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Treatment Options > Chemotherapy > Side Effects
Patient Guide to Hand-Foot Syndrome
Carolyn Vachani, RN, MSN, AOCN
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: March 16, 2007
What is Hand-Foot Syndrome (HFS)?
HFS is a skin reaction that appears on the palms of the hands and/or the soles of the feet as a result of certain chemotherapy agents. It may also be referred to as acral erythema, palmar plantar erythema (PPE), or Burgdorf reaction. Chemotherapy drugs known to cause HFS include: capecitabine (Xeloda®), fluorouracil (5-FU), liposomal doxorubicin (Doxil®), doxorubicin (Adriamycin®), cytarabine (Ara-c®), hydroxyurea (Hydrea®), sunitinib (Sutent®) and sorafenib (Nexavar®).
HFS can start as a feeling of tingling or numbness in the palms and/or soles, which progresses to swelling, redness, peeling skin, and tenderness or pain. If there is no change in the treatment, the hands and/or feet can blister (which can then become infected), becoming very painful and interfering with daily activities. It is very important to notify your doctor at the first sign of HFS. Most patients that develop HFS do so within the first few weeks of therapy, but it can also happen after being on the medication for many months.
What causes HFS?
No one knows for sure, but there are a few theories. The most widely accepted theory is that the small blood vessels in the palms and/or soles break due to use, pressure, or increased temperature, causing an inflammatory reaction and possibly releasing the drug into the area. Many of the suggested prevention strategies or treatments for HFS are based on this theory.
How can I prevent HFS?
Unfortunately, there is nothing that is guaranteed to prevent HFS. The key is to catch it early and adjust the medication dose to prevent it from getting worse or happening again. It is important to understand that several studies have shown that reducing the dose of chemotherapy to relieve HFS does not reduce the effectiveness of the treatment. Some tips to help prevent HFS include:
- Avoid tight fitting clothing (socks, stockings) or tight shoes. Wear loose, comfy shoes when going out and slippers around the house.
- Avoid activities that rub the skin or put pressure on the palms or soles for one week after treatment (or as often as possible if you are on a daily medication). Any activity that puts pressure on the palms or soles should be avoided, but some examples include: washing vigorously, running, jumping, working with garden or repair tools (i.e. shovel, screwdriver, hammer) or chopping food.
- Apply a moisturizer to your hands and feet liberally and often, but gently to avoid rubbing the skin too harshly. Try applying a generous amount of moisturizer at bedtime and wear a loose pair of gloves or socks to bed to promote absorption of the lotion. Some recommended moisturizers are Bag Balm, Udderly Smooth Cream, Eucerin and Aveeno. Avoid any lotions or creams that contain perfumes, alcohol or glycerin.
- Avoid hot water such as a hot tub, steam room, hot bath or shower. Use warm water to shower or bathe.
- Avoid sun exposure as your skin is very sensitive to the sun while on treatment. Remember, you get sun exposure just sitting in a sunny window! Wear SPF 30 or higher daily or wear long sleeved shirts and pants.