Hand and foot syndrome in cancer therapy [chemotherapy, targeted therapy, and radiotherapy]

Content

What causes hand-foot syndrome 

Hand-foot syndrome and hand-foot skin reaction are very common complications of chemotherapy, in which the patient develops skin lesions on the palms and feet.

In the treatment of cancer, some chemotherapy drugs tend to directly affect skin cells, limiting their physiological functions. In places of pressure and friction (heels, friction zones caused by shoes, palms), skin lesions appear, accompanied by pain, itching, numbness, peeling, redness, rash, which causes significant discomfort to the patient. In women, the syndrome manifests itself somewhat more often than in men.

An additional risk of hand and foot syndrome during chemotherapy occurs in the following cases:

  • Age 65+
  • Overweight (friction in the folds of the skin, a lot of pressure on the feet)
  • Associated skin diseases
  • Liver and kidney dysfunction
  • Smoking, alcohol abuse
  • Overheating (hot water procedures, active physical activity, climate)
  • Increased bleeding
  • Combination of 2 or more chemotherapy drugs

Symptoms of hand-foot syndrome

In addition to the palms of the hands and the soles of the feet, in rare cases, the elbows and knees may also be affected. Most affected: the pads of the fingers and toes, the lateral surfaces of the feet. Sometimes signs of the syndrome are observed between the fingers and near the nails.

What determines the intensity of the degree of manifestation?

The manifestations and intensity of hand-foot syndrome and hand-foot skin reaction depend on the type of drug, its dose, duration of treatment and individual body response. Symptoms most often appear 1 to 4 weeks after the start of chemotherapy treatment.

three degrees of disease severity:

There are three degrees of severity of the hand-foot syndrome:

  1. Slight redness, tingling, slight swelling, thickening of the skin (hyperkeratosis)

    The patient does not experience pain and leads a normal life.

  2. Dry skin, peeling, burning, slight swelling, blisters, bruising, hyperkeratosis

    The patient experiences pain when touching the affected areas and may experience difficulty in daily activities (eg, discomfort when pressing the door handle sharply or when using scissors)

  3. Severe peeling, cracking, swelling, severe blisters and bruising

    The patient experiences severe pain (including when walking) and cannot perform simple actions, such as holding a spoon or toothbrush

In the case of a particularly severe skin lesion, the oncologist can reduce the dose of the administered drug, or suspend the treatment of the disease until the condition of the palms and feet returns to normal and the complication can be attributed to the first stage. Competent prevention and timely detection of symptoms and appropriate treatment of hand-foot syndrome can alleviate the patient’s condition and significantly reduce the feeling of discomfort.

Memo: how to relieve unpleasant symptoms

Cancer patients are advised to use the following checklist to help minimize symptoms of hand and foot syndrome with chemotherapy:

Prevention:

  • See a podiatrist (foot specialist) before starting therapy and one month after it ends
  • Before starting therapy, do a pedicure to cleanse the feet of the stratum corneum
  • Avoid overheating of the body, avoid hot baths, solariums, saunas, avoid long exposure to the sun
  • For hygiene procedures, use mild detergents and warm water. Do not rub your body with a towel, but gently pat dry. Use moisturizer after every hand wash
  • Avoid long walks and standing
  • Avoid activities that involve squeezing objects (working with a knife, pliers, pruner, etc.)
  • Wear comfortable leather shoes, avoid narrow lasts and high heels, do not wear synthetic shoes that lack ventilation – shoes should not press or rub, socks and tights should not squeeze the leg
  • Do housework and country work only in cotton gloves. Avoid using harsh cleaning chemicals
  • For the period of therapy, give up long nails and trimmed manicure
  • From the very beginning of the treatment procedures, moisturize the skin of the hands and feet with a softening cream or balm several times a day. For severe dry skin, apply a balm with a regenerating effect.

Treatment

To relieve symptoms, doctors prescribe a wide range of drugs with analgesic, antimicrobial, decongestant action, as well as moisturizers. For open wounds on the hands and feet, healing, skin-restoring sprays are used.

Cooling (eg, with ice packs) of affected skin on the feet and hands leads to a reduction in itching and therefore improves the tolerability of therapy, however, it is worth consulting the correct use of a cold compress with your doctor to avoid a cold burn

If there is thickening of the stratum corneum on the palms and soles of the skin (hyperkeratosis), your doctor may recommend cream or balm with 10% urea

Do not rub, scratch damaged skin, do not open blisters

Seek immediate medical attention if:

  • Feel hot and chilly
  • Opened bleeding
  • Swelling increased sharply
  • The pain grows
  • Discharge appeared on damaged areas of the skin

Treatment must be agreed with the doctor, self-medication may not work or aggravate the situation, and precious time will be lost. Following the recommendations from the handbook will help reduce the pain of hand-foot syndrome, improve skin condition and return to a normal lifestyle faster.

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