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Article

The Importance of Cosmetics in Oncological Patients. Survey of Tolerance of Routine Cosmetic Care in Oncological Patients

by
María-Elena Fernández-Martín
1,2,*,
Jose V. Tarazona
2,
Natalia Hernández-Cano
3 and
Ander Mayor Ibarguren
3
1
ISCIII-UNED PhD Programme on Biomedical Sciences and Public Health, Universidad Nacional de Educación a Distancia, 28040 Madrid, Spain
2
Risk Assessment Unit, National Environmental Health Centre, Instituto de Salud Carlos III, Ministry of Science and Innovation, Carretera de Majadahonda a Pozuelo km 2.200, 28220 Madrid, Spain
3
Dermatology Department, University Hospital La Paz, 28046 Madrid, Spain
*
Author to whom correspondence should be addressed.
Cosmetics 2025, 12(4), 137; https://doi.org/10.3390/cosmetics12040137 (registering DOI)
Submission received: 7 May 2025 / Revised: 23 June 2025 / Accepted: 24 June 2025 / Published: 27 June 2025
(This article belongs to the Special Issue Feature Papers in Cosmetics in 2025)
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Versions Notes

Abstract

The expected cutaneous adverse effects (CAE) of oncology therapies can be disabling and even force the patient to discontinue treatment. The incorporation of cosmetics into skin care regimens (SCRs) as true therapeutic adjuvants can prevent, control, and avoid sequelae. However, cosmetics may also lead to adverse reactions in patients. The aim of our study was to assess the impact of the tolerability of cosmetics used in routine skin care on quality of life in this vulnerable population group through a survey. In addition, information was collected to improve the knowledge of the beneficial effects of cosmetics and the composition recommended. Hospital nurses guided the patients to fill in the surveys, which were done once. The main uses are related to daily hygiene care, photoprotection, and dermo-cosmetic treatment to prevent or at least reduce the skin’s adverse effects. More than 30% (36.36%) of patients perceived undesirable effects or discomfort with the use of cosmetics (27.27% in the facial area, 27.27% in the body and hands, and 22.73% in the scalp and hair). Intolerance was described for some soaps and creams used in the facial area. This study provides additional evidence on perceived tolerance supporting updates of clinical practice guidelines, highlights consolidated knowledge and evidence on the use of cosmetics, as well as new recommendations on the use and composition of cosmetics intended for oncological patients. There is a need for more knowledge about cosmetic ingredients and formulations, including ingredients of concern, such as endocrine disruptors.

1. Introduction

Cosmetics and personal care products (PCPs) have become an indispensable part of our daily lives and improve our quality of life [1]. In addition to their standard uses in skin hygiene and conditioning, cosmetics are currently used to enhance physical appearance and beauty and for solar protection. They have also become therapeutic aids that improve the quality of life of patients with skin diseases. Aesthetic treatments and cosmetic products mitigating the side effects of cancer therapy can alleviate perceived distress, improve skin symptoms, and improve the health-related quality of life (HQoL) of these patients [2]. Moreover, the use of cosmetics products is associated with specific needs, such as therapy for premature skin aging [3], the control of skin diseases such as atopic dermatitis [4] and rosacea [5], and skin cancer prevention through sunscreens [6]. Routine SCRs contribute to improving the quality of life of people in general [1,3] and have become true therapeutic adjuvants in patients with skin diseases [7]. In particular, preventing and controlling the cutaneous side effects of antineoplastic therapies is becoming a critical part of care algorithms for managing the side effects associated with antineoplastic therapies [8,9] and radiotherapy [10].
Skin toxicities include the expected CAE of oncological therapies (chemotherapy, targeted therapy, and immunotherapy), the dermatological effects of hormone therapy, and the effects of radiotherapy on the skin, such as acute and chronic radiodermatitis. The adverse events cover a range of conditions, including dry skin (xerosis), skin irritation, photosensitivity, pigmentary changes, and pruritus. The adversity rates vary depending on the treatment type and duration of treatment. The most commonly identified adverse events associated with chemotherapy and targeted therapy treatment are nail and periungual changes, papulopustular eruptions, acneiform eruptions, hand–foot syndrome, and xerosis [11]. Pruritus, exanthema, and vitiligo are the most common adverse events associated with immune therapy [12]. Radiodermatitis is the most common adverse event associated with radiotherapy treatment, and alopecia and skin aging may occur with hormone therapy [13]. Skin disorders such as the appearance of telangiectasias, changes in skin pores, increased laxity, loss of luminosity and citrine color of the skin, as well as hypersensitivity to certain cosmetics with a tendency to redness, have also been described, changing the personal self-image of an oncological patient [14] and may influence their quality of life.
Dermatologic care focuses on preparing the skin before, during, and after treatment to minimize side effects, repair the skin barrier, and return the skin to a normal state after treatments. The SCR requires different cosmetic guidance at each stage. The role of specialized dermatology (oncodermatology) in the diagnosis, prevention, and treatment of toxicities from anticancer therapies is becoming increasingly important, and cosmetics are part of it. General recommendations have been developed for the initiation and selection of skin care products in oncology patients. There are recommendations on what factors should be taken into account when using dermo-cosmetics in specific types of skin toxicity, based on international expert consensus [8]. Additional recommendations have been developed regarding special considerations linked to high ultraviolet exposure [15].
Commercial companies are constantly offering cosmetic products for use in oncological patients. However, a significant percentage of products recommended for these patients and other vulnerable groups contain possible endocrine disruptors chemicals (EDCs) [16], for which specific susceptibility of oncological patients, including hormone-dependent cancers, has been postulated [17].
There are some studies on oncodermatology and cutaneous adverse effects related to cancer therapies on patients’ quality of life [18]. Some cover specific agents such as epidermal growth factor (EGFR) inhibitors [19], makeup products [20], and cosmetic ingredients such as niacinamide [21]. However, evaluating how oncology patients perceive their tolerability to commonly used cosmetic products is needed. Certain consumer products may indirectly affect the HQoL of cancer patients undergoing oncological therapies. These effects are not only related to functional aspects, such as irritation and sensitivity but also to the indirect health effects that can be attributed to cosmetics. These effects go beyond beauty, hygiene, and cleanliness. Thus, patients may experience negative effects on their self-image, confidence, social function, and well-being [22]. Routine SCRs may have a positive impact on consumers’ quality of life [1]. In patients with skin affected by oncological therapies, the negative impact of the disease itself can be reduced through a well-designed SCR, but inadequate SCRs may also have a negative impact. The aim of this study is to investigate the impact of (in)tolerance of routine or habitual cosmetic (skin care) on the HQoL in patients affected by anticancer therapy-induced skin toxicity. The results will provide a global vision of the importance of cosmetics in the oncological patient.

2. Materials and Methods

This clinical study has been conducted in accordance with the guidelines of the International Conference on harmonization (ICH) and the Declaration of Helsinki and complies with the rules described in 1–61 of the ICG for Good Clinical Practice (GCP) with respect to vulnerable patients. The Research Ethics Committee of Hospital University La Paz issued a favorable opinion and accepted that the study be carried out.

Study Design

Twenty-four patients from the Hospital La Paz (Madrid, Spain), diagnosed with cancer and receiving chemotherapy, targeted therapy, hormonal therapy, and/or radiotherapy, participated in the study. Cutaneous toxicity related to cancer treatment was evaluated according to CTCAE v.5 (Common terminology Criteria for Adverse Events, Version 5.0, Spanish version) [23]. Only patients without topical drug intervention were included.
Patients with pre-existing skin diseases that could interfere with the outcome of the study (atopic dermatitis, contact dermatitis, psoriasis, rosacea, severe photosensitivity, scleroderma, xerosis) and/or known allergy to cosmetic ingredients or history of allergy to cosmetic products were excluded.
Two questionnaires were prepared, one to be completed by physician, with health data (Questionnaire C—Dermatologist Questionnaire), and the other by the patient, with data on cosmetic skin care regimen management (Questionnaire B—Cosmetic Skin Care Management). Patients also completed the DLQI (Dermatology Life Quality Index) questionnaire (Questionnaire A—Quality of Life Questionnaire). Each questionnaire was passed once.
Nurses from the oncology department of the Hospital La Paz (Madrid, Spain) were responsible for overseeing the questionnaires and guiding the patients through the process. Patients were given written information about the study and signed an informed consent form.
The questionnaire A (Quality of Life Questionnaire) corresponds to the generic quality of life instrument in dermatology DLQI validated and adapted to the Spanish population (10 questions). Addendum: authorized by Spanish Academy of Dermatology and Venereology (ADVE) [24] for use, reproduction, and distribution. The DLQI consists of 10 questions, covering symptoms and perceptions (question 1,2), daily activities (3,4), leisure (5,6), work/study (7), interpersonal relationships including sexuality (8,9) and treatment (10). Each question is answered by a tick box: “not at all”, “a little”, “a lot”, or “very much”, with scores of 0, 1, 2, and 3, respectively, with the possibility of “not relevant”. Each question is scored from 0 to 3. Scores are summed, giving a range from 0–1 (no effect on patient’s life), 2–5 (small effect on patient’s life), 6–10 (moderate effect on patient’s life), 11–20 (great effect on patient’s life), and 21–30 (extremely great effect on patient’s life). The result is considered an indicator of the impact of the dermatologic condition on the patient’s quality of life. All questions relate “to the last week” situation [25].
The Questionnaire B—Cosmetic Skin Care Management collects information on routine/habitual use of cosmetics and the degree of tolerance to them at the present time. Was prepared ad hoc by the authors of this study and consists of 7 subsections.
Section 1 of 7 included the patient number, patient initials, date.
Section 2 of 7 included the demographic data: sex (male or female), level of education, and employment status.
Section 3 of 7 asked about current symptoms and/or dermatological problems. This section includes five subsections: facial area, body area (back, neck, décolleté, arms, hands, fingers, toes, feet, legs...), hair, scalp, and nails. For each section, a list of possible symptoms was presented, as detailed below. For the body area, the list included pruritus/itching, dry skin, scars, redness, pain, skin sensitivity, depigmentation/vitiligo, acne/papules/pustules/pimples, and others. For the facial area, the items were acne/papules/pustules/pimples, couperose (red veins), erythema/redness, depigmentation/vitiligo, hyperpigmentation/spots, and scars. For the hair area, the items were changes in color or texture, hair loss (alopecia), and others. For the scalp area, the items were desquamation, pruritus and other. For the nail area, the items were inflammation, pain, changes in appearance, and others.
Section 4 of 7 inquired about (i) undesirable effects experienced during the routine or habitual use of cosmetic products (irritation, stinging/itching, unpleasantness, insufficient results, none, and other), (ii) the level of tolerance (bad, regular, normal, good, or very good), and (iii) the frequency of use (daily or not daily). The inquiry covered hygiene products (soap, makeup remover, wipes, tonic, none, other), moisturizing products (cream, emulsion, serum, lotion, gel, oil, ointment, none, other), and others (makeup products, sun protection, none, and other) used in the facial area.
Section 5 of 7 included the same questions (i), (ii), and (iii), for the body area and hands. The inquiry covered, (a) hygiene products (bar soap, liquid soap, gel, none, and other); (b) moisturizing products (cream, emulsion, ointment, oil, none, and other); and (c) others (sunscreen, none, and other).
Section 6 of 7 included the same questions (i), (ii), and (iii), for the hair and scalp area, focusing on hygiene products (shampoo, conditioner, mask, none and other).
Section 7 of 7 included questions on purchase behavior, with the following subsections: (a) purchase channels: pharmacy (pharmacy office, online pharmacy), online websites of cosmetic products advertised as cosmetics for oncological patients, herbalist, drugstores, supermarkets, dermatology clinics/cosmetic medicine clinics; (b) cosmetics advertised for oncological patients (yes or no); (c) factors of choice (price, composition, doctor’s recommendations, friend recommendations from other patients, pharmaceutical recommendations; (d) information source (medical, advertising); (e) the number of facial hygiene, facial moisturizing, body hygiene, body moisturizing, and hair hygiene products they had tried in the last month.
Descriptive statistical methods and graphs were used for analyzing the results.

3. Results

3.1. Surveys on the Management of Cosmetic Skin Care Regimens and the Quality of Life of Oncological Patients

The sample consists of 22 patients out of 24 recruited, aged 34 to 79, 20 female and 2 male. Two patients were discarded; one of them did not complete the survey, and another one was discarded for having a history of allergies to cosmetic ingredients (fragrance/perfumes).

3.1.1. Responses to Questionnaire C—Dermatologist Questionnaire

The information provided by the dermatologists indicated that the main type of cancer covered in this study is breast cancer (n = 13, 65%), followed by lung cancer (n = 4, 20%), uterine cancer (n = 1, 5%), ovarian cancer (n = 1, 5%), and colon cancer (n = 1, 5%), as shown in Figure 1.
Most patients presented dermal toxicity (n = 19, 86.00%); only three patients did not present dermatological toxicities diagnosed by the dermatologists. The diagnosed problems corresponded to 14 types of ECA (Figure 2), with a high degree of dermal toxicity CTCAE-v5, highlighting the xerosis/dry skin (n = 6, 23.08%). Four ECA types were not included in CTCAE-v5a (induced lupus, anagen effluvium, seborrheic dermatitis, keratosis pilaris, and rosacea).
Seven patients were diagnosed with two different ECAs, and one patient suffered three types of ECA.
The main anticancer therapy was chemotherapy (60.00%), followed by targeted therapy (10.00%), hormonotherapy (10.00%), immunotherapy (10.00%), and RT (6.67%); see Figure 3. Eight patients received combined therapies; in particular, chemotherapy and targeted therapies (12.50%), chemotherapy and immunotherapy (37.50%), chemotherapy and hormonotherapy (25.00%), chemotherapy and associated RT (12.50%), and chemotherapy, hormone therapy, and RT (12.50%). One patient did not receive oncological treatment.

3.1.2. Responses to Questionnaire B—Cosmetic Skin Care Management

Responses to Section 3: Symptoms and/or Dermatological Problems at the Present Time, by Areas (Facial Area, Hair Area, Scalp Area, and Nails)
The patients, in general, reported more than one symptom. The main self-reported dermatologic symptoms in the facial area were redness in the couperose and hyperpigmentation (Table 1). In the body, the symptoms focused on skin dryness, redness, and sensitive skin (Table 2). In the hair area, the main reports were hair loss and hair changes (Table 3). In the scalp, itching (50.00%) was the main symptom, and in nails, a change in apparence (48.28%).
Responses to Section 4: Cosmetic Skin Care Management Cosmetic Habits (Hygiene and Hydrating) in the Facial Area
The responses on perceived undesirable effects related to the use of routine or habitual cosmetic products are presented in Figure 4, and the tolerance to routine or habitual cosmetic products is in Figure 5.
Most patients reported no adverse effects when using routine cosmetic products. Some patients reported itching or irritation with certain products (makeup, sunscreen, soap, makeup remover, tonic, and cream) for the facial area. The tolerance to these products was mostly satisfactory, but perceived intolerance was reported in some cases with soap and cream. Regarding use patterns, 20 patients reported using hygiene products daily, 18 reported using moisturizing products daily, and only one reported using sunscreen.
Responses to Section 5: Cosmetic Skin Care Management Cosmetic Habits (Hygiene and Hydrating) in the Body Area and Hands
The responses on perceived undesirable effects related to the use of routine or habitual cosmetic (hydrating, hygiene, makeup, and sunscreen) products in the body area and hands are presented in Figure 6, and the tolerance to routine or habitual cosmetic products in Figure 7.
In the body and hands areas, most patients did not experience adverse effects when using routine or habitual cosmetic products; the reported effects were itching/stinging with liquid soap and cream and irritation with sunscreen and gel. In the area of hydration, no adverse effects were noted with the use of emulsion creams and oil, highlighting the good tolerability of the products. Some intolerances were reported in the case of creams.
Regarding use patterns, 100% of hygiene products and 94% of moisturizing products were used daily.
Responses to Section 6: Cosmetic Skin Care Management Cosmetic Habits (Hygiene and Hydrating) in the Hair Area and Scalp
The responses on perceived undesirable effects related to the use of routine or habitual cosmetic (shampoo, conditioner, mask) products in the hair area and scalp are represented in Figure 8, and the tolerance to routine or habitual cosmetic products in Figure 9.
In most cases, there were no side effects. The reported effects were for shampoo, conditioner, and mask that caused irritation or itching in some cases. The tolerance to these products was generally good. Only 22% of patients used these products daily.
Responses to the Questions on Cosmetic Purchasing Behavior (Questionnaire B—Cosmetic Skin Care Management, Section 7)
Regarding the number of products tested in the past month (Table 4), most patients tried at least one product per category, with a small percentage trying three or more.
Regarding the channel of purchase, pharmacies were the main channel, followed by supermarkets (Table 5).
With respect to cosmetics advertised for oncological patients, only 31.8% of the patients focused on products marketed specifically for oncological patients (Figure 10).
In general, patients used medical advice as a source of information (77.27%), as opposed to advertising (22.73%).
In terms of factors of choice, the priority was for medical recommendation, followed by pharmaceutical recommendation (Figure 11).

3.1.3. Results of Responses to Questionnaire A—Quality of Life Questionnaire

Of the total of twenty-two patients selected who met the selection criteria, nine obtained a score of 0–1 (no effect on patient’s life), seven obtained a score of 2–5 (small effect on patient’s life), three obtained a score of 6–10 (moderate effect on patient’s life), three obtained a score of 11–20 (great effect on patient’s life), and none obtained a score of 21–30 (extremely great effect on patient’s life) (Figure 12).

4. Discussion

Current cancer therapies may induce a wide range of dermatological toxicities affecting the skin, mucous membranes, hair, and nails, with distinct patterns of dermatologic adverse events by drug class [26]. Breast cancer patients after whole breast radiotherapy may experience skin dryness, hypersensitivity, and hyperpigmentation in the irradiated area, which may induce depressive psychological status, impacting the quality of life in this patient [27], and even in everyday life and leisure [28]. The association between dermatologic adverse events and declining quality of life includes a variety of factors, such as physical discomfort, changes in body image, self-esteem decrease, and disturbing social interactions [26]. These events affect the patient’s quality of life and may require dose reduction, delay, or even discontinuation of treatment; severe cases may affect the patient’s survival odds [29] and HQoL [30]. Therefore, diagnosis and management of these dermatologic conditions are crucial in the multidisciplinary care of cancer patients. Adequate outpatient dermatology consultations can reduce the interruption of anticancer therapy [31]. In fact, prophylactic treatment and early management of dermatologic adverse events by experienced dermatologists can alleviate the negative effects on HQoL and allow the continuation of life-prolonging treatment [26]. The emphasis should be on SCR and the use of specific cosmetics [8]. The use of cosmetics in oncological patients is increasing [32]. There is sufficient information to prove their usefulness, especially in the prevention and management of radiodermatitis (the most studied event). New emerging therapies have a great dermatological impact, and SCR also plays a very important role.
However, the use of unsuitable cosmetic products could provoke undesired effects, decreasing patients’ HQoL; hence, the importance of choosing the right cosmetics. Skin care in cancer patients may be suboptimal due to a lack of products and knowledge specific to this vulnerable population group. In addition to specific oncodermatological treatment, the regular use of cosmetics is currently part of people’s quality of life, also for oncological patients. Recent statistics show that European consumers use, on average, over seven different cosmetic products daily and nearly thirteen cosmetic products weekly. The use of cosmetics for skin care in oncological patients is poorly supported by scientific evidence, hence the importance of generating information on the use of cosmetics for routine use in these patients.
Our results provide information on the (in)tolerance to routine products based on perception and self-reported effects. More than 30% (36.36%) of patients perceived undesirable effects or discomfort with the use of cosmetics (27.27% in the facial area, 27.27% in the body and hands, and 22.73% in the scalp and hair). To the best of our knowledge, there are no other similar studies on oncological patients. In a study on the general Korean population, 23% of participants experienced side effects from using skin care and cosmetic products. In that study, the most reliable source of information on skin care products was the dermatologist, while less than one-third of the participants were satisfied with the dermatologist’s recommendations [33].
Of the twenty-two patients selected, nineteen had ECAs diagnosed by dermatologists; of these, seven had DLQI scores of no effect on patient’s life (0–1), six had small effects on patient’s life (2–5), while three patients obtained moderate effects on patient’s life (6–10) and three had great effects on patient’s life (11–20). The first two groups (DLQI score between 0 and 5) were considered “favorable”, and scores higher than five were “unfavorable”. Sixteen patients (72.72%) obtained favorable DLQI scores.
Both favorable and unfavorable DLQI scores were obtained in patients with ECAs diagnosed by dermatologists. The three patients without ECA diagnosed by a dermatologist obtained favorable DLQI. Eight out of eleven patients with one ECA and five out of seven with two ECAs obtained favorable DLQI. Considering these results, DLQI does not appear to be directly related to the number or type of ECAs that were diagnosed by the dermatologist. Xerosis was the most frequent finding, followed by papule–pustular rash, acneiform eruption, paronychia, alopecia, and nail darkening.
All 22 patients reported skin problems on Questionnaire B. Scarring was a common event in the three patients without dermatologist-diagnosed ECA. The group of patients with a DLQI score of 11–20 (great effect on patient’s life) reported significantly more self-reported skin problems (up to five) compared with the favorable DLQI group.
The most frequently reported skin problems in the group with favorable DLQI were body xerosis, nail disorders, and hair disorders. The group with unfavorable DLQI mostly reported the same symptoms, plus body pruritus and erythema or redness in the facial area.
Five out of the eight (62.50%) patients who indicated adverse effects when using routine cosmetic products obtained a favorable DLQI.
Four out of the six (66.66%) patients that reported bad/regular tolerance obtained unfavorable DLQI. Patients reporting normal, good, and very good tolerance, 13 (86.66%), obtained a favorable DLQI.
A previous study suggested that the quality of life improves with the use of three items developed specifically for cancer and skin cancer management (skin moisturizer, face moisturizer, and face wash). That study assessed tolerability with a dermatology-specific self-reported quality of life instrument, the Skindex-16 questionnaire. Our study is the first to use DLQI in oncological patients related to oncological skin toxicity and tolerability to cosmetics. The DLQI has been previously used in over 36 different skin conditions [25] but not for tolerability of cosmetics. It has been used in parallel with nine other dermatology-specific measures and with severe health measures, willingness to pay, and total illness burden [25].
The results of the purchasing channel survey can provide guidance to manufacturers on how to target the marketing and dissemination of information on their products. Most patients had tried at least one cosmetic per group in the past month. Physicians were the main source of information, and pharmacies were the main purchasing places. Therefore, it is essential that physicians have a broad knowledge of cosmetics’ indications and receive information on the composition and specific recommendations and patterns for oncological patients. The reason for frequent cosmetic changes may be that the current product is not satisfactory or that skin conditions change rapidly. A key question is whether all recommended products meet a consensus of composition.
Consensus guidelines on preventive management of skin toxicities related to anticancer therapies include cosmetic recommendations and skin care regimens. They are based on systematic literature reviews and supported by the personal experience of experts (expert consensus) when solid evidence was not available. There is consensus on skin toxicities related to anticancer therapies in general [8,9,34,35], with the most complete being from Dreno et al. (2023) [8]. There are also guidelines for specific therapies, such as radiotherapy [36], and for effects, such as fibroblast growth factor receptor (FGFR) inhibitors [37], EGFR inhibitors [38], and immune checkpoint inhibitor therapy [39,40,41]. Other guidelines focus on specific cancer types and treatments, such as radiodermatitis in breast cancer [42], radiodermatitis in the head and neck [43], acute radiodermatitis [36,44,45], late and chronic (fibrosis) radiodermatitis [46,47], or have been specifically designed to maintain the skin barrier function [48].
The algorithms for patients with oncology treatment-related skin toxicities focus on general skin care measures for prevention and management. Those include skin care formulations free of additives, fragrances, perfumes, and sensitizing agents, and a physiologic pH [8,9]. However, there is not a consensus on the ideal composition of a cosmetic product for oncological patients.
Adverse reactions to cosmetics may result from allergic sensitization or irritant stimuli, such as rubbing associated with washing and drying the skin. The use of occlusive products such as makeup may aggravate inflammatory processes. On the other hand, the application of makeup can reduce anxiety and tension and improve the quality of life of patients. It is important to provide guidance on the appropriate composition and use of cosmetics and PCPs commonly used by oncological patients.
Warnings have been issued for some hazardous products used in the skin care regimens of oncology patients, such as potential irritant products (e.g., benzoyl peroxide, tretinoin, tazarotene, and adapalene), soaps, and ointments. However, it should be noted that other substances, including those with potential endocrine-disrupting activity, have been identified in cosmetics recommended for oncological patients [16], which may not be appropriate due to possible drug interactions [49] and increased susceptibility [17].
Pan et al. (2016) [50] showed that epidermal growth factor ligands enhanced the potency of butylparaben to stimulate oncogene expression and breast cancer proliferation in vitro through Erα, suggesting that parabens may be active at exposure levels that were not previously considered toxicologically relevant in studies testing their effects in isolation. Therefore, it is necessary to formulate cosmetics intended for oncological patients, taking into account the specific mechanisms of each type of cancer. For example, the addition of butylparaben to cosmetics used in hormone-dependent breast cancer could be counterproductive. The expression of the aromatase enzyme was modified by fragrance ingredients and caused imbalances in estrogen levels in the body [51]. Most consumers remain unaware or poorly informed about the potential risks they take when exposing themselves to compounds contained in personal care products.
Oncological patients affected by skin adverse effects of anticancer therapies who require cosmetic care for prevention, control, and recovery may be vulnerable to cosmetics containing possible EDCs. EDCs may affect the efficacy of patient treatments, interact with anticancer drugs [49], and worsen skin conditions. In addition, EDCs can worsen skin conditions such as atopic dermatitis [52], aggravate allergic diseases [53], influence melanoma [54,55], or produce acne [56]. A recent review found studies linking parabens to dermatological conditions with a potential role in cellular aging and the induction of non-melanoma skin cancer [52].
Some studies have used creams with parabens [57,58,59]. It should be noted that propylparaben and methylparaben qualify as substances under evaluation for endocrine disruption [60] under EU legislation and should not be recommended for hormone-dependent cancer patients. It is, therefore, important that the oncological patient receive cosmetic advice from a trained professional, both for routine cosmetic recommendations and for the SCRs needed to prevent and control ECA caused by anticancer therapies. The survey result highlights that most patients followed the recommendations of health in most consensus approaches. It should be noted that many contain ultraviolet filters with suspected endocrine-disrupting properties, such as homosalate, avobenzone, or octisalate [16]. Cosmetic ingredients with suspected endocrine-disrupting properties may not be recommended for oncological patients, especially those with hormone-dependent cancer [49].
The survey results show that the patients tried at least one product in the last month. This result can be interpreted as a need to try new cosmetics due to low satisfaction, resulting in a lack of adherence to cosmetic products. The comparison of dressing versus cream did not show any advantage (more than 50% of patients stopped the treatment temporarily) probably because of the difficulty of its application [61].
The survey results suggest high care in oncological patients regarding the recommendation source and purchase channel for cosmetics. However, the prevalence of intolerances to routinely used cosmetics in oncological patients seems to be higher than for the general population. This combination triggers the need for informing and training physicians and pharmaceuticals on the special care required when recommending cosmetic products to oncological patients. This should be supported by science-based assessments of the cosmetic ingredients addressing disease-related vulnerabilities [49] and a proper system for passing information to health-care professionals.
The establishment of a scale assessing the tolerance of cosmetic products habitually used by oncological patients, also indicating its impact on their quality of life, could support the prescription capacity of health professionals. As a complement, the cosmetic industry should formulate suitable products for these patients according to consensual and uniform criteria.
The use of some cosmetic products and PCPs may further deteriorate the skin condition in the case of skin toxicities caused by oncology therapies. Mechanisms other than sensitization and allergy may be responsible for these adverse effects in oncological patients, such as endocrine disruption.
Furthermore, cosmetics employed with regularity should not exacerbate the skin’s condition, which has already been modified by oncological therapies. The composition must be adequate not only for this reason but also to not interfere with the medication or worsen endocrine cancer.
Combining the results from the ECAs diagnosed by the dermatologist (Questionnaire A), the skin symptoms perceived by the patients, the adverse effects reported by the patients with the use of regular cosmetics, as well as their tolerance to them (Questionnaire B), with the results of DLQI (Questionnaire C), it can be concluded that the use of regular cosmetics does not particularly influence the quality of life of the patients and that it seems to be more influenced by the ECAs they present. Nevertheless, it is recommended to monitor the use of cosmetics to ensure that they have an adequate composition that does not aggravate the skin conditions and does not interfere with the treatment of the oncologic disease.

The Importance of Cosmetics in Oncological Patients

We highlighted the importance for the patients to get persuaded that daily hygiene care, photoprotection, appropriate pharmaceutical and dermo-cosmetic treatment, and absolute compliance to clinical guidelines at the early beginning of the oncologic therapy can reduce or even prevent the skin adverse effects of anticancer therapies.
The combination of cosmetic science within a multidisciplinary treatment for oncological patients prevents the cutaneous adverse effects in oncology patients receiving oncological therapies.

Author Contributions

Conceptualization, methodology M.-E.F.-M. and J.V.T.; formal analysis, investigation, and data curation, M.-E.F.-M.; writing—original draft preparation, M.-E.F.-M. and J.V.T.; writing—review and editing, J.V.T.; survey construction, M.-E.F.-M., N.H.-C. and A.M.I. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Ethic Committee Name: COMITÉ DE ÉTICA DE LA INVESTIGACIÓN CON MEDICAMENTOS. Hospital Universitario La Paz. Approval Code: internal code: 2022-085-1, code HULP: PI-5259_Approval Date: 12 May 2022.

Informed Consent Statement

The informed consent forms of the patients who were part of the study are on file at the Hospital La Paz (Madrid, Spain).

Data Availability Statement

All data supporting the reported results are publicly available and can be found in the references and websites indicated throughout the document.

Acknowledgments

Nurses from the oncology department of the La Paz hospital were responsible for administering the questionnaires and guiding the patients through the process; the authors acknowledge their contributions.

Conflicts of Interest

The authors declare no conflicts of interest.

References

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Cosmetics 12 00137 g001
Figure 1. Cancer types of patient survey (Questionnaire C—Dermatologist Questionnaire).
Figure 1. Cancer types of patient survey (Questionnaire C—Dermatologist Questionnaire).
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Figure 2. Types of ECA diagnosed by dermatologist (Questionnaire C).
Figure 2. Types of ECA diagnosed by dermatologist (Questionnaire C).
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Figure 3. Patient anticancer agent types (Questionnaire C).
Figure 3. Patient anticancer agent types (Questionnaire C).
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Figure 4. Perceived undesirable effects experienced when using routine or habitual cosmetic products in the facial area (Questionnaire B–Cosmetic Skin Care Management, Section 4 of 7).
Figure 4. Perceived undesirable effects experienced when using routine or habitual cosmetic products in the facial area (Questionnaire B–Cosmetic Skin Care Management, Section 4 of 7).
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Figure 5. Self-reported tolerance to routine or habitual cosmetic products in the facial area (Questionnaire B–Cosmetic Skin Care Management, Section 4 of 7).
Figure 5. Self-reported tolerance to routine or habitual cosmetic products in the facial area (Questionnaire B–Cosmetic Skin Care Management, Section 4 of 7).
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Figure 6. Perceived undesirable effects experienced when using routine or habitual cosmetic products in the body area and hands (Questionnaire B—Cosmetic Skin Care Management, Section 5 of 7).
Figure 6. Perceived undesirable effects experienced when using routine or habitual cosmetic products in the body area and hands (Questionnaire B—Cosmetic Skin Care Management, Section 5 of 7).
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Figure 7. Self-reported tolerance to routine or habitual cosmetic products in the body area and hands (Questionnaire B—Cosmetic Skin Care Management, Section 5 of 7).
Figure 7. Self-reported tolerance to routine or habitual cosmetic products in the body area and hands (Questionnaire B—Cosmetic Skin Care Management, Section 5 of 7).
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Figure 8. Perceived undesirable effects experienced when using routine or habitual cosmetic products in hair area and scalp (Questionnaire B—Cosmetic Skin Care Management, Section 6 of 7).
Figure 8. Perceived undesirable effects experienced when using routine or habitual cosmetic products in hair area and scalp (Questionnaire B—Cosmetic Skin Care Management, Section 6 of 7).
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Figure 9. Self-reported tolerance to routine or habitual cosmetic products in the hair area and scalp (Questionnaire B—Cosmetic Skin Care Management, Section 6 of 7).
Figure 9. Self-reported tolerance to routine or habitual cosmetic products in the hair area and scalp (Questionnaire B—Cosmetic Skin Care Management, Section 6 of 7).
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Figure 10. Cosmetic advertised for oncological patients (Questionnaire B—Cosmetic Skin Care Management, Section 7 of 7).
Figure 10. Cosmetic advertised for oncological patients (Questionnaire B—Cosmetic Skin Care Management, Section 7 of 7).
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Figure 11. Factors of choice (Questionnaire B—Cosmetic Skin Care Management, Section 7 of 7).
Figure 11. Factors of choice (Questionnaire B—Cosmetic Skin Care Management, Section 7 of 7).
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Figure 12. Results of responses Questionnaire A—Quality of Life Questionnaire (DLQI).
Figure 12. Results of responses Questionnaire A—Quality of Life Questionnaire (DLQI).
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Table 1. Symptoms and/or dermatological problems at the present time, facial area (Questionnaire B—Cosmetic Skin Care Management).
Table 1. Symptoms and/or dermatological problems at the present time, facial area (Questionnaire B—Cosmetic Skin Care Management).
Facial Area Symptoms
Acne–papules–pustules–pimples14.29%
Couperus (red veins)23.81%
Erythema, redness38.10%
Hyperpigmentation, spots14.29%
Scars9.52%
Table 2. Symptoms and/or dermatological problems at the present time, body area (Questionnaire B—Cosmetic Skin Care Management).
Table 2. Symptoms and/or dermatological problems at the present time, body area (Questionnaire B—Cosmetic Skin Care Management).
Body Area Symptoms
Itching/Itching11.25%
Dry skin20.00%
Scars13.75%
Redness18.75%
Pain8.75%
Skin sensitivity18.75%
Acne–papules–pustules–pimples1.25%
Hyperpigmentation–spots3.75%
Dyspigmentation–vitiligo2.50%
Small pimples1.25%
Table 3. Symptoms and/or dermatological problems at the present time, hair area (Questionnaire B—Cosmetic Skin Care Management).
Table 3. Symptoms and/or dermatological problems at the present time, hair area (Questionnaire B—Cosmetic Skin Care Management).
Hair Area Symptoms
Hair loss (Alopecia)50.00%
Hair changes (color, texture)44.44%
Weakness5.56%
Table 4. Number of products tested in past month and number of patients tested products cosmetics by type of cosmetic (Questionnaire B—Cosmetic Skin Care Management, Section 7 of 7).
Table 4. Number of products tested in past month and number of patients tested products cosmetics by type of cosmetic (Questionnaire B—Cosmetic Skin Care Management, Section 7 of 7).
Number of Products Tested Number of Patients
Facial HygieneFacial HydrationBody HygieneBody HydrationHair Hygiene
500010
401000
302031
231303
151011139
054333
No answer94526
Table 5. Purchasing channels (Questionnaire B—Cosmetic Skin Care Management, Section 7 of 7).
Table 5. Purchasing channels (Questionnaire B—Cosmetic Skin Care Management, Section 7 of 7).
Purchasing ChannelsNumber Patients
Pharmacy (pharmacy office or online platform)15
Online websites of cosmetic products promoted as cosmetics for oncology patients2
Dermatology Clinics—Aesthetic Medicine Clinics3
Supermarkets10
Herbalists4
Drugstores3
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Fernández-Martín, M.-E.; Tarazona, J.V.; Hernández-Cano, N.; Mayor Ibarguren, A. The Importance of Cosmetics in Oncological Patients. Survey of Tolerance of Routine Cosmetic Care in Oncological Patients. Cosmetics 2025, 12, 137. https://doi.org/10.3390/cosmetics12040137

AMA Style

Fernández-Martín M-E, Tarazona JV, Hernández-Cano N, Mayor Ibarguren A. The Importance of Cosmetics in Oncological Patients. Survey of Tolerance of Routine Cosmetic Care in Oncological Patients. Cosmetics. 2025; 12(4):137. https://doi.org/10.3390/cosmetics12040137

Chicago/Turabian Style

Fernández-Martín, María-Elena, Jose V. Tarazona, Natalia Hernández-Cano, and Ander Mayor Ibarguren. 2025. "The Importance of Cosmetics in Oncological Patients. Survey of Tolerance of Routine Cosmetic Care in Oncological Patients" Cosmetics 12, no. 4: 137. https://doi.org/10.3390/cosmetics12040137

APA Style

Fernández-Martín, M.-E., Tarazona, J. V., Hernández-Cano, N., & Mayor Ibarguren, A. (2025). The Importance of Cosmetics in Oncological Patients. Survey of Tolerance of Routine Cosmetic Care in Oncological Patients. Cosmetics, 12(4), 137. https://doi.org/10.3390/cosmetics12040137

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