From the Guidelines
Hand-foot syndrome, a common side effect of certain chemotherapy medications, should be managed with a combination of preventive measures and treatments, including moisturizing creams, avoiding hot water, and wearing loose cotton socks and gloves. To manage hand-foot syndrome, also known as palmar-plantar erythrodysesthesia, it is essential to recognize the condition early and take proactive approaches to care. According to the study 1, recognition and correct clinical phenotyping is key to risk stratification and the formulation of an appropriate management plan. This includes the decision on when to reduce the dose, stop the drug, or treat with corticosteroids. Some key points to consider in managing hand-foot syndrome include:
- Applying moisturizing creams containing urea or ammonium lactate to hands and feet several times daily before starting chemotherapy known to cause this syndrome
- Avoiding hot water, wearing loose cotton socks and gloves, and using cold packs for symptom relief during treatment
- Considering over-the-counter pain relievers like acetaminophen or ibuprofen for mild cases
- Reducing chemotherapy dose or prescribing topical corticosteroids like clobetasol 0.05% cream twice daily for up to two weeks for moderate to severe cases, as recommended by the study 1
- Oral pyridoxine (vitamin B6) at 50-150 mg daily may help some patients, though evidence is mixed, and it is crucial to consult with an oncologist before starting any new medication. It is also important to note that hand-foot syndrome occurs because chemotherapy drugs leak from small blood vessels in the hands and feet, causing inflammation and damage to surrounding tissues, as mentioned in the study 1. The extremities are particularly vulnerable due to their numerous capillaries and high pressure from daily activities. Therefore, it is essential to contact a healthcare provider immediately if symptoms interfere with daily activities or if severe blistering or ulceration develops, and to follow the management plan recommended by the study 1 to minimize the risk of morbidity, mortality, and improve quality of life.
From the Research
Definition and Incidence of Hand-Foot Syndrome
- Hand-foot syndrome (HFS) is a common skin reaction to systemic therapy, particularly with chemotherapeutic treatments such as pegylated liposomal doxorubicin, docetaxel, and fluoropyrimidines 2.
- The incidence of HFS is dependent on the chemotherapeutic drug used, the treatment schedule, and the median duration of treatment 2.
- HFS can cause significant discomfort and impairment of function, especially in elderly patients, and may seriously impact quality of life 2.
Pathogenesis and Clinical Features
- HFS is a dose-limiting cutaneous toxicity of many chemotherapeutic agents, including multikinase inhibitors such as sorafenib and sunitinib 3.
- The high prevalence of HFS reported by patients treated with these medications underscores the need for greater understanding of the pathogenesis and management of this syndrome 3.
Management and Prevention
- Effective measures for prevention and treatment of HFS include systemic and topical treatments, dose reductions, and switching to other drugs in the same class that are associated with lower rates of HFS 2.
- Celecoxib and urea cream have been shown to be effective in preventing HFS/HFSR in patients receiving systemic cancer treatment 4, 5, 6.
- Celecoxib is more effective in preventing all-grade capecitabine-induced HFS, while urea cream shows more benefit in preventing moderate to severe sorafenib-induced HFSR 5.
- Urea cream has advantages in reducing the incidence of severe HFS and is a safe and viable topical prevention strategy that can reduce the incidence of high-grade HFS in patients undergoing chemotherapy 6.