OVERVIEW

What is Hand-Foot Syndrome?

Hand-foot syndrome is one of the common skin toxic reactions caused by chemotherapy drugs and targeted therapies. It mainly manifests as erythema, numbness, swelling, pain, cracking, and hyperpigmentation on the palms and soles. It typically appears during the 2nd to 3rd treatment cycle, though a very small number of patients may experience it as early as 3-5 days after treatment^[1].

The severity of hand-foot syndrome varies from person to person. Most patients, under medical guidance, can effectively alleviate symptoms through topical ointments, neurotrophic drugs, pain relievers, and other methods.

How Common is Hand-Foot Syndrome?

The incidence of hand-foot syndrome varies depending on the type and dosage of the drug, with an overall occurrence rate of approximately 6%-64%^[4]. Among chemotherapy drugs, it is commonly seen with capecitabine (used for colorectal cancer), with an incidence rate of 22%-77%^[5]. Among targeted therapies, sorafenib (used for advanced liver and kidney cancer) is a typical example, with an incidence rate of about 30%-50%^[6].

Additionally, the incidence varies with different treatment regimens. For example, in patients treated with doxorubicin alone, the incidence is 22%-29%, while in those receiving doxorubicin combined with fluorouracil, the rate can be as high as 89%^[2].

How Long Does Hand-Foot Syndrome Last?

The duration of hand-foot syndrome varies among individuals but generally gradually improves within 1-5 weeks after discontinuing the medication.

Which Department Should Be Consulted for Hand-Foot Syndrome?

Patients with hand-foot syndrome can seek treatment in the oncology or dermatology department. Under medical guidance, symptoms can be alleviated through topical ointments, neurotrophic drugs, pain relievers, and other methods. If necessary, the dosage of anticancer drugs may need to be reduced or even discontinued.

Is It Necessary to Stop Medication After Hand-Foot Syndrome Occurs?

Discontinuing medication is not always necessary after the onset of hand-foot syndrome.

For patients with mild symptoms, lifestyle adjustments, topical ointments, neurotrophic drugs, and pain relievers can help manage symptoms under medical supervision. For moderate to severe cases (e.g., skin numbness, erythema, pain affecting daily life, severe blisters, or bleeding), reducing the drug dosage may be required, and in severe cases, discontinuation may be necessary^[2]. The specific approach should be determined by the treating physician based on individual patient conditions.

SYMPTOMS

What are the common manifestations of hand-foot syndrome?

Hand-foot syndrome typically occurs on the palms and soles but may also appear in other friction-prone areas, such as the armpits or groin. Common manifestations include^[2,7]:

(1) Sensory abnormalities and pain: Such as numbness in the hands and feet, a cotton-like sensation under the feet; reduced sensitivity to hot and cold temperatures; itching, tingling, or even burning pain in the skin.

(2) Skin changes: Redness, swelling, cracking, peeling, or flaking (small or large patches of skin lifting), and in severe cases, blisters or bleeding; may also manifest as skin thickening or hyperpigmentation (e.g., darkening of hands and feet).

(3) Nail toxicity: Discoloration, shedding, or deformation of fingernails or toenails; severe cases may involve localized infection or ulceration.

CAUSES

What are the main causes of hand-foot syndrome?

Hand-foot syndrome is primarily caused by certain chemotherapy drugs and targeted therapies.

• Common chemotherapy drugs that may induce hand-foot syndrome include: capecitabine, fluorouracil, oxaliplatin, vinorelbine, docetaxel, paclitaxel, liposomal doxorubicin, etc.;
• Common targeted therapies include sunitinib, sorafenib, pazopanib, regorafenib, gefitinib, etc.^[2,3].

Preventive measures include avoiding skin friction (wearing loose clothing and footwear, minimizing scratching), reducing exposure to temperature extremes (avoiding contact with very hot or cold objects), and practicing sun protection and moisturizing.

DIAGNOSIS

How is Hand-Foot Syndrome Diagnosed?

The diagnosis of hand-foot syndrome is relatively straightforward. Doctors can diagnose it based on the patient's relevant medication history and characteristic clinical manifestations, which include:

(1) Sensory abnormalities and pain: Such as numbness in the hands and feet, a sensation of walking on cotton; reduced sensitivity to hot and cold; itching, tingling, or even burning pain in the skin.

(2) Skin changes: Redness, swelling, cracking, peeling, or flaking (small or large patches of skin lifting); in severe cases, blisters or bleeding may occur. It can also manifest as skin thickening or hyperpigmentation (e.g., darkening of the hands and feet).

(3) Nail toxicity: Discoloration, shedding, or deformation of fingernails or toenails; in severe cases, localized infections or ulcers may develop.

TREATMENT

How to treat hand-foot syndrome? Can it be cured?

Medications for hand-foot syndrome are divided into topical and oral treatments. It is important to note that patients with severe symptoms (such as skin numbness, erythema, pain affecting daily life, severe blisters, bleeding, etc.) should reduce or discontinue medication under the guidance of a doctor. Please consult your physician for details^[2,7].

(1) Topical treatments: Moisturizing or keratolytic ointments, such as urea cream, petroleum jelly, or aloe vera gel, can be applied externally. For patients with skin ulcers, growth factor gel can promote ulcer healing. For those with significant pain, analgesic medications (such as lidocaine gel) may be applied as needed.

(2) Oral medications: For patients experiencing numbness or tingling in the hands and feet, oral mecobalamin tablets can nourish the nerves. Some studies also suggest that vitamin B6, vitamin E, or corticosteroids may alleviate symptoms. For patients with severe pain, oral celecoxib, gabapentin, or pregabalin can be used for pain relief.

Most patients with hand-foot syndrome show improvement after the above treatments, dose adjustments, or discontinuation of medication.

DIET & LIFESTYLE

What should patients with hand-foot syndrome pay attention to in daily life?

(1) Reduce skin friction: Avoid local friction on hands and feet, try not to scratch the skin, choose loose and comfortable gloves, socks, and shoes that absorb sweat, use soft insoles, and avoid wearing overly tight shoes.

(2) Maintain moisture and warmth, reduce irritation: Keep the skin of hands and feet clean and moisturized by applying lubricating lotions; keep hands and feet warm in cold weather, and avoid contact with excessively hot/cold objects, chemical detergents (dish soap, laundry detergent, etc.), alcohol, or other irritants.

(3) Avoid sun exposure and strenuous physical activity: Avoid direct sunlight and use sunscreen when unavoidable. Refrain from heavy physical labor to reduce pressure on hands and feet.

(4) Maintain a balanced diet and supplement B vitamins: Eat a balanced diet and consume foods rich in B vitamins, such as oats, soybeans, peanuts, fresh vegetables, and fruits.

(5) Take medication on time. For patients with skin blisters, bleeding, or ulcers, ensure proper cleaning to avoid skin infections.

PREVENTION

Does hand-foot syndrome occur in all patients undergoing chemotherapy? Can hand-foot syndrome be prevented?

Not all patients receiving chemotherapy/targeted drugs will develop hand-foot syndrome. We can effectively reduce its likelihood by taking certain measures, thereby achieving prevention.

Specific preventive measures include:

(1) Minimize skin friction: Avoid local friction on hands and feet, refrain from scratching the skin, choose loose, comfortable, and sweat-absorbing gloves, socks, and shoes, use soft insoles, and avoid wearing overly tight footwear.

(2) Maintain moisture and warmth, reduce irritation: Keep the skin of hands and feet clean and moisturized by applying lubricating lotions; keep hands and feet warm in cold weather, and avoid contact with extremely hot/cold items, chemical detergents (dish soap, laundry detergent, etc.), alcohol, or other irritating substances.

(3) Avoid sun exposure and strenuous physical activity: Avoid direct sunlight and use sunscreen when unavoidable; refrain from heavy physical labor to reduce pressure on hands and feet.

(4) Maintain a balanced diet and supplement B vitamins: Eat a balanced diet and include foods rich in B vitamins, such as oats, soybeans, peanuts, fresh vegetables, and fruits.