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Hand-Foot Syndrome (Palmar-Plantar Erythrodysesthesia)

 

This section has been reviewed and approved by the PLWC Editorial Board, 03/06

Hand-foot syndrome is a side effect of some types of chemotherapy that causes redness, swelling, and pain on the palms of the hands and/or the soles of the feet. Hand-foot syndrome occurs when small amounts of chemotherapy leak out of the capillaries (small blood vessels) in the hands and feet. Once out of the blood vessels, the chemotherapy damages the surrounding tissues. Although less common, hand-foot syndrome can also occur on other areas of the skin, such as the knees and elbows.

The following chemotherapy may cause hand-foot syndrome:

  • Capecitabine (Xeloda)
  • Cytarabine (Cytosar-U)
  • Floxuridine (FUDR)
  • Fluorouracil (5-FU)
  • Idarubicin (Idamycin)
  • Liposomal doxorubicin (Doxil)

Symptoms

In mild to moderate hand-foot syndrome, the following symptoms may occur on the palms and/or soles:

  • Redness (resembling a sunburn)
  • Swelling
  • A sensation of tingling or burning
  • Tenderness
  • Rash

Symptoms of severe hand-foot syndrome include the following:

  • Cracked, flaking, or peeling skin
  • Blisters, ulcers, or sores on the skin
  • Severe pain
  • Difficulty walking or using the hands

Treatment

If you develop severe hand-foot syndrome, your doctor may reduce your chemotherapy dose or alter your chemotherapy schedule. If necessary, your doctor may temporarily stop your chemotherapy until your symptoms improve.

The following medications may be used to treat hand-foot syndrome:

  • Oral or topical (applied to the skin) corticosteroids to reduce inflammation
  • Topical dimethyl sulfoxide (RIMSO-50) to help reduce leakage of chemotherapy from the capillaries
  • Vitamin B6 (pyridoxine [Nestrex]) to help reduce symptoms
  • Over-the-counter pain relievers, such as acetaminophen (Tylenol), to help relieve pain

Management and prevention

Management and prevention of symptoms focuses on avoiding friction and heat, which make the symptoms worse. The following suggestions may help you manage symptoms and prevent hand-foot syndrome from becoming worse:

  • Avoid prolonged exposure of hands and feet to hot water when washing dishes or bathing.
  • Take cool showers or baths.
  • Avoid exposure to sources of heat, including saunas, sitting in the sun, or sitting in front of a sunny window.
  • Avoid activities that cause unnecessary force or friction on the feet, such as jogging, aerobics, and long walks.
  • Avoid contact with harsh chemicals used in laundry detergents or household cleaning products.
  • Avoid the use of rubber gloves to clean with hot water, as rubber traps heat against your skin.
  • Avoid using tools or household items that require you to press your hand against a hard surface, such as garden tools, knives, and screwdrivers.

Other things you can do to help manage symptoms of hand-foot syndrome include:

  • Cool your hands and feet with ice packs or cool compresses for 15 to 20 minutes at a time. (Avoid applying ice directly to the skin.)
  • Elevate your hands and feet when sitting or lying down.
  • Carefully pat your skin dry after washing or bathing-try not to rub your skin with a towel.
  • Gently apply mild skin care creams to keep your hands moist. Avoid rubbing or massaging lotion into your hands and feet, as this creates friction.
  • Wear loose, well-ventilated shoes and clothes.

More Information

PLWC: Managing Side Effects

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