Hand–Foot Syndrome (HFS) / Palmar–Plantar Erythrodysaesthesia (PPE)
Hand–foot syndrome is a common side effect of some chemotherapy and targeted therapies, including capecitabine, fluorouracil, liposomal doxorubicin, cytarabine, and kinase inhibitors such as sorafenib, sunitinib and pazopanib. It causes painful inflammation of the hands and feet and can significantly affect quality of life and treatment tolerance.
Symptoms may include redness, swelling, tenderness, tingling, numbness, itching, hyperpigmentation, blistering, skin peeling, ulceration and pain. Symptoms usually develop days to weeks after starting treatment.
Prevention
Preventing HFS is the first step in management. Strategies include:
- Regular use of topical emollients, especially 10% urea-based creams
- Topical or oral corticosteroids to reduce inflammation
- Vitamin E cream or other moisturisers
- Avoiding heat, friction and pressure on hands and feet
- Wearing loose-fitting shoes and socks
- Avoiding activities that cause rubbing or gripping
- Elevating and cooling hands and feet during treatment
- Gentle skin care (pat dry, avoid harsh soaps)
- In selected cases, medications such as COX-2 inhibitors (e.g. celecoxib) or nicotine patches may be used
Management by Severity (CTCAE Grading)
Grade 1 (Mild):
- Redness or mild skin changes without pain
- Continue chemotherapy
- Apply 10% urea-containing emollient
- Reassess after two weeks
Grade 2 (Moderate):
- Peeling, blistering or swelling that interferes with daily activities
- Delay chemotherapy up to two weeks or until symptoms improve
- Continue 10% urea-containing emollient
- Assess and manage pain
- Reassess after two weeks
Grade 3 (Severe):
- Severe peeling, bleeding, cracking or swelling with significant pain
- Delay chemotherapy and reduce dose
- Continue 10% urea-containing emollient
- Provide appropriate analgesia
- Consider dermatology referral
- If no improvement, further dose reduction or discontinuation may be required
Key Points
- HFS usually improves within two weeks after stopping treatment
- Early recognition and management can reduce severity
- Effective management helps maintain quality of life and avoid treatment interruptions
- Patients should seek medical advice if symptoms worsen, bleeding occurs, or daily activities are affected
Please contact our Nurses on 07 5445 5794 or [email protected] if you have any questions.
All information provided by Bloomhill is mainly based on research from the Qld Cancer Council and best practice guidelines. Our model of care utilizes the Clinical Oncology Society of Australia (COSA) domains of wellness along with available clinical evidence. Always consult your care team regarding matters that affect your health. This is a guide intended for information only.
