Hand-foot syndrome (HFS), or palmar-plantar erythrodysesthesia, is a skin reaction that affects the palms of your hands and the soles of your feet. It’s a common side effect of some types of chemotherapy. Symptoms include redness, swelling and sometimes pain. Often, you can manage symptoms with lifestyle changes and over-the-counter medications.
Hand-foot syndrome (HFS), or palmar-plantar erythrodysesthesia, is a common side effect of some types of chemotherapy. Chemotherapy is a common cancer treatment. HFS is a skin reaction that you may experience as redness or swelling on the palms of your hands or the soles of your feet.
The first cases of hand-foot syndrome were diagnosed in people with leukemia receiving high doses of cytarabine. Other types of chemotherapy commonly associated with HFS include:
Other (less common) chemotherapy treatments associated with HFS include:
The strength of your chemotherapy dose and how it’s administered affect your likelihood of getting HFS. You’re at greater risk of HFS if you receive high doses of chemotherapy on a continuous schedule.
In other words, you’re more likely to get HFS if you have high amounts of chemotherapy drugs in your system over a long period.
The first signs of hand-foot syndrome usually start two to three weeks after chemotherapy begins. You may notice tingling in your palms and the soles of your feet. As symptoms progress, they may include:
Symptoms can range from minor skin changes with no pain to pain that’s so severe it keeps you from doing everyday activities.
Your healthcare provider may suspect you have HFS if you’re receiving chemotherapy and display the associated symptoms.
If you’re also receiving cancer drugs called multikinase inhibitors, your healthcare provider may need to rule out a condition similar to hand-foot syndrome called hand-foot skin reaction (HFSR). HFSR is a side effect of multikinase inhibitors. It also causes skin changes. Symptoms include painful, thick, yellowish skin in places like your joints, soles and palms.
Your healthcare provider may look at the skin cells underneath a microscope to determine if the skin changes are HFS or HFSR.
The National Cancer Institute developed a grading system to classify HFS based on its seriousness. Your grade of HFS will affect how your healthcare provider chooses to treat or manage it.
Your healthcare provider may stop chemotherapy, adjust your dose or switch to a different type of chemotherapy drug if you have severe symptoms that interfere with your quality of life.
Sometimes, making these changes can make the cancer treatment less effective. If this is the case (or if your symptoms are mild), your provider may recommend strategies for managing side effects.
Most people with hand-foot syndrome can manage symptoms with lifestyle changes. You can soothe and manage symptoms if you:
You should also avoid activities that cause friction on your palms or soles. At least in the short term, avoid activities like jogging, where your feet frequently pound the ground. Avoid activities that require you to grip a tool or device for long periods.
Use a fragrance-free lotion that doesn’t contain alcohol. Alcohol can dry your skin and worsen your symptoms. Some studies show that applying 10% urea cream on your skin three times a day can help your skin feel better.
Symptoms usually improve between two to five weeks after stopping chemotherapy.
It’s a good idea to get treated for any existing skin conditions before starting chemotherapy.
Many strategies that manage HFS can also potentially prevent HFS. For example, your healthcare provider may recommend that you begin regularly applying moisturizer the same day you start chemotherapy. You can be proactive by avoiding heat exposure and activities that stress the skin on your palms and soles.
Everyone experiences HFS differently, even if they receive the same chemotherapy drugs. HFS may be a minor nuisance or so unpleasant that it requires changing your approach to cancer treatment.
Usually, symptoms go away after you complete chemotherapy. Taking care of your skin can prevent long-term effects, like scarring.
Some people temporarily lose their fingerprints with HFS. This can be an inconvenience if you need to be fingerprinted for some reason, like international travel.
Fingerprints usually return within a few months after treatment ends.
Keep your healthcare provider informed about the symptoms you’re experiencing during chemotherapy. It’s important that they know if you:
A note from Cleveland Clinic
Chemotherapy is an essential cancer treatment that often comes with downsides, like unwanted side effects. Hand-foot syndrome (HFS) is one of the more common side effects that you may experience during chemotherapy. Let your healthcare provider know if you’re experiencing skin changes during treatment. They can recommend ways to help ease your symptoms. Or they can change your chemotherapy treatment if necessary.
Last reviewed by a Cleveland Clinic medical professional on 08/31/2022.
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