Hand-Foot Syndrome

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.

HFS isn’t life-threatening. But it can feel uncomfortable and even painful. This is why it’s important to work with your healthcare provider to take extra care of your skin.

Symptoms of hand-foot syndrome

The first signs of hand-foot syndrome usually start two to three weeks after you start chemo. You may notice the following symptoms on your palms or the soles of your feet:

• Dry skin
• Numbness
• Painless swelling
• Tingling or itching
• Redness (for people with lighter skin) or darkening (for people with darker skin)
• Less sensitivity to hot or cold

Your symptoms may get worse. This can cause:

• Pain
• Blisters and peeling
• Further reduction of sensitivity to hot or cold
• Inability to grip objects or stay on your feet for too long

Hand-foot syndrome causes

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:

• Capecitabine
• Docetaxel
• Methotexrate
• Pegylated liposomal doxorubicin (PLD)
• 5-fluorouracil

But there are many others.

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 (over a long period).

Complications of this condition

Some people with HFS lose their fingerprints for a short time. This can be an inconvenience if you need to be fingerprinted for some reason, like for international travel. And it can keep you from unlocking devices, like phones or tablets, with your fingerprint.

Fingerprints usually return within a few months after treatment ends.

How doctors diagnose this condition

If you’re getting chemotherapy, your healthcare provider may diagnose HFS based on your symptoms.

Other cancer drugs can cause a condition similar to hand-foot-syndrome, called hand-foot skin reaction (HFSR). If you’re receiving multikinase inhibitors as part of your cancer treatment, your provider may need to rule out HFSR. HSFR causes painful, thick, yellowish skin in places like your joints, soles and palms. Your provider may look at skin cells underneath a microscope to determine if the skin changes are HFS or HFSR.

What is the grading system for hand-foot syndrome?

The U.S. National Cancer Institute developed a grading scale to classify HFS based on severity. The grade of HFS will affect how your healthcare provider decides how to treat or manage it.

• Grade 1 hand-foot syndrome: Symptoms may include swelling in your palms and soles and color changes (redness or darkening), but no pain.
• Grade 2 hand-foot syndrome: In addition to grade 1 symptoms, you may have blisters, bleeding and peeling skin. You may have pain that makes everyday activities more difficult.
• Grade 3 hand-foot syndrome: In addition to grade 2 symptoms, you may have severe pain that makes it harder to do basic things. You may have difficulty dressing, bathing or going to the bathroom.

How is hand-foot syndrome treated?

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 reduce the effectiveness of the cancer treatment. If this is the case (or if your symptoms are mild), your provider may recommend strategies for managing side effects.

How can I manage symptoms?

Most people with hand-foot syndrome can manage symptoms with lifestyle changes. You can soothe and manage symptoms if you:

• Use corticosteroid creams to reduce inflammation.
• Use moisturizers (emollients) to keep your skin hydrated and protected.
• Use oral (by mouth) or topical (on your skin) pain relievers, as recommended by your healthcare provider. Types include diclofenac (Voltaren®) and celecoxib (Celebrex®).
• Protect your skin from heat (for example, avoid sun exposure and hot showers or baths).
• Apply ice packs or cold compresses to your wrists and ankles to reduce blood flow to your hands and feet.
• Elevate your hands and feet.
• Pat your skin gently when applying lotion or using a towel. Don’t rub your skin.
• Wear light, loose-fitting socks and shoes (like slippers).

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.

Examples include:

• Chopping vegetables (gripping a knife)
• Weeding a garden (gripping garden tools)
• Making home repairs (gripping tools)

What is the best lotion for hand-foot syndrome?

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.

Recovery time

Symptoms usually improve between two and five weeks after stopping chemotherapy.

When should I see my healthcare provider?

Keep your healthcare provider informed about the symptoms you’re experiencing during chemotherapy. It’s important that they know if you:

• Have symptoms that are worsening
• Have skin cracking or peeling that’s making you bleed
• Have symptoms that are interfering with your everyday life

What can I expect if I have hand-foot syndrome?

Everyone experiences HFS differently, even if they’re getting 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.