0 comments

Today involves the increasing popularity of body modification, including partial or complete removal of body hair. The methods used to remove body hair include shaving, clipping, waxing, epilation, depilatory creams, laser hair removal, electrolysis, sugaring and threading. Many of these methods cause trauma that can provide an entry point for infection. And yet, for someone diagnosed with cancer, hair removal typically takes a back step while treatment for cancer takes precedence.

If a spa professional is not educated to work with people that are living with cancer, a simple misjudgement can become unsightly and can cause harm.

Today, with improved procedures and products for hair removal two keys issues still exist: pain and trauma by heat, friction or both. So, when dealing with your client that is living with cancer, a lot more thought needs to be put into these hair removal services.
 
Viruses
Several viruses are linked with cancer in humans. Our growing knowledge of the role of viruses as a cause of cancer has led to the development of vaccines to help prevent certain human cancers. These vaccines can only protect against infections if they are given before the person is exposed to the cancer-promoting virus.

Human papilloma viruses (HPVs) are a group of more than 150 related viruses. They are called papilloma viruses because some of them cause papillomas, which are more commonly known as warts. Some types of HPV only grow in skin, while others grow in mucous membranes such as the mouth, throat, or vagina. HPV has been shown to reside on pubic and perianal hairs. Traumatic hair removal in these areas might result in an infection and subsequent clinical manifestation of HPV.

All types of HPV are spread by contact (touch) and are highly contagious. Awareness about the possibility of spread of cutaneous warts (caused by the human papilloma virus) following temporary hair removal methods, such as shaving, waxing, threading, and using depilatory creams, needs to be taken seriously so any person providing a service of hair removal can practice safety measures.
 
Surgery 
When a person is having a surgical procedure in an area of the body that is covered with hair, patients are urged to leave the area of their surgery to the medical team who can complete the task effectively with sterilized clippers.

Professional services
If waxing is preferred the client should check with medical team prior to surgery regarding their policies regarding hair removal and how long prior to surgery this must be done. Any burns or skin removal can create a sore, hence an infection risk. If waxing is a first time option for the client they need to take into consideration possible pain and irritation. Any adverse reactions can cause possible cancellation of the surgery.

Tweezing
Tweezing can be time consuming so it is relatively safe if done correctly without causing any broken skin. Tweezers need to be well sanitized.

At home
Shaving can cause tiny cuts and abrasions and where skin is damaged, bacteria can grow and multiply which can then infect the nearby surgical site. A blade that has not been sterilised also creates a risk by exposing the skin near the surgery site to harmful bacteria. Shaving can also cause folliculitis, an infection in the hair follicle usually caused by the bacteria Staphylococcus (staph) or a fungus.

Depilatories can also irritate the skin so using this cream would not be a good idea prior to surgery if this have never been used before.

It is, however, recommended that patients shower or bath the day before or on the day of surgery to ensure the skin around the incision site is as clean as possible to prevent any surgical site infections. Obviously serious infections of surgical wounds can extend a hospital stay, cause long-term disability and even life-threatening conditions.
 
Chemotherapy
Not all chemotherapy drugs cause hair loss. Some cause hair thinning or partial hair loss. From a psychological standpoint, hair loss is one of the most feared side effects to treatment so be aware hair loss is not a welcome side effect for many. Patients undergoing chemotherapy may have a weakened immune system which implies they are not ideal candidates for hair removal treatments.

Professional services
Waxing can be extremely painful for someone who is not feeling well during chemotherapy. It may hurt the client to have the hair pulled from the root, and the wax also adheres to their skin, taking skin cells with it as it's removed.

While that is a benefit for people with no health challenges, the client with a sensitive, fragile skin affected by chemotherapy drugs may get more irritation and inflammation. This can be exacerbated if the client has a reaction to the chemicals in the wax, and, if the wax used is too hot, there's also a risk of burning the skin. If the skin is not held taut when pulling the wax strips off, bruising may occur. Waxing would be high risk for the neutropenic and/or thrombocytopenic client. Also remember, another added skin side effect for this client is dry skin. If the skin is not properly hydrated, it could be more easily irritated and the risk for tearing the skin is higher.

The melanocytes can also be affected by certain toxic chemotherapy agents, and they can either produce hyperpigmentation, or they can trigger hypopigmentation. Medical tape when pulled off the skin can produce hyperpigmentation, so what do you think waxing can produce? Any aggressive wax formulations can ignite the melanocyte activity through cellular trauma, however, the melanocytes are already being affected by chemotherapy agent(s).

Sun protection is absolutely necessary post waxing services.
Tweezing uses no chemicals that touch the skin, so it's relatively safe. Removing hair from the root lasts about the same amount of time as waxing. Removing each hair individually using tweezers can be time consuming, and it may be the only option if the skin is experiencing side effects like itching, burning, peeling or stinging from other options. When tweezing, ensure the skin is held taut, or you may accidently grab the skin, causing broken skin.

Home care
Shaving brings about the same risks mentioned above.
The chemicals in a depilatory cream may irritate the skin causing burning, redness, inflammation, blisters, peeling, or a rash, especially if the cream is left on too long. The smell of these products can be quite offensive to a person undergoing chemotherapy.

After completing chemotherapy, some women can experience unwanted facial hair due to the menopause ‘kick in’. This hair can occur approximately one month after the last chemotherapy treatment. What is interesting sometimes this resolves on it’s own, other times the person actually gets the hair removed professionally or they do it themselves with an electric razor. Depilatories can irritate the skin as it may be too soon after completion of chemotherapy.
 
Biological Therapy
A group of biological therapy drugs such as: Cetuximab (Erbitux), Erlotinib (Tarceva), Gefitinib (Iressa) and Panitumumab (Vectibix) can cause hair loss on scalp; yet increased hair on face and eyelashes. Vandetanib (Caprelsa) can cause hair loss over the entire scalp and reduced hair on legs or arms; can increase the growth and curling of the eyelashes and eyebrows, and increase facial hair growth.
These changes don’t usually happen right away, but they may be noticed as treatment continues.

This group of drugs may not as many adverse reactions to hair removal, however, it must be noted that they can be administered in conjunction with chemotherapy.

Professional services
Waxing Is not recommended as it can irritate a sensitive skin and may be a cause for infection.
Tweezing is relatively safe if tweezers have no sharp edges.

Home care
Shaving could also present with a risk for infection, however, an electric razor would be a better option to remove any new or increased hair growth.

Depilatories
Depilatories may cause a reaction to the skin.
 
Hormone
Aside from the loss of elasticity, skin thinning and dryness, vellus hair on the face becomes a visible problem for women on hormone therapy drugs. Unwanted facial hair is very common in menopausal women. An increase in facial/body hair is called hypertrichosis.

This group of drugs may not as many adverse reactions to hair removal, however, it must be noted that they can be administered in conjunction with chemotherapy.

Professional services
Waxing may cause burning and tearing of the skin. Hot wax may be a better option than strip wax, however, it must be well determined by the spa professional whether the skin can handle any waxing.
Tweezing is relatively safe if tweezers have no sharp edges.

Home care
Shaving could also present with a risk for infection, however, an electric razor would be a better option to remove any new or increased hair growth.

Depilatories may cause discomfort and may irritate the skin.
 
Radiation Therapy
Radiation therapy will generally cause hair loss to the body part that is being treated therefore the area affected is localised. For example, if the client’s arm was treated with radiation, they may lose hair on their arm, but the hair on their head would not be affected by radiation therapy.

Hair loss may be temporary or permanent, depending on the total amount of radiation received and other treatments such as chemotherapy. When hair loss is temporary, it will likely re-grow within 3 to 6 months after treatment is complete. The re-growth of hair is often thinner or of a different texture.

Over time, a person who has undergoing external beam radiation therapy may experience fibrosis in the area of radiation. Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This can be a reactive, benign, or pathological state. In response to injury, this is called scarring.

In the case of fibrosis, hair is unable to grow through the hardened skin. This can lead to a cessation of hair production and the death of hair follicles.

Professional services
Waxing on areas of skin that has received radiation therapy may be thinner or a different texture. Be aware of any possible neuropathic pain which could be accompanied by loss of sensation. If hair growth is in an area of radiated skin, it is not advised to wax over this area. It would be like waxing over a sunburned area, yet over time the skin may be more fibrotic. The heat from the wax can ‘burn’ over a previous area of ‘burnt skin’.

Tweezing can be performed if hair is present.

Homecare
Shaving can be done using an electric razor in this area of localised skin if hair is present.

Depilatories can be used if skin can handle the chemicals and if hair is present.
 
Other cautions
The client who is taking steroid medication as part of cancer treatment may experience thin or fragile skin which can bruise and tear which may lead to infection. Any hair removal services that could cause tearing of the skin and create a risk for infection should not be done whilst using such medication, and not until three months after completing the treatment or when the skin has recovered somewhat to its ‘new normal’.
 
Immunosuppressed
If the client’s immune system is not functioning as well as it should, their body does not have the same level of protection against infection or against rogue cells that start to show cancerous changes. In addition, some of these immunosuppressive drugs can also predispose to skin cancer through other mechanisms specific to that individual drug.

Therefore, the client is at a much greater risk for developing skin cancer and a range of skin infections. Often these infections develop in unusual ways that can be easily missed unless the client is seen by a spa therapist with experience treating those immunosuppressed.

Hair removal techniques that minimize trauma to the epidermis, such as trimming or use of depilatory creams, should be discussed with patients who are immunosuppressed.

It has been suggested that approximately 60% of people with diabetes will develop cancer in their lifetime, so also knowing about diabetes can bring about a good (or not so good) outcome.

A report indicates that a person after experiencing Brazilian waxing landed up with the entire area denuded and bleeding once wax removed the hair. After examination a purplish-red plaque over the mons pubis extending to the inguinal folds was observed. At the border of this plaque, brownish-red planar verrucous papules were noted, and a diagnosis of epidermodysplasia verruciformis was given.

Folliculitis
Folliculitis is the name given to a group of skin conditions in which there are inflamed hair follicles. The result is a tender red spot, often with a surface pustule. Folliculitis may be superficial or deep. It can affect anywhere there are hairs, including chest, back, buttocks, arms and legs.
  • Eosinophilic folliculitis is a specific type of folliculitis that may arise in some immune suppressed individuals such as those infected by human immunodeficiency virus (HIV) or those who have cancer.
  • Bacterial folliculitis is commonly due to Staphylococcus aureus. If the infection involves the deep part of the follicle, it results in a painful boil.
  • Drug caused folliculitis may be caused by the intake of corticosteroids, protein kinase inhibitors (epidermal growth factor receptor inhibitors) and targeted therapy drugs Vemurafenib (Zelboraf), Dabrafenib (Tafinlar) for metastatic melanoma.
Moles
Raised moles and abnormal looking moles should not be shaved, nor hair removal services applied to these moles. Any abrasions on the skin, broken skin and bruises should not have hair removal services applied to those areas. Hair clipping can be performed and this is done by cutting the hair growth using a small razor comb and surgical scissors specifically for this purpose.

Spa professionals who specialise in hair removal can offer a valuable added service* when they recognise unusual moles. Since we cannot diagnose, we can provide this valuable added service, and provide a copy of the outcome for their visit to their Physician.

So, when to start hair removal services after completing cancer treatment? I would clearly say when the skin integrity has improved to it’s ‘new normal’ and for each individual this could be anything from 4 weeks - 6 months and ongoing. Remember, some individuals have to monitored for life and their skin integrity needs to be assessed on a regular basis due to changes to medications and/or side effects.
 
Mole guide

For a free mole measuring and counting ruler and for more information on other hair removal services such as electrolysis, dermal blading, sugaring, threading and laser/IPL see www.oti-oncologytraining.com
 
Morag Currin Photo-534 As a leader in our industry, Morag has spent over 25 years in the wellness industry, researching and learning about cosmetic chemistry, advanced skin analysis, reflexology, aromatherapy and other modalities. She is the pioneer for oncology aesthetics globally and she researches and teaches to inspire therapists who want to make a positive impact on their clients living with cancer.

She is the author of Oncology Esthetics: A Practitioner’s Guide (Allured Books 2009 and 2014) and Health Challenged Skin: The Estheticians’ Desk Reference (Allured Books 2012) and her work has appeared in numerous national and international publications. More than an esthetician, she’s a sought–after speaker who loves being a trailblazer and she also continues to reach out to those suffering from a variety of health challenges through equine therapy.

References:
Sonthalia Sidharth, MD, DNB, MNAMS,a Arora Rahul, MD,b and Sarkar Rashmi, MD, MNAMS, FAADc, Cosmetic Warts, Pseudo-Koebnerization of Warts after Cosmetic Procedures for Hair Removal, J Clin Aesthet Dermatol. 2015 Jul; 8(7): 52–56. PMCID: PMC4509587

Mark G. Kirchhof, MD PhD, Sheila Au, MD, Brazilian waxing and human papillomavirus: a case of acquired epidermodysplasia verruciformis, CMAJ February 3, 2015 vol. 187 no. 2 First published September 2, 2014, doi: 10.1503/cmaj.140198

Durdu M, Ilkit M. First step in the differential diagnosis of folliculitis: cytology. Crit Rev Microbiol. 2013 Feb;39(1):9-25. doi: 10.3109/1040841X.2012.682051. Epub 2012 May 29. Review. PubMed PMID: 22639852.
Topics: Client Care
 

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