What are the other Names for this Condition? (Also known as/Synonyms)

• Burgdorf Syndrome
• Chemotherapy-Induced Acral Erythema
• Toxic Erythema of the Palms and Soles

What is Hand-Foot Syndrome? (Definition/Background Information)

• Hand-Foot Syndrome (HFS) is a painful skin condition that affects the palms and soles of individuals undergoing chemotherapy. HFS is probably caused due to the side effect of chemo-medication on skin tissue
• A variety of chemotherapy medications have been implicated, which include 5-fluorouracil, methotrexate, EGFR tyrosine kinase inhibitors, cabozantinib, and regorafenib. Hand-Foot Syndrome is seen in both children and adults
• The rashes in Hand-Foot Syndrome are painful. The condition can cause numbness in the affected skin region. The blisters may also ulcerate and peel. The lesions may slowly spread to involve the arms and legs too
• The treatment measures for Hand-Foot Syndrome include stopping or discontinuing the use of such medications, along-with providing symptomatic treatment for the skin rashes
• With adequate treatment (stoppage of the offending medication), Hand-Foot Syndrome may disappear. However, the condition usually recur on resumption of chemotherapy

Who gets Hand-Foot Syndrome? (Age and Sex Distribution)

• Hand-Foot Syndrome may affect children and adults of any age group
• It is reported that about 1 in 50 individuals undergoing chemotherapy may be affected by this skin condition
• Both males and females are affected
• Individuals of all racial and ethnic background can be affected

What are the Risk Factors for Hand-Foot Syndrome? (Predisposing Factors)

The risk factors for Hand-Foot Syndrome may include:

• Chemotherapy using a variety of medications in individuals with malignancies is commonly known to result in Hand-Foot Syndrome. The chemotherapy drugs causing the condition may include any of the following:
  • Axitinib
  • BRAF inhibitors including vemurafenib and dabrafenib
  • Cabozantinib
  • Cytarabine
  • Docetaxel
  • Doxorubicin
  • Emitafur
  • Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors
  • Hydroxyurea
  • Intravenous 5-fluorouracil (including its prodrug capecitabine)
  • Methotrexate
  • Pazopanib
  • Regorafenib
  • Sunitinib
  • Tegafur
  • Vinorelbin
• Occasionally, Hand-Foot Syndrome is also associated with sickle-cell disease

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Hand-Foot Syndrome? (Etiology)

• Administration of chemotherapy medications for any underlying malignancy is the most common cause of Hand-Foot Syndrome
• The chemotherapy drugs are cytotoxic in nature; they produce an adverse reaction in the body, which leads to an abnormal cell-mediated immune response in the body

Hand-Foot Syndrome is a skin condition that is non-contagious. It cannot be transmitted from one individual to another.

What are the Signs and Symptoms of Hand-Foot Syndrome?

The signs and symptoms of Hand-Foot Syndrome include:

• Presence of reddish skin rashes with swelling, numbness, and peeling of skin on palms and soles
• The lesions may also involve the elbows and knees
• Hand-Foot Syndrome is generally painful; the lesions are tender and painful to touch
• The appearance of rash may take place within days to months of administering chemotherapy. Initially, the individual may feel tingling and numbness of the affected area
• Then, the affected areas become painful and swollen with the appearance of red papules
• Eventually, the affected areas show blistering and peeling-off of the superficial layers of the skin
• The lesions then heal with skin thickening (callus formation)

Additionally, signs and symptoms of the underlying malignancy being treated with chemotherapy medications may be noted.

How is Hand-Foot Syndrome Diagnosed?

A diagnosis of Hand-Foot Syndrome may involve the following:

• A thorough medical history assessment and complete physical examination
• Assessment of the signs and symptoms; assessing the combination of signs and symptoms along with chemo-medication being given
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Hand-Foot Syndrome?

The complications of Hand-Foot Syndrome are typically from the presence of the underlying malignancy being treated through chemotherapy. In general, the complications may include:

• Cosmetic issues that result in emotional stress
• Bleeding and ulceration of the skin may result in secondary viral or bacterial infections
• Difficulty in performing simple/routine tasks with one’s hands
• Difficulty in walking
• Recurrence of the skin rashes
• Other side effects of chemo-medications may also be noted

How is Hand-Foot Syndrome Treated?

The treatment of Hand-Foot Syndrome depends on the underlying cause, which is chemotherapy in most cases. Discontinuing the offending chemotherapy medication helps in resolution of the symptoms within weeks.

Treatment is provided for Hand-Foot Syndrome to decrease severity of the symptoms and this may include:

• Cooling hands and feet during chemotherapy: It may either decrease the incidence of the condition, or decrease severity of the symptoms
• Topical pain medications and pain relievers
• Changing the chemotherapy agent suitably (using alternatives)
• Steroid therapy can be used to reduce inflammation and relieve symptoms
• Use of ice packs to cool skin: It is important that ice is NOT applied directly onto skin
• Administration of topical and/or oral corticosteroids may be helpful in some cases

Since HFS is a common condition in individuals using anti-cancer medications, the healthcare provider typically monitors such individuals for the appearance of any related signs and symptoms.

How can Hand-Foot Syndrome be Prevented?

Currently, there are no known methods to prevent the occurrence of Hand-Foot Syndrome. However, one may lower the risk, or reduce severity of the skin condition by considering the following factors:

• It is reported that staying in a cool environment immediately before the chemotherapy session may help prevent rashes in some individuals
• Avoid hot water exposure to hands and feet that may occur during a bath or while washing clothes
• Restrict activities that cause increased friction on hands/feet such as jogging, use of sports rackets, etc.; avoid walking with bare feet
• Avoid any harsh or strong chemicals on hands and feet
• Avoid using hand tools (such as garden implements, carpentry tools, kitchen ware, etc.) that require them to be tightly gripped
• Gently apply moisturizing creams; avoid rubbing them too hard onto skin, since friction can cause increased severity of the symptoms
• Inform your physician if you are allergic to any medication

What is the Prognosis of Hand-Foot Syndrome? (Outcomes/Resolutions)

• The prognosis for Hand-Foot Syndrome is usually good, since the skin condition may resolve after stoppage of chemotherapy
• However, Hand-Foot Syndrome may recur on resuming treatment for the underlying malignancy using chemotherapy drugs

Additional and Relevant Useful Information for Hand-Foot Syndrome:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse