Hand - foot syndrome and chemotherapy

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Hand foot syndrome otherwise known as Palmer-Planter erythema is a condition which can occur with some chemotherapy and biological agents. The severity of the condition depends on:

• The type of drug used
• The dose used
• How many cycles have been given
• The inherent sensitivity of the recipient
• How the hands are looked after during treatment. 

There are several types and levels of severity of hand foot syndrome:

•  Initially the skin can get thicker and split in the creases or around the nails.
•  As the number of cycles progresses, they can start reddening, as in, then flake 
• The underlying skin can becoming swollen and uncomfortable. 
• On the feet, this can lead to blisters and ulceration making walking difficult, just at a time when it is advised to keep mobile. 
• Secondary infection can set causing more swelling, pain and pus formation
• The nail beds can also be effected leading to infection and damage to the nails
• Asian and black patients can get considerably darker especially on the hand
• Hand foot syndrome can also be associated with a skin  rash in other parts of the body or face.

The  common chemotherapy drugs most commonly associated with this side effect include:

• Capecitabine (xeloda), 
• Caelyx
• Infusional 5 Florouracil  
• Biological agents such as Sunitinib and Sorafeneib

What can be done to help (self help guidelines)? 

[1] Your doctor may reduce the dose of your medication or increase the time between the cycles - reduce dose intensity  to allow your skin to recover. In most cases, reducing the dose intensity in response to hand foot syndrome should not reduce the effectiveness.

[2] Your doctor may prescribe some pyridoxine 50mg tablets three times a day to be take with capecitabine. Although the evidence for this is small some patients have reported this is helpful.

[3] Keep the skin clean especially around the nail beds but avoid strong soaps or those with artificial perfumes and colours 

[4] Avoid friction - wear well fitting shoes, perhaps gloves at night. 

[5] You may have to consider wearing training shoes when the skin is at its worse. Many patients often report that shoes with leather insoles are more comfortable than those made with synthetic materials.

[6] If the skin starts seeping pus ask your medical team to take a swab and consider antibiotics

[7] Keep the skin and nail beds well moisturised but avoid creams which are based on petroleum (the vast majority available over the counter) and those which contain artificial chemicals, preservatives, colours and perfumes. 

[8] For the nails beds we recommend naturemedical nail remedy as an ideal moisturiser as it is based only on natural waxes and oils combined with essential oils which have  and anti-microbial properties. 

[9] For the rest of the skin on the hands and feet, massage liberal quantities of a natural oil which does not contain artificial chemicals which can irritate sensitive broken skin such as perfumes, colours or preserves. As with the nails and lips natureMedical products are ideal because of their completely natural, artificial chemical free philosophy. In particular, the hand-foot oil has natural salicylates which have strong anti-inflammatory properties.