Hand-Foot Syndrome Induced by Chemotherapy: Management

English: My hands after about 10 days of capec...
Hands after 10 days of capecitabine showing signs of medium-severe chemotherapy-induced hand-foot syndrome (Photo credit: Wikipedia)

What: Hand-foot syndrome is a common side effect of certain chemotherapy drugs, including capecitabine (Xeloda) and doxorubicin (Adriamycin). It also carries the more fancy descriptor palmar-plantar erythrodysesthesia. The symptoms typically being 2 to 12 days after you get the drug, and can iclude redness and swelling of the palms and soles. This can progress to scaling, dryness, pain, itching, or even blisters and ulceration. The palms are more commonly affected than the soles of the feet, in my experience.

How common is it? With Xeloda, just over half of patients will get some degree of hand-foot syndrome (bad in about 10 to 25%). Liposomal doxorubicin leads to the condition in about 40% of patients (especially painful in 1 to 20%).

Is it always bad? Some studies suggest capecitabine-induced hand-foot syndrome may be associated with better outcomes among those being treated for metastatic breast cancer.

What do I do? First, avoid excessive friction or trauma of the hands and feet. Consider protective gloves and socks. If you have pain, ask your doctor about opiod pain medicine or whether you may use non steroidal anti-inflammatory drugs. Treatment with topical steroid creams such as clobetasol or betamethasone may help, as can moisturizers such as ammonium lactate (lactic acid) 12% or salicylic acid 6% applied to affected areas. Your doctor may use systemic premedication with dexamethasone (Decadron), as studies with it for hand-foot syndrome linked to liposomal doxorubicin have been promicing. Celecoxib (Celebrex) 200 mg twice daily might help, too but check with your care team. Regional cooling of the hands and feet may help. Unfortunately, some patient need a decrease in their chemotherapy (or a treatment break).

I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

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