Hand-foot syndrome

Hand-foot syndrome, also called palmar-plantar erythrodysesthesia, is a skin reaction on the palms of the hands and soles of the feet.

Certain cancer medicines can cause hand-foot syndrome. But even if you are given a cancer medicine known to cause hand-foot syndrome, there are things you can do to lessen the chances of developing it. On this page, we'll explain why hand-foot syndrome happens and ways to prevent or reduce symptoms.

What are the symptoms of hand-foot syndrome?

Hand-foot syndrome usually starts with these symptoms:

• Tingling or numbness in the hands, feet, or both
• Tightness or stiffness of the skin of the hands or feet

Other symptoms, which usually appear a few days after the first group, may include:

• Tenderness
• Redness on the palms and soles of the feet that looks like a sunburn
• Swelling
• Burning or itching
• Rash
• Pain

If symptoms worsen, they may include:

• Cracking, flaking, or peeling of skin on the palms and soles of the feet
• Blisters, calluses, ulcers, or sores on the skin that can become infected
• Severe pain that makes it difficult to walk and/or use your hands

If you develop hand-foot syndrome, you’re most likely to experience symptoms within the first week of the treatment causing it, although it’s possible to develop them after several months of treatment. Hand-foot syndrome is usually worse during the first 6 weeks of targeted therapies and after 2 to 3 months of chemotherapy.

Although not life-threatening, hand-foot syndrome can be uncomfortable and affect your day-to-day activities. Be sure to let your care team know if you notice any symptoms of hand-foot syndrome.

What causes hand-foot syndrome?

Hand-foot syndrome is caused by exposing the skin on the palms of the hands and soles of the feet to certain medicines. This exposure happens when tiny amounts of the medicine leak out of the small blood vessels, called capillaries. When medicine leaks out, it can lead to tissue damage in that area.

In early-stage treatment, certain chemotherapies are the main cause of hand-foot syndrome. These include:

• Capecitabine (Xeloda)
• Doxorubicin (Adriamycin)
• Fluorouracil (5-FU)
• Ixabepilone (Ixempra)

There are no targeted therapies used for early-stage breast cancer that cause hand-foot syndrome. There are some targeted therapies for metastatic breast cancer that can cause hand-foot syndrome. You can learn more about those at the end of this page.

Not everyone who takes these medicines develops hand-foot syndrome, and the symptoms and how severe they are can vary among those who do.

Without proper care, hand-foot syndrome can get worse during treatment.

How can I lower my risk of developing hand-foot syndrome?

The potential for hand-foot syndrome rises with heat and friction on your hands and feet. When you're doing certain activities that cause heat and friction, it can increase the amount of medicine in the capillaries and the amount that leaks out. Making some adjustments to your activities can reduce your chances of getting hand-foot syndrome.

Here are a few tips:

• Avoid hot water when washing your hands, doing dishes, or taking showers or baths.
• Keep baths short and use cool or tepid water when possible.
• Wear white cotton gloves underneath rubber or vinyl dishwashing gloves if washing dishes in hot water. Used alone, rubber or vinyl gloves can hold heat and sweat against your palms, increasing the potential for hand-foot syndrome.
• Avoid too much pressure and friction on the palms of your hands and soles of your feet:
  • Gently apply mild moisturizing creams or lotions.
  • Avoid massaging your feet or hands.
  • Avoid rubbing your skin with a towel after bathing or washing. Carefully pat your skin dry instead.
  • Wear well-fitting shoes.
  • Use caution with vigorous activities such as running, jumping, aerobics, racquet sports, and long walks.
  • Avoid using knives, garden tools, hand tools such as hammers, and any other activities that require the hands to strongly grip or squeeze an object.
• Prop up your feet and hands while you are lying or sitting down to lessen any swelling.
• Avoid too much sun and other sources of heat such as saunas, hot tubs, or steam rooms. Wear sunscreen or long-sleeved shirts and pants.
• Avoid direct contact with harsh chemicals such as household cleaning products or laundry detergents.
• Wear loose, comfortable, and well-ventilated clothes and shoes. Do not walk barefoot, and use socks and slippers to reduce friction on the bottoms of your feet.

How can I manage hand-foot syndrome?

Talk to your care team right away if you notice your hands and feet getting red or tender. They may be able to adjust the dose of the medicines causing the symptoms. Your doctor may also be able to change your treatment schedule or stop treatment for a time to prevent symptoms from getting worse.

Your care team may also suggest a few medical and nonmedical methods to manage symptoms and keep hand-foot syndrome from getting worse. Here are some strategies:

• Keep your hands and feet cool by putting your palms and soles of your feet on a wet towel, an ice pack, or a bag of frozen peas wrapped in a towel. This can help provide short-term relief for pain and tenderness. Alternate on and off, for 15 to 20 minutes at a time. Be sure not to put ice directly on your skin. Soaking palms and foot soles in cold water can also help.
• Take over-the-counter pain relievers such as acetaminophen (Tylenol), ibuprofen, naproxen, or celecoxib (Celebrex) to help ease discomfort.
• Use corticosteroid creams to reduce inflammation.
• Use topical anesthetics such as lidocaine to reduce pain in the palms and soles.
• Prevent dryness and cracking of your skin by using very thick, mild moisturizing creams, such as Bag Balm, on your hands and feet multiple times a day. Apply them heavily at night and wear loose-fitting socks and gloves to keep in the moisture and help your skin absorb it. Gently pat the lotion into your skin and avoid vigorous rubbing, which creates friction. Avoid lotions with perfumes, alcohol, or glycerin.
• Supplements such as vitamin B6 may help to manage this condition. Talk with your care team before starting any supplements.

Hand-foot syndrome and metastatic breast cancer treatment

People in treatment for any stage of breast cancer can experience hand-foot syndrome if they’re given a treatment that can cause it. The symptoms may slowly grow over time, especially if you are taking a medicine for a long period. The symptoms may appear more quickly, be more severe, and take longer to heal with each cycle of treatment.

There are certain treatments only approved to treat metastatic breast cancer (MBC) that can cause hand-foot syndrome. These include the chemotherapy treatment Liposomal doxorubicin HCL liposome injection (Doxil) and the following targeted therapies, approved to treat HER2-positive MBC:

• Lapatinib (Tykerb)
• Margetuximab (Margenza)
• Tucatinib (Tukysa)

If you develop hand-foot syndrome, your care team may:

• Give you medicine to manage the symptoms
• Lower the dose of your MBC treatment if hand-foot syndrome symptoms interfere with daily activities
• Change your treatment schedule so that you get the medicine less frequently
• Give you a treatment break, a temporary stop to treatment to allow your body to heal
• Recommend switching you to a different treatment

Most treatments have built-in recommendations to lower the dose or change the timing of the medicine if symptoms are causing difficulty. Studies show that in most cases, even if the dose is lowered or changed, the treatment will still be effective against the cancer. If the dose change would not be effective, your healthcare team would recommend a different treatment for you.