Hand-foot Syndrome

Hand-foot syndrome is also called palmar-plantar erythrodysesthesia. It is usually caused by systemic anti-cancer treatment.

Symptoms include redness, swelling, dryness, tightness of the skin, thick calluses or blisters on the palms of the hands and the soles of the feet. You may have severe pain, soreness and sensitivity to touch or even difficulty in walking or using your hands.

Which anticancer drugs are associated with hand-foot syndrome?

Several drugs may cause hand-foot syndrome, including:

1. Chemotherapy:

• Capecitabine
• 5-FU
• Doxorubicin
• Docetaxel
• Paclitaxel
• Cytarabine
• Liposomal doxorubicin

2. Targeted therapy:

• Sunitinib
• Cabozantinib
• Pazopanib
• Sorafenib
• Axitinib
• Regorafenib

When does hand-foot syndrome usually appear?

Hand-foot syndrome usually appears in the first 2-3 months of treatment. But, it can appear in the first month especially when using targeted agent. It often begins as redness in the hands and feet, more common to start at the palms first. The redness is usually a patch over the palm, then gradually extends to the whole palms and soles with dry skins and crackings over the joints in the hands and feet.

Grading Scale for Hand-Foot Syndrome (NCI CTCAE version 5.0)

• Apply emollient cream: Those containing urea, salicylic acid or clobetasol (low dose steroid) are most useful.
• Apply topic analgesic balm or gel: You can apply analgesic balm or gel, such as those containing lidocaine, on your painful areas in the palms and soles.
• Oral pain killers: If pain persists after topic medications, you can try oral pain killers such as NSAIDS (e.g. naprosyn, ibuprofen, diclofenac), COX-2 inhibitors (e.g. celebrex) and paracetamol. Your doctor may also give you anticonvulsants or antidepressants (e.g. pregabalin, gabapentin) if you have numbness or tingling sensation over the fingers and feet.
• Topical or oral antibiotics: If there are blisters, erosions or discharge from the wound, your doctor may prescribe a course of topical or oral antibiotics.
• Refer to a podiatrist: Your doctor may refer you to visit a podiatrist if you have thick calluses or nails. The podiatrist will cut the nails carefully to prevent infection.

1. Skin Care:

• Avoid hot showers and pat your skin dry with a towel instead of rubbing, especially the hands, feet and skinfold areas.
• Limit the use of hot water on your hands and feet when washing dishes or bathing.
• Avoid tight bandages, dressings or adhesive tape to skin.
• Don’t wash hands too often and avoid hot water.
• Limit frequency and duration of bathing or showering.
• Use bath/ shower oil or mild moisturising soaps.
• Liberal use of creams to keep your hands moist. Avoid rubbing or massaging lotion into your hands and feet.
• Avoid using alcohol-containing hand products.
• Wear thick cotton gloves and/or socks at night.
• Wear loose fitting, well-ventilated shoes and clothes.
• Tell your doctor or nurse if you have any rashes or itching.

2. Nail Care

• Keep nails clean.
• Avoid nail biting, tearing of skin around the nail, cutting nails too short.

3. Activities:

• Don’t go swimming as water containing chlorine can worsen rashes.
• Avoid using hands for activities that might cause abrasion or mechanical stress (climbing) or tight gripping (such as use of tools or musical instruments).
• Wear gloves for washing, cleaning, working.
• Avoid walking barefoot. Wear soft slippers and thick cotton socks to prevent trauma and friction on your feet.

4. Diet

• Always need adequate hydration and nutrition to prevent skin dryness or desquamation.
• Recommend drinking at least 8 cups of water every day.
• Eat more food rich in protein, vitamins B and C.