Hand foot syndrome

This is a common side effect associated with a number of chemotherapy drugs affecting the skin and sensation on the palms and soles. The symptoms usually resolve within two weeks if the drug causing the effect is stopped.

What causes hand foot syndrome?

The exact cause of hand foot syndrome is unknown, but it tends to occur days to weeks after commencing treatment with certain chemotherapy drugs. It most commonly develops after six weeks of treatment.

What are the symptoms of hand foot syndrome?

Hand foot syndrome is characterised by the gradual onset of reactions over the palms and soles including:

  • skin redness
  • tenderness
  • pain
  • swelling
  • tingling
  • numbness
  • itching
  • blistering lesions
  • dry rash
  • thinning and broken skin which weeps fluid
  • ulceration
  • sensory impairment

How can hand foot syndrome be prevented/managed?

Your care team will discuss if you are at risk of hand foot syndrome before starting treatment. Prior to starting treatment, you should avoid the use of soaps, use lukewarm water, avoid heat and sun exposure and liberally apply emollients on your skin.

The following may help you reduce the development and severity of hand foot syndrome as well as pain, discomfort and further infection:

  • gently apply an emollient to hands and feet daily (e.g. an emollient containing urea 10%)
  • bathe or shower in lukewarm water
  • soak hands and feet in a basin of cold water for 15 minutes three to four times per day if possible
  • avoid sun exposure and use a SPF 30+ sunscreen
  • avoid activities that cause friction and rubbing of the skin surfaces or even slight pressure on hands, such as vigorous washing, clasping or clapping of hands, gripping tools or appliances, typing, playing musical instruments and driving
  • avoid contact with chemicals such as detergents and cleaning products
  • elevate hands and feet when sitting
  • wear cotton gloves
  • wear thick cotton socks especially if standing for long periods
  • use a gel shoe insole cooled prior to placing in your shoe
  • avoid tight-fitting shoes
  • avoid any unnecessary walking, jogging or vigorous exercise
  • avoid topical anaesthetic containing creams as they may exacerbate skin toxicity
  • avoid exposure of hands and feet to heat
  • report any skin changes to health professionals as soon as possible

Symptoms may be treated using topical wound care, cold compresses, moisturisers, topical corticosteroids and systemic analgesics. The most effective treatment for hand foot syndrome involves delaying planned treatment or reducing treatment dosages. Severe cases may require stopping the chemotherapy drug which is causing hand foot syndrome and/or referral to a dermatologist.

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