Hand-Foot Syndrome Palmar Plantar Erythrodysesthesia
Hand-foot syndrome is a side effect of some chemotherapy drugs that results when a small amount of drug leaks out of the blood vessels, damaging tissues. This tends to happen in the hands and the feet because of the increased friction and heat that your extremities are exposed to through daily activities.
Hand-foot syndrome is most commonly associated with Xeloda (capecitabine) chemotherapy used to treat breast and colon cancer but can be a side effect of other treatments as well. Hand-foot syndrome is painful and can result in dose reductions that limit the effectiveness of cancer treatment - solutions are needed to allow optimal Xeloda dosing.
- What is hand-foot syndrome?
- Which drugs cause hand-foot syndrome?
- What are the symptoms of hand-foot syndrome?
- How can hand-foot syndrome be prevented?
- How is hand-foot syndrome treated?
- What else can I do?
What is hand foot syndrome
Hand-foot syndrome is a side effect of some chemotherapy drugs that results when a small amount of drug leaks out of the smallest blood vessels in the palms of the hands and soles of the feet. The amount of drug in the capillaries of the hands and feet increases due to the friction and subsequent heat that is generated in those extremities. As a result, more drug may leak out of capillaries in these areas. Once out of the blood vessels, the chemotherapy drug damages surrounding tissues.
Which drugs cause hand foot syndrome
The chemotherapy drugs that have been reported to cause hand-foot syndrome in some patients include1
- Capecitabine (Xeloda®)
- Cytarabine (Cytosar-U®)
- Floxuridine (FUDR®)
- Fluorouracil (5-FU)
- Idarubicin (Idamycin®)
- Liposomal doxorubicin (Doxil®)
- Nexavar (sorafenib)
- Sutent (sunitinib)
- Zelboraf (vemurafenib)
- Inlyta (axitinib)
- Cabometyx,
- Cometriq (cabozantinib)
- Stivarga (regorafenib)
- Votrient (pazopanib)
What are the symptoms of hand foot syndrome
Symptoms of hand-foot syndrome include:
- Tingling or burning
- Redness
- Flaking
- Swelling
- Small blisters
- Small sores on the palms of the hands or soles of the feet
How can hand foot syndrome be prevented?
Changes to your normal, daily activities after chemotherapy can reduce your chances of developing hand-foot syndrome.
Reduce exposure of hands and feet to friction and heat by avoiding the following:
- Hot water (washing dishes, long showers, hot baths)
- Impact on your feet (jogging, aerobics, walking, jumping)
- Using tools that require you to squeeze your hand on a hard surface (garden tools, household tools, kitchen knives)
- Rubbing (applying lotion, massaging)
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Medications
Diclorenac is a non-steroidal anti-inflammatory drug used for the treatment of arthritis. Recent clinical trials however have demonstrated that use of the topical gel preparation can reduce both the incidence and severity of Xeloda (capecitabine) induced hand-foot syndrome.4
Clobetasol can both prevent and treat Hand-foot syndrome.
How is hand foot syndrome treated
Hand-foot syndrome is first treated by reducing the dose or stopping treatment with the chemotherapy drug that is causing it. Other approaches to managing hand-foot syndrome include:
Corticosteroids: Steroids work by reducing inflammation. Your doctor may recommend a systemic corticosteroid (administered in a pill) to help relieve the symptoms of hand-foot syndrome.
Dimethyl - sulfoxide (DMSO): Topical treatment with DMSO has shown activity in treating leakage of chemotherapy drugs into tissues.2
Vitamin B6 (pyridoxine): A small clinical trial has shown that treatment with vitamin B6 can reduce the symptoms of hand-foot syndrome.3
What else can I do
For relief of symptoms associated with hand-foot syndrome, try the following:
- Cool with ice packs for 15-20 minutes at a time
- Elevate hands and feet
- Apply antibiotic ointment on open sores
- Apply moisturizers sparingly
- Avoid constrictive clothing
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References
- Nagore E, Insa A, Sanmartin O. Antineoplastic therapy-induced palmar plantar erythrodysesthesia (‘hand-foot’) syndrome. Incidence, recognition and management. Am J Clin Dermatol. 2000 Jul-Aug; 1(4): 225-34.
- Lopez AM, Wallace L, Dorr RT, Koff M, et al. Topical DMSO treatment for pegylated liposomal doxorubicin-induced palmar-plantar erythrodysesthesia. Cancer Chemother Pharmacol. 1999; 44(4): 303-6.
- Fabian CJ, Molina R, Slavik M, Dahlberg S, et al. Pyridoxine therapy for palmar-plantar erythrodysesthesia associated with continuous 5-fluorouracil infusion. Invest New Drugs. 1990 Feb; 8(1): 57-63.
- https://meetings.asco.org/abstracts-presentations/226783
