Table of Contents
What Is a Hand-Foot Syndrome?
Palmar-plantar erythrodysesthesia, often known as hand-foot syndrome (HFS), is a prevalent adverse consequence of several chemotherapy regimens. Chemotherapy is a frequently used for cancer treatment. HFS is a type of skin reaction that can cause swelling or redness on the soles of the feet or palms of the hands.
There are numerous different names for it, such as:
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Palmar plantar erythrodysaesthesia.
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Plantar palmar erythroderma.
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Toxic erythema of the palms and soles.
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Burgdorf syndrome.
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Chemotherapy-induced acral erythema.
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Palmar plantar erythema.
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Palmar-plantar (palmoplantar) dysaesthesia.
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Acral erythema.
What Causes Hand-Foot Syndrome?
The peculiarity of hand-foot syndrome is that it only affects the palms and soles. It has been suggested that the medication is released by the eccrine sweat glands into the perspiration. Many of these sweat glands can be found on the palms and soles, where sweat production is constant. After concentrating on the skin, the medication kills the skin cells, increasing quickly by cytotoxically acting on them.
The skin cells on the palms are known to divide more quickly than those on the back, making them more vulnerable to the effects of chemotherapy. The compound that transforms the prodrug Capecitabine into the active medication 5-Fluorouracil is very efficient in the palms. Other distinct characteristics of the skin of the palms and soles include blood circulation, temperature, and pressure-related effects, which may be necessary. Activities of everyday living may be related to the palms' more frequent participation than the soles'.
What Kind of Chemotherapy Results in Hand-Foot Syndrome?
Initial examples of hand-foot syndrome were identified in leukemia patients on high-dose Cytarabine therapy. Additional forms of chemotherapy that are frequently linked to HFS include:
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Capecitabine.
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PLD, or pegylated liposomal Doxorubicin.
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5-Fluorouracil.
Other chemotherapy medications related to HFS that are less prevalent include:
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Bleomycin.
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Cisplatin.
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Cyclophosphamide.
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Daunorubicin.
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Doxifluridine.
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Toposide.
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Fludarabine.
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Gemcitabine.
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Hydraulic acid.
What Are the Symptoms of Hand-Foot Syndrome?
The hand-foot syndrome typically manifests itself a few days after starting chemotherapy, though it can take a few months to develop and multiple cycles of the drug. The palms are always affected, whereas the backs of hands, fingers, toes, tops of feet, and soles of feet are less frequent.
The initial signs and symptoms are a feeling of tingling, numbness, a tightness or stiffness sensation, pain in the fingers or palms, and occasionally, a little later, the soles of the feet or toes. The intense redness of the palms and soles, which is regular and well-defined, emerges two to four days later. Swelling and burning discomfort are possible side effects. Severe cases could blister and infrequently ulcerate. Severe reactions have been linked to onycholysis or lifting of the nails. Individuals with dark skin types may have thickening and darker skin tones. It could make it challenging to carry out routine tasks like walking, buttoning clothes, or handling objects. Skin peeling and cracking are possible. Injuries might not heal as well.
When the chemotherapy is stopped, the reaction typically subsides in one to two weeks, meaning that it has healed by the time the next cycle is scheduled. Except if there is ulcerated skin or necrosis (skin loss/death), recovery occurs without scarring. The reaction will become more severe and manifest sooner, and it will take time to heal with each consecutive course of chemotherapy.
Hand-foot syndrome is not life-threatening, but it does negatively impact the quality of life and is frequently a side effect that limits dosage.
How Is Hand-Foot Syndrome Graded?
To categorize HFS according to its severity, the National Cancer Institute created a grading system. The way a doctor decides to handle or manage the HFS will depend on the grade.
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Grade 1: No discomfort, but possible symptoms include color changes (reddening or darkening) and swelling in the palms and soles.
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Grade 2: Blisters, bleeding, and peeling skin may be present along with grade 1 symptoms. There may be pain that makes daily tasks more challenging.
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Grade 3: Severe discomfort that makes it difficult to do daily tasks, along with Grade 2 symptoms. Dressing, bathing, or using the restroom could be challenging.
How Does One Diagnose Hand-Foot Syndrome?
If individuals have signs of HFS and are undergoing chemotherapy, their doctor might consider they suffer from the illness.
The doctor may need to rule out Hand-Foot Skin Reaction (HFSR), a disorder that is similar to Hand-Foot Syndrome, if taking multikinase inhibitors for cancer. One adverse consequence of multikinase inhibitors is HFSR. It also modifies the skin. Thick, painful, yellowish skin in areas such as the palms, soles, and joints are symptoms.
To identify if the skin alterations correspond to HFS or HFSR, a medical professional may use a microscope to examine the skin cells.
How Is the Hand-Foot Syndrome Treated?
The sole known treatment for hand-foot syndrome up until recently consisted of stopping the chemotherapy, resting till the side effect subsided, and then starting treatments again at a lesser dose and less often.
Before beginning chemotherapy, it is crucial to educate patients about this illness so they can report it right away, especially if they are taking oral chemotherapy medications at home.
It is advised to use a hand or foot moisturizer before beginning chemotherapy. Limiting the reaction may be achieved by avoiding mechanical stress on the entire body's hands, feet, and skin, including friction, heat, pressure, irritants, and adhesives. Wearing comfortable clothing that fits loosely helps prevent friction or tight pressure.
There have been mixed results when trying to stop the reaction by cooling the hands and feet while receiving chemotherapy. Analgesics, cold compresses, and elevating or cushioning the affected areas may provide some relief once the reaction has started. Numerous therapies, such as topical and oral pyridoxine (vitamin B6), topical and oral corticosteroids, and topical vitamin E, have been explored, mainly on small numbers of patients. The results have been mixed.
Conclusion:
One of the most critical cancer treatments, chemotherapy, frequently has drawbacks, such as adverse reactions. The Hand-Foot Syndrome (HFS) is a frequently encountered adverse effect of chemotherapy. Inform the doctor of any alterations in the skin while undergoing therapy. They can offer suggestions on how to lessen the symptoms.
