Pretty Sick

The Beauty Guide for Women with Cancer


By Caitlin M. Kiernan

Illustrated by Jamie Lee Reardin

Read by Caitlin M. Kiernan

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The ultimate resource to looking your best during and after cancer treatment from a veteran beauty industry insider

When beauty editor Caitlin Kiernan received the shattering diagnosis of cancer, she was obviously concerned about her health. But as a working professional, she knew she had to learn, quickly, how to look her best while feeling her worst. Caitlin called on her list of extensive contacts–from top medical doctors to hair stylists, makeup artists, and style mavens–to gather the best and most useful tips to offset the unpleasant effects of treatment. The result is this comprehensive beauty guide for women with cancer, covering every cosmetic issue, from skin care, to hair care, wig shopping, nail maintenance, makeup tricks, and much, much more. Illustrated with charming drawings by Jamie Lee Reardin and peppered with advice from celebrities and cancer survivors, Pretty Sick will be a welcome and trusted resource, helping women look and feel their best.



It was gearing up to be one of the biggest events Life & Style Weekly magazine had ever held. The Kardashian Klan had RSVP'd. So had all of Bravo's Real Housewives, including NeNe Leakes, Countess Luann de Lesseps, and Ramona Singer. And the fashion world's top stylists—including my friend Robert Verdi—were working the red carpet before it had even been rolled out. The Style Awards party was held to celebrate the magazine's fall fashion issue that was dedicated to Hollywood's most influential trendsetters. Held on the rooftop of the Dream Hotel, the party coincided with New York Fashion Week and was one of the most buzzed about events of the season. E! News was there, so was Entertainment Tonight, the New York Post, the Daily News—and a slew of other news organizations. It was set to be one of those magical New York nights.

As the magazine's beauty director, I was responsible for writing and assigning all the beauty coverage in the magazine. It was also part of my job to report on the latest beauty trends, test new products on the market, and to interview celebrities, their glam squads, and the leading experts in the industry. Because of that, I had a hand in nominating and selecting the celebrities and influencers that were going to be featured in our special style issue. And when it came to the party, I helped get these influencers to attend. Not such an easy feat. But collectively, we pulled it off and the night had arrived without any major hitches.

Getting ready for the event was another story. By the night of the party, I was smack-dab in the middle of treatment for breast cancer. I had been diagnosed in July and by September I had already had several surgeries and two rounds of chemotherapy. While getting ready for a dressy event would normally take about an hour, now it took almost three. Chemo made my skin break out in hives and it required time and skills to hide them. Thankfully, I had years of beauty reporting under my belt so I knew how to apply foundation and concealer like a pro. My hair was another matter. I tried, several times, to curl it into sexy, beachy waves. But ever since I started losing clumps at a time, it tended to look limp and lifeless no matter what I did to it. After several frustrating attempts at styling, and close to tears, I pulled it up into a sleek topknot. I finished with a swipe of almost neon orange lipstick. I figured the bold shade, which was totally on trend, would help distract from any obvious signs of my sickness.

Once the doors opened, the room filled with the who's who of the fashion and beauty world. I sipped on a drink and started to work the room. I talked with Khloé Kardashian and Lamar Odom, and neither seemed to notice that I was in the middle of a major health crisis. Khloé complimented my lipstick and my Jimmy Choo heels while we talked about her visiting Lamar's children in Brooklyn. Melissa Gorga and Cindy Barshop, two of Bravo's Real Housewives, grabbed me for an impromptu picture in the photo booth that was rented for the event. After, as we looked at the ten-plus pictures we took, Melissa commented on my glowing skin and asked who my facialist was. My answer: "I don't have one."

It was in that moment that I realized that nobody at the party—minus a few of my colleagues—knew I had cancer. I was standing among Hollywood's elite makeup artists, hairstylists, fashion stylists, talent scouts, agents, and celebrities—people who are known for their looks or whose jobs it is to create a flawless aesthetic—and not one of them had a clue I was sick.

It wasn't because I had done such a stellar job applying my concealer—although that did help. Nobody knew because I had my own notable glam squad helping me maintain my looks during cancer treatment. I had Ted Gibson telling me how to brush my thinning hair without pulling out any additional strands. I had Dr. Brian Kantor (the dentist for 50 Cent, the New York Knicks, and Penelope Cruz) keeping me stocked up on rinses to prevent the mouth sores chemo normally caused. And I had Elle Gerstein, JLo's manicurist, giving me tips on how to keep my nails from falling out. For every physical feature that could possibly be affected by cancer treatment, I had an expert in that specialty on speed dial. And I called every one of them.

If I hadn't been a beauty director with such incredible sources, I wouldn't have been able to show up at the party looking so good, so "normal." Like any good reporter, I had done research before I started treatment but there wasn't one book, one website, one resource that had all the information I needed on how to maintain my skin, hair, nails, mouth—and even my vajajay—during cancer treatment.

For cancer patients, it's often considered taboo to care about your looks when you should be focused on fighting for your life. While it was important to keep perspective on the health goals at hand, looking good, for me, was equally vital to my recovery. It helped me stay positive and focused on living, rather than being sick and all the possible negative outcomes that can come of it.

I can't tell you how many times I faced scrutiny when I would inquire or talk about the aesthetic elements and side effects of my treatment. But why is it so wrong to care? Why are cancer patients made to feel vain if they want their mastectomy reconstruction results to look and feel like real breasts, or ask about losing their hair?

The fact of the matter is beauty treatments are an adjunct therapy to cancer treatments. If you look good, you feel better. Even when I was feeling like shit—if I resembled a hint of my "normal self," it helped me get out of bed and power through the day. They say there are more important things in life than beauty and fashion but I'm here to tell you that they are just as important—if not more so—when you are sick. And why should anyone have to choose between their health or their beauty? They shouldn't—and don't—have to. The two are not mutually exclusive.

Maybe it's because beauty came late in life to me, and I wasn't ready to give it up so fast. Growing up, I was a chubby redheaded child with a face full of freckles and a precocious personality. By high school, I had discovered my inner rebel thanks to the Sex Pistols. And I did my best to channel Johnny Rotten with a neon-orange bi-level bob, ten-hole Dr. Martens, and ripped clothes held together with safety pins. I also shared his pimply skin problem too, which didn't win me any boyfriends. By college, Madonna was my idol, so naturally push-up bras became my go-to fashion statement. I didn't have the bust for them, but I wore them like they were my job. When I took a gig as "shooter girl" doling out shots of tequila and vodka at the Wave, a nightclub on Long Beach Island, bustiers became my uniform. It was then that I realized the power of boobs and fashion. When I graduated, I landed a job as editorial assistant in the newsroom of my hometown paper. I worked the news desk typing up the fire calls, police blotter, and obituaries. While I knew all the juicy scoops in town, I longed for a more glamorous role. On the night JLo wore that infamous slit dress to the MTV Video Music Awards, I scored an interview with the designer, Donatella Versace, and wrote up the story on deadline. It was selected as the cover. Two days later, I was promoted to the coveted job of fashion columnist.

While I loved fashion, it always felt a little cliquey to me. If you weren't a size two or rolling in money, there were certain things that would always be off-limits. But beauty is democratic. Obsessed with Beyoncé's limited edition Chanel bag? Good luck getting one. Love her smoky eye shadow? The look was easy to achieve—by anyone, on any budget. When I became a beauty director at a national magazine, I got to interview all the greats in the beauty world. I listened to their tips and tricks and then put them to work at home. In just a few years, I transformed into a full-fledged glamour girl. And it was just as I was feeling like I was coming into my own, achieving my potential fabulousness, that I was diagnosed with cancer. Talk about bad timing.

For the one in eight women who are diagnosed with breast cancer every year; the one in seventeen women diagnosed with lung cancer; or one in twenty-three who will be diagnosed with colorectal cancer, most of us don't know how to adjust our beauty routines during surgery, treatment, and life after. Most of us don't know what type of wig to shop for. Most don't know how to care for our skin when it's undergoing intense radiation. Why? Because there has never been a book dedicated to comprehensive beauty advice for cancer patients. Until now.

Pretty Sick: The Beauty Guide for Women with Cancer is my way of paying forward all the amazing advice, tips, and tricks that I received during my battle with breast cancer. That intel helped me look and feel better during the darkest days of my life. My hope is that by paving the way, it makes the journey less bumpy for you.





how treatment affects your sense of smell

Smell. I know this is the last thing you are probably thinking about right now. But as a cancer survivor, and former beauty director, it's the first thing I'm going to ask you to consider. Here's why:

From this point forward, every minute of this journey you are now on is going to be captured forever in your brain by your sense of smell. Mundane moments, even fleeting seconds, that you will most likely forget: sitting in the chemo suite with a drip in your arm; putting your wig on in the morning; taking a shower weeks after surgery—will be stored in your mind like a Polaroid picture by your sense of smell. One familiar whiff—and bam!—you will be transported back to any of these moments by your sense of smell. Memories, emotions, will feel as raw and real as they did when you first lived them. This phenomenon is called "scent memory."

Scent memory is a normal—yet unique—occurrence that we've all experienced: the aroma of fresh peeled apples brings you back to baking with your grandma; a breeze of lilac and you're playing again in the yard of your childhood home; a specific hair spray reminds you of prom night twenty years ago. Over half of the patients in chemotherapy treatment will experience temporary changes to their sense of smell. Those having radiation therapy for head and neck cancers can also experience a reduced or heightened sense of smell. This change of sense can trigger powerful memories months and years down the road.

So why am I telling you this? What does this have to do with cancer and your beauty regimen? A lot actually. I'm going to share a story to explain why.

A year before I was diagnosed with breast cancer, I had major back surgery. During that time, I used all of my regular skin care products. Why wouldn't I, right? A year later—after a rotation of different cleansers, serums, and toners—I came back to that same La Prairie face cream that I had used during my recovery from surgery. Instantly, I started having flashbacks to the days when I was out of work on disability, and, in essence, learning how to walk again. It was one of the most difficult times in my life and the memories brought up by the smell of that face cream made me feel depressed and helpless all over again. The emotions were so terrible, so tangible, I felt like I was reliving the whole experience.

Obviously, I didn't want a reoccurrence of this during my battle with breast cancer. So, after my initial doctors appointments and a week before my first surgery, I switched out all my staple (and favorite) beauty products. Instead of opting for inexpensive drugstore replacements, I decided to be a bit indulgent and choose some really luxurious products. I mean, why not? The road ahead was going to suck. This was the least I could do to pamper myself both emotionally and physically. I stocked up on La Mer moisturizer, Rodin Olio Lusso body oil, and Fresh Hesperides Grapefruit Bath & Shower Gel. I figured that the high-end ingredients would be essential in healing my ravaged skin and I wouldn't miss the hefty price tags if the smells reminded me of this shitty time in my life.

So, why does our sense of smell change?

"One theory is that a number of chemotherapeutic agents alter cell turnover in the olfactory pathway, the olfactory hypothelium, or the cells at the top of the nose," says Dr. Richard Doty, the director of the Smell and Taste Center at the Perelman School of Medicine at the University of Pennsylvania. "Those cells die off and are replaced by stem cells that produce new olfactory receptor cells and then the process of regeneration is inhibited by the chemotherapeutic agents. As a consequence, smell is affected."

Specific chemotherapy drugs responsible for affecting smell include: carboplatin, cisplatin, cyclophosphamide, dacarbazine, dactinomycin, doxorubicin, 5-fluorouracil, levamisole, mechlorethamine, methotrexate, paclitaxel, and vincristine.

In her book The Scent of Desire, Dr. Rachel Herz, one of the leading experts in the psychology of smell, discusses the very realness of this phenomenon. "More than any other sensory experience, fragrances have the ability to trigger our emotions: to fill us with joy and rage, to bring us to tears and to make our hearts ache, to incite us with terror, and to titillate our desires." Herz goes on to write how many New Yorkers who survived the attacks on the World Trade Center on September 11, 2001, have this experience whenever they smell anything charred or dusty. She adds one stunning fact that can't be ignored. "Not only do odors trigger emotions, they can become emotions." How is this possible? The reason is this: No other sensory system (sight, taste, touch, hearing) makes direct contact with the amygdala, the area of the brain where emotion and emotional memory is processed and the hippocampus, where associative learning takes place. Because of this, Herz writes, "odors can literally be transformed into emotions through association and then act as proxies for emotions themselves, influencing how we feel, how we think and how we act." The two are fundamentally interconnected while being independently functional.

Studies show that children and adults exposed to "frustration-associated odors" during tests were less creative and motivated to solve the problems compared to their peers who weren't exposed and ultimately successful at the tasks presented. Just think about the effect a scent memory—linked to the day of your surgery, wig shopping, or your radiation treatments—could do to your positive attitude and recovery process. It can be life-altering, I will tell you that.

Here's the thing: most beauty products—even the unscented ones—have a smell. And because of that, they aren't exempt from scent memories. So, here's my advice:

Now is the time to shelve your favorite beauty products.

This includes obvious items like your perfume and body lotion but it also applies to things you normally won't think twice about, like toothpaste and hand wash. Making this swap early—as close to the day of your diagnosis as possible—will prevent them from having any connection to your cancer. After all your treatments and surgeries are over, you can swap your favorites back in. But during this time, treat yourself to a few items you wouldn't normally splurge on. You deserve it—and so does your body!

perfume: to spritz or not to spritz

In many ways, perfume tells the story of a person's life. For me, each chapter of my life is defined by the perfume I was wearing at the time. In high school I wore Giorgio Beverly Hills. In college, it was Elizabeth Arden's Red. For my first job I wore YSL's Opium—a scent I thought was mature and sophisticated. The day I was offered the beauty director position, I had traces of Jo Malone Orange Blossom lingering on my wrists and neck. Today, I'm all about Tom Ford Private Blend. For most women—and many men—perfume helps us project to the world who we aspire to be. This is certainly true for me. So, when I was sick, I didn't want to give that up. I still wanted to smell feminine, sexy—like my (regular) self. I wanted, no, needed, that element of normalcy and happiness.

Studies show that the very existence of scent elevates one's mood. People who have lost their ability to smell—no matter what the cause—are more likely to experience depression. So, while it can be tricky for cancer patients to use products with fragrance, if you're anything like me, it's still very important to have some wafting around. So, if you are going to wear perfume, my advice is that you set aside your signature scent and find a temporary replacement.

Now I know what you're going to say: You've worn the same fragrance for the last ten years. It's your absolute favorite and everyone knows when you enter a room by the gorgeous aroma that trails behind you. This is precisely why you don't want to wear it now. Besides the fact that you don't want to create cancer-affiliated scent memories, the changing chemicals in your skin will most likely cause the perfume to produce a different smell than what you are used to. "I think this is essential information for patients who are being treated," says Dr. Avery Gilbert, psychologist from the University of Pennsylvania and author of What the Nose Knows: The Science of Scent in Everyday Life. "It's very important to shelve your favorite fragrance for a while, so that you don't link it to the negative aspect of the experience." Instead, choose a backup blend that you love almost as much but could stand to live without in the long run. Here's how to do just that…

determine your skin's sensitivity

The first thing you want to do is evaluate how sensitive your skin is to determine the concentration that it can handle. Granted, this may change once chemotherapy or radiation treatments commence but it will give you a baseline gauge for how reactive your skin is and might be. If your skin tends to get itchy, red, or irritated from the cold weather, allergies, or a sweat-filled workout—that indicates it could be supersensitive once you are in the thick of treatment. "Fragrances are categorized by the range of concentration that they fall into," says Lisa Lewis, senior vice president and Fragrance Academy Director at Givaudan, global leader in the creation of fragrance and flavors. The Swiss-based company is behind some of the most iconic and best-selling fragrances including Calvin Klein Obsession, Dior J'adore, Angel by Thierry Mugler, Gucci Guilty, and Dolce & Gabbana—to name a few. "Going from a lower concentration to a higher concentration you have: body mists/splash, eau de toilette, perfume/parfum, and then essential oils."

start light, finish strong

If your skin seems a little sensitive but you still want to wear a scent, it's safest to try a body mist or splash first. These contain the lowest concentration of fragrance, making them the mildest option and the fastest to evaporate in the skin, hence the least irritating. My advice: Do a patch test on a hidden part of your body and see how your skin fares. If no reaction occurs, you can probably handle a more concentrated fragrance like an eau de toilette. If an eau de toilette is no problem, move on to perfume. You will only know by giving it a test run.

spray, delay, then decide

Selecting a "swap in" fragrance when your skin and sense of smell are changing can be challenging. The pH of your skin, your body chemistry, has a direct impact on how a fragrance smells. Conversely, the change in the mucous membranes of your nose will affect how you interpret that smell. So, it's important to test potential candidates on your skin before making a decision. "You should give a fragrance an hour to really experience it," says Lewis. "When you first spray, you get the top notes. Then, over the next ten to thirty minutes is what we call the mid-notes. Followed by the residual, the dry down, which is what lingers on your skin." That ending aroma often smells completely different from how it started, so it's important to give it time to diffuse completely before breaking out the benjamins.

give it time, before you rewind

When can you go back to wearing your oldie but goodie? The earliest would be one month after chemo ends. "The figures given for the complete turnover of the cells in the nose is something in the order of thirty to thirty-five days," says Dr. Gilbert. His advice: "Because cell turnover has been slowed down or knocked down a bit, it might take a little bit more time. Two months would be the safe waiting time to bring back your signature scent or the original brands you used to use."

scentsational notes

Scent has the amazing ability to change how we feel—so why not harness that to enhance your mojo? When you're shopping for a new fragrance, consider the notes it contains. Over the last two decades, Givaudan and International Flavors & Fragrance (among others) have studied the subjective and physiological effects of aromas and fragrances on emotions via "mood mapping." "There are studies about how different fragrances can impact different moods and that can be extremely effective for patients," says Lewis, whose mother is a two-time breast cancer survivor. Below are some notes that work wonders for your well-being.


Need a quick pick-me-up? Instead of grabbing a coffee, spritz a citrus-based scent instead! Notes including orange, grapefruit, bergamot, and lemon are energizing. So are certain florals. A study conducted in 2010 revealed that the tiny flower jasmine could help relieve depressive thoughts and increase alertness with one whiff!


Studies show that if you are looking to attract a mate you should select a fragrance with gourmand notes including honey, chocolate, and vanilla, which have aphrodisiacal powers. (Men think they are absolutely scrumptious!) But they also have the ability to calm the nerves. This capability also extends to warmer notes like amber (which smells like vanilla) and sandalwood. But there is one surprising scent that acts like an air-based Xanax: green apple. During a control panel conducted in 2008, the scent helped control feelings of anxiety during stressful moments and provided a noticeable reduction in headaches including migraines. Apparently, "An apple a day keeps the doctor away" isn't just some stupid expression…


There's a reason why lavender oil is used in almost every spa—it's well documented for easing both the mind and body. But did you know that green, leafy notes do too? Researchers in Australia found that a chemical released by newly mown grass makes people more joyful and relaxed. Pine also has some relaxing powers. A study conducted at Japan's Kyoto University examined the Japanese custom of strolling in the forest, known as shinrin-yoku or "forest bathing." On the days participants walked through the pine-filled woods, their levels of depression and anxiety were significantly reduced. Here's my advice for those who celebrate Christmas: The next time your relatives are coming over for the holidays, it might be wise to get a real pine tree…

a word about oils

Fragrance or perfume oils are typically made with essential oils. Because the scent is more concentrated, it also tends to be more irritating on the skin. Besides the potential to cause headaches and nausea, they can also prompt hives, rashes, and sores. For those with estrogen-positive cancers, like myself, there are some oils that should be avoided. These essential oils contain phytoestrogens that can mimic estrogen in the body, enhance the effects of estrogen, or cause symptoms of estrogen depletion—any of which may result in a hormonal imbalance. While the levels are probably nothing to worry about in dab-sized applications, it's important to be informed and aware of any potential side effects they could cause. Three oils are especially known to exaggerate changes in estrogen levels: lavender, rosemary, and tea tree oil. Others to avoid include clove, chamomile, licorice, oregano, peppermint, nutmeg, thyme, sage, and verbena.


With all the products we use every day—from hand wash to hair spray—it's almost impossible to use all fragrance-free beauty products. Finding a shampoo without a "fresh" scent is tough! But your health is worth the hunt. When shopping, labels can often be misleading. Terms like "hypoallergenic," "natural," and "organic" don't necessarily mean they are fragrance-free or gentle. You have to read the ingredient list and give the product a good whiff to know for sure. Some products are scented with fruit or herb extracts and those are generally natural and nonirritating. Choosing scent-free beauty products is the safer route and will help keep your skin smooth, supple, and rash-free. An extensive list of brands and specific scent-free products can be found in Chapter 3 (here). Use that list as a guide for what products to buy and use while in treatment.

where to wear your fragrance


On Sale
Sep 19, 2017
Hachette Audio

Caitlin M. Kiernan

About the Author

Caitlin Kiernan is an award-winning journalist, beauty expert, and cancer survivor. A former fashion columnist and beauty director she has appeared on E! News, Wendy Williams, and Fox News among other programs. Her freelance work has appeared in the Wall Street Journal, Women’s Health, Yahoo, Harper’s Bazaar, StyleWatch, Today, Refinery29, the New York Times, and other outlets.

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