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Onco-dermatology: a missed opportunity for the dermocosmetics industry?

Published on 2 February 2024
Adele Carrot
Written by

Adele Carrot

Skin Care

It may be surprising to hear that the skincare industry has not adequately addressed the needs of over 80% of patients undergoing anticancer therapy, who are affected by skin irritations1. These dermatological side effects can not only cause pain but also decrease patients’ quality of life and prompt them to slow down or even stop treatments. While categorised as “supportive” care, skincare in oncology therefore plays a crucial role in improving treatment adherence by enhancing body image and helping reduce distress.

When examining products targeted at cancer patients in the dermocosmetic market, the focus primarily revolves around sun protection and skin cancer. As consumers are becoming increasingly inclined towards preventative care, renowned brands such as Eucerin and ISDIN choose to display their dedication to skin cancer prevention, as depicted in Figure 1. They promote sunscreens and other prophylactic products specifically formulated for actinic keratosis and other forms of non-melanoma skin cancer. However, there is more to onco-dermatology (also often spelled oncodermatology), which refers to the diagnosis, treatment and management of skin conditions that develop in relation to cancer treatments. Dermocosmetic brands could do more to support patients across cancer types and throughout their entire treatment journey by offering specialised products beyond sunscreen, which is the focus of this insight piece.

Figure 1: Dermalogica, Eucerin, SVR Laboratoire Dermatologique and ISDIN are committed to combating skin cancer*2

* From top left to bottom right: Dermalogica x Skcin partnership to raise awareness of the prevention and early detection of skin cancer in the UK. Eucerin’s Actinic Control MD SPF 100 and SVR Laboratoire Dermatologique’s AK Secure DM Protect indicated for the prevention of actinic keratosis and non-melanoma skin cancer. ISDIN’s commitment to eradicating skin cancer

Anticancer treatments often cause skin issues, affecting patients’ wellbeing and adherence

Anti-cancer treatments increase skin sensitivity and can cause a broad spectrum of acute side effects, as detailed in Figure 2. Common manifestations include dryness (xerosis), peeling, itching (pruritus), and changes in skin colour, which becomes red or darker. Treatments also impact the scalp and hair roots, typically leading to hair loss 2-3 weeks after initiation. This can in turn cause folliculitis, an inflammation of the hair follicles resulting in the appearance of pustules (small red spots).

Figure 2: Most common anticancer treatment side effect affecting patients' hair, skin and nail health3

Areas exposed to radiation therapy commonly develop radiation dermatitis, an inflammation affecting up to 90% of patients4. Its severity varies, ranging from mild redness and irritation to more severe reactions involving blistering, moist desquamation (skin peeling) and pain. When followed by chemotherapy, radiation recall can also occur, a reaction mimicking these acute effects.

Chemotherapy can induce photosensitivity, skin pigmentation changes, rashes, and painful cuticles. Targeted therapies, like epidermal growth factor receptor inhibitors, frequently cause cutaneous reactions, including acneiform eruption and rash. These have been observed in over 80% of patients receiving these agents5.

These side effects not only subject patients to varying degrees of discomfort and pain, but also elevate the risk of infections if left untreated. Blisters and nails are especially susceptible, with common complications such as paronychia (infection of the fingernails and toenails folds)6. In particularly severe cases, Oncologists would have to reduce or even suspend anticancer treatments until the skin heals, potentially allowing for disease progression.

As a result, skin complications can greatly influence patients’ motivation to endure treatment due to a notable reduction in quality of life. Alterations in body appearance (such as hair loss, scarring, swelling), sensation (e.g., pain) and functioning (such as restricted movement) strongly affect both the physical and emotional well-being of patients throughout their cancer journey. These are associated with concerns, embarrassment, and psychological distress (feelings of exhaustion and helplessness/hopelessness), making it challenging to maintain a fulfilling social and professional life. These challenges are exacerbated by the simultaneous occurrence of other side effects, ranging from fatigue and anaemia to nausea and weight loss. In most severe cases, in absence of adequate care, patients can feel overwhelmed and choose to slow down or even stop their anticancer treatment7.

To address anticancer side-effects such as skin problems, patients can ask their healthcare team about support services – usually these services are offered to patients with uncurable cancers first but can also be extended to other types of cancers. Supportive care in oncology covers the prevention and management of adverse effects from cancer and its treatment, including physical and psychological symptoms, from diagnosis to post-treatment care8. It incorporates complementary services such as psycho-oncology, physiotherapy, dietetics, oncology aesthetics and more. The latter generally refers to personalised and gentle skincare addressing appearance-related challenges to enhance well-being and self-esteem. This also includes makeup, wig and haircare, nail care, and relaxation therapies. Patients can access supportive care at any age and for any type and stage of cancer, at any time during cancer treatment. Good supportive care provided early generally improves quality of life, possibly lengthening patients’ survival and reducing the need for aggressive treatments near the end of their lives9. Nevertheless, access to this help in practice is subject to various challenges.

While most patients find supportive care as important as treatments10, health care professionals (HCPs) specialising in oncology prioritise treatment success over supportive care as their primary objective is to ensure patients’ survival. Oncologists and other relevant Specialists tend to focus on side effects affecting vital functions (e.g., heart and lung activity) and that would require stopping treatments (e.g., severe allergic reaction). They therefore often lack time to monitor other adverse reactions mainly impacting quality of life, such as mild to moderate skin irritations.

Other factors come into play, such as a perceived lack of evidence-based interventions, and the delegation of this care responsibility to other HCPs. Nurses are frequently tasked with assessing patients during each visit, providing advice, signalling significant adverse effects to Oncologists, and referring patients to the right Specialists, including Dermatologists. In practice, both Oncologists and Nurses commonly overlook skin irritations due to a lack of awareness about their impact, considering them as normal side effects not requiring additional care. Few also know about the existence of specialised dermocosmetics. As a result, up to 84% of patients are not referred to a Dermatologist in practice11. HCPs often do not discuss dermal problems unless patients bring up the topic, leading to patients suffering in silence, unaware that they could receive professional support.

Additional barriers to Dermatologist or Oncology Aesthetician referrals commonly found across markets include the limited availability of these Specialists and a lack of reimbursement. Dermatologists who do not specialise in oncology usually lack awareness of cancer-specific skin issues to provide appropriate advice. As anticancer treatments increase the sensitivity of the skin, many HCPs have traditionally considered the risk of skincare further irritating the skin to be too high to recommend any treatment. Regarding reimbursement, insurances typically only cover treatments deemed “essential”, which does not necessarily include prophylactic and adjuvant dermal treatments.

Another contributing factor to consider is the disproportionate focus on breast cancer and women, which can overshadow the needs of other cancer patients. The acknowledgment of the value and incorporation of oncology aesthetics within oncology centres has primarily been spurred by breast cancer awareness initiatives. Numerous studies focusing on the impact of less vital side effects on patients’ lifestyles and self-esteem, such as appearance issues, fatigue, and low mood, have been conducted in the context of breast cancer12. Several support systems, including support groups and complementary clinical services have been established specifically to aid breast cancer patients. While these achievements are commendable, disparities in funding, research and complementary services between breast cancer and other cancer types have resulted in unequal awareness and access to supportive care across hospitals and cancer centres, contingent to their specialisation13.

As a result, all HCPs involved in oncology stand to benefit from awareness initiatives elevating the role of cancer-informed dermatological interventions.

Efforts to support patients in preventing and treating skin changes also remain insufficient within the dermocosmetic industry. Patients stand to gain from a range of skincare, cosmetics, and spa solutions, as depicted in Figure 3. These products must adhere to specific criteria, being hypoallergenic, preferably perfume-free, and preservative-free. They should contain safe, effective and skin-calming ingredients such as shea butter, urea, ceramides, panthenol, glycerin, aqua posae filiformis and niacinamide14.

SPF50 sunscreen remains a critical product, but we need more awareness regarding its use across cancer types to manage photosensitivity and prevent burns and hyperpigmentation during and up to a year after anticancer treatment.

Dermatologists strongly recommend using gentle cleansers and moisturising pre-emptively and during treatment to improve the skin barrier and reduce the risk of irritations and complications. Creams and ointments are preferred over lotions and gels, which are not sufficiently hydrating15.

Makeup plays a role in addressing aesthetic skin changes, enhancing body image, boosting motivation, and helping patients maintain social and professional activities. Corrective makeup for sensitive skin can conceal signs of fatigue, define eyes and eyebrows during hair loss, add colour to the face, and cover acneiform eruptions and scars.

Spa treatments can help patients and their skin recover post-treatment. Tailored dermatological programs typically target irritations, redness, severe skin dryness and itchiness, inflamed scars, burning sensations, pain, as well as physical and emotional exhaustion. They usually offer a comprehensive care encompassing hydrating treatments and workshops around makeup, diet and adapted exercise. In some markets, these can be prescribed by HCPs (typically GPs, Oncologists and Surgeons) and reimbursed. For instance, three weeks of post-cancer thermal treatments offered by brands such as Eau Thermale Avène, La Roche-Posay and Uriage are entirely covered by French health insurance.

Currently, a few small to medium players offer products specially formulated for patients undergoing treatment, such as Diego dalla Palma, MooGoo, Neogenesis and iS Clinical. Such brands are typically created by Onco-Dermatologists or by patients themselves. For instance, a patient in remission launched Ameōn after an Oncologist introduced her to cryotherapy16. Jennifer Young’s Beauty Despite Cancer was created in the UK with the help of the NHS, and even offers training courses to spas and skincare clinics to welcome oncology patients. While a lot of companies mainly target women, Jennifer Young’s offering is more comprehensive, including skincare for men17.

However, patients are rarely aware of these options due to limited marketing and awareness campaigns. Many find the market confusing as they struggle to find skincare and cosmetic products that are explicitly labelled as safe when undergoing treatment. Dermocosmetic firms are often inclined to avoid such indications due to the requirements, including expensive safety studies, and the business risks, such as limiting their target audience and inhibiting business growth.

This is a missed opportunity for the industry, as patients tend to be proactive and seek skincare solutions to soothe side effects during treatment and to reconstruct their skin post-treatment, even if this topic is not discussed with HCPs. This lack of guidance leads them to try nonspecialised skincare products that can easily further irritate their skin. Unaware of potential sensitisers such as perfumes, preservatives, astringent, and acidic ingredients, they inadvertently use generic, previously well tolerated products that will irritate their vulnerable skin. For example, petroleum-based creams can trap heat and make the skin redder and more uncomfortable. Alternatively, many look for ‘natural’ products, thinking that these would be gentler and safer for their skin. However, some ingredients, especially essential oils, can cause irritations18.

Although much remains to be done, well-established skincare brands have recently committed themselves to providing appropriate solutions and raising awareness among patients. Focusing on moisturisers as the key prophylactic solution recommended by Dermatologists, La Roche-Posay, Bioderma and Eau Thermale Avène are adapting their offering to meet these needs. As detailed in Figure 4, these brands adopted different strategies to create and label products for oncology patients.

La Roche-Posay labels gentle and hydrating products from their Lipikar dry skin range, Toleriane sensitive skin range and Cicaplast damaged skin range, as suitable for patients undergoing cancer treatments. Their star products are Lipikar Balm AP+M moisturiser and Cicaplast Baume B5 repairing balm. The former’s Aqua Posae + Microresyl formula targets the microbiome and is combined with niacinamide, glycerine and shea butter for better hydration. In comparison, Cicaplast has a richer formula, with the prebiotic complex Tribioma, vitamin B5, madecassoside and antibacterial agents (zinc and manganese) to help restore more damaged skin.

Eau Thermale Avène’s Tolérance range is indicated to control the skin reactivity of hypersensitive and intolerant skin types more broadly. It features a postbiotic active ingredient, D-SensinoseTM, derived from Avène Thermal Spring Water. Avène claims a 90% reduction in stinging and 70% reduction in skin sensitivity based on their own studies.

The Bioderma Medi-Secure range was developed in collaboration with the leading cancer research and treatment centre in France, Institut Curie, with a focus on caring for weakened and dry skin. Clinical studies conducted under medical and oncological supervision back up its safety and efficacy, claiming a 95% reduction in skin dryness and 80% improvement in overall well-being for patients with skin dryness induced by chemotherapy19.

When comparing specialised oncology dermocosmetics with generic products, we find a price premium of 76% for skincare cosmetics, 40.93% for makeup cosmetics and 30.19% for skin treatments. This valuation is particularly noteworthy when considering the large population afflicted by cancer in North America and Europe, estimated at 6.96 million individuals in 202020. We can approximate the highest market potentials to be 262 million USD for skincare and 81 million USD for makeup in the targeted therapy segment in this region, as detailed in Figure 5. However, only a small proportion of this opportunity is currently captured due to low awareness among patients and low attention from HCPs.

The importance of support beyond anticancer treatments is gaining recognition across countries in both healthcare and the industry. More medical institutions are incorporating supportive therapies including oncology aesthetics into cancer care programs. Although slow, dermocosmetic companies are increasingly recognising and addressing the unmet needs of the oncology patient population. Not only do they respond with adapted skincare products, but also by funding research, collaborating with HCPs to spread awareness, and providing patient services.

Nevertheless, the industry is capable of increasing its contribution to patient support. Skincare offering is still limited, and there is room for greater initiatives to address the dermal needs of patients across all cancer types.

Companies could partner with medical institutions to fund new research and better understand patients’ unmet needs. As an illustration, Bioderma has been collaborating with Institut Curie for 10 years to improve the quality of life of patients being treated for cancer by addressing side effects. They have created a space for more comprehensive care and to further research of skin pathologies linked to anticancer treatments, the Area for Care and Skin Study within Institut Curie’s hospital in 2019. Multiple clinical trials are conducted there to analyse skin toxicities to better understand, treat and prevent them. By doing this, they also participate in promoting the monitoring of inflammation measurement, skin thickness and hydration rate21.

Skincare brands could also offer more tools to patients and collaborate with associations to increase awareness and access to supportive care and specialised dermocosmetics. Direct to patient communication campaigns hold the potential to empower patients, enabling them to improve their skincare regimen and to request better care from their healthcare team. For instance, La Roche-Posay moderates an online private cancer community group, shares brochures on skin side effects and offers online consultations with a Skin Expert to match appropriate products to their needs. The company also donates skincare products and creates educational resources for patients in partnership with organisations including the American Cancer Society and Macmillan Cancer Support22.

Thirdly, working with Dermatologist key opinion leaders with a special interest in onco-dermatology is key in reaching HCPs and offering training to raise awareness of skin side effects. This would help elevate the role of specialised dermatology and oncology aesthetics by emphasising skin problems’ impact on treatment success. For example, La Roche-Posay’s consultant Dermatologist Dr Hextall lectures Oncologists, Pharmacists and Specialised Nurses in the US to promote early effective management of skin side effects23.

A crucial message to convey to Oncologists and other HCPs overseeing anticancer treatments is that decreased wellbeing caused by skin side effects has repercussions on treatment success. By emphasising that skin toxicities not only cause discomfort and pain but also play a part in discouraging patients from completing their treatments, we could pave the way towards a more comprehensive care model and better treatment results.

Sector & Segment provides tailored research and analysis of more “niche” dermocosmetic markets and related patient journeys. Our experts can investigate the competitive landscape and provide insights on medical pathways to help you refine your go-to-market strategy.

We can leverage our experience to help you:

  • Size and quantify the market opportunity
  • Analyse the market landscape and uncover avenues for differentiation
  • Identify patient needs and pain points
  • Profile and segment relevant patients and HCPs
  • Design engaging strategies for HCPs to enhance their awareness of dermatological concerns and optimise patient outreach

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Adele Carrot
Written by

Adele Carrot


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