Hand-Foot Syndrome During Cancer Treatment

Hand-foot syndrome is a skin reaction to a medicine, such as those used for cancer treatment. The skin on the palms of your hands and the soles of your feet becomes red, swollen, sore, or even starts to peel or crack. It is also called palmar-plantar erythrodysesthesia.

It usually starts during the first 2 to 6 weeks of treatment. Many people first notice tingling or warmth, and that feeling can get worse if nothing is done about it. Most people recover from hand-foot syndrome when treatment is adjusted or finished.

Chemotherapy medicines that can cause hand-foot syndrome include capecitabine (Xeloda), liposomal doxorubicin, fluorouracil (5-FU), gemcitabine, cytarabine, and azacitidine and decitabine.

Some targeted therapies can cause it too, particularly the group called angiogenesis inhibitors: bevacizumab (Avastin), sorafenib (Nexavar), sunitinib (Sutent), regorafenib (Stivarga), pazopanib (Votrient), and axitinib (Inlyta).

If one of these is part of your plan, it is worth asking at the start what to watch for, so you recognize the first changes rather than waiting until walking hurts.

Early symptoms are easy to dismiss:

• dry skin
• redness
• tingling or itching
• mild pain or numbness
• mildly decreased sensitivity to touch, hot, and cold

If it is not treated and gets worse, symptoms can include increased redness like a sunburn, with swelling; cracked and peeling skin; blisters; and more decreased sensitivity to touch, heat, and cold.

That second list is what you are trying to avoid. The gap between the two stages is usually where reporting the symptom makes the most difference.

There is no single number you get told. In practice, severity is read along that same path, from dry, red, tingling skin at one end to intense redness with swelling, cracking, peeling, and blisters at the other. Two things matter most: whether the skin is still intact, and how much the symptoms are limiting what you can do. Severe hand-foot syndrome is the level that prompts a change to the cancer treatment itself.

Skin care and protection carry most of the weight:

• Apply a gentle, alcohol-free moisturizing lotion.
• Rest your hands and feet often, and elevate them when you can.
• Keep the skin clean, cool, and dry. Ice packs can help if you can tolerate them.
• Wear well-fitting shoes with padding.
• Limit time in hot water, and avoid hot tubs.
• Wear sun-protective clothing.
• Ask for help handling sharp, hot, or cold objects.
• Do not puncture blisters, because that can let infection in.

Your care team may also prescribe treatment: steroid creams or lotions containing urea, steroid pills, pain medicine, skin-cooling gloves or socks, or special hand and foot soaks.

Some ordinary habits make it worse. Avoid long walks or runs, excessive gripping with your hands, chopping, gardening, and prolonged pressure on your hands or feet. Skip manicures and pedicures. Avoid extended contact with warm or hot water, tight clothing and footwear, sun exposure, and intense hand or foot activity.

Popping a blister yourself is not a shortcut to relief. It is a route to infection.

If hand-foot syndrome is severe, your cancer care team might recommend reducing the cancer treatment dose or taking a short break from your cancer treatment. That is a normal, planned response to a side effect, not a sign that treatment has failed. It is also the main reason to report symptoms early rather than pushing through them, because a smaller adjustment made sooner is often enough.

Tell your care team if your hands or feet start to hurt or peel.

If a blister breaks on its own, contact your cancer care team.

Report all symptoms, whether they have changed, and what helps and what does not, at each visit or as directed by your care team. If your team has given you its own rule about when to call between visits or after hours, follow that rule.

This side effect is not only a skin problem. Severe hand-foot syndrome can make walking difficult and make it hard to handle objects. It increases the risk of falls, and of burns and wounds, and open sores can let infection in. Reduced sensitivity to touch, heat, and cold is part of why: you may not feel a pan that is too hot, or a shoe that is rubbing a raw spot.

Practical adjustments follow directly from that. Sit down for tasks you would normally stand for. Break activity into shorter stretches with rest in between. Hand off the chopping, the gardening, and anything involving sharp or hot items. Choose padded, well-fitting shoes over anything tight.

Fingerprint changes can happen, though permanent loss is rare, and the skin usually recovers over weeks to months after treatment.

• Call your care team now, day or night, if you run a temperature of 100.4°F (38°C) or higher while on chemotherapy or targeted therapy. CDC treats fever during chemotherapy as a medical emergency, because blood counts may be low and an infection can become life-threatening within hours. If you cannot reach them within minutes, go to an emergency department and say you are on treatment.
• Call 911 or go to an emergency department if the fever comes with shaking chills, confusion, a racing heartbeat, or skin that is mottled or clammy — those point to sepsis.
• Call your care team the same day if a blister on your palm or sole breaks open on its own, or if a crack or raw patch starts to look infected — spreading redness around the edge, yellow or cloudy drainage, or new warmth and swelling, without fever. Open skin on the hands and feet is the route infection takes, which is why ACS says to contact your team when a blister opens rather than waiting.
• Call your care team within a day or two if your palms or soles begin to hurt or peel, if walking or gripping has become difficult, or if numbness means you can no longer feel heat properly. These are the changes that let your team adjust the dose early, while a small adjustment is still enough.

Helpful next pages include Side Effects of Cancer Treatment, Immune-Related Side Effects, Low White Blood Cells During Chemotherapy, and Supportive Care.

• American Cancer Society, Hand-Foot Syndrome