Hand-Foot Syndrome: A Common Side Effect of Breast Cancer Treatment

What to expect and what you can do
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One of the lesser-known side effects from chemotherapy is a skin reaction known as hand-foot syndrome , in which the palms of the hands and soles of the feet become red and painful, and the skin may peel, blister, or develop sores. The official name of this condition is palmar-plantar toxicity , though doctors may also call it erythrodysesthesia or erythema . It's much easier to call it by its common name, hand-food syndrome, which is sometimes abbreviated HFS.

This condition isn't the same as neuropathy , which is nerve damage (also caused by chemo) and causes tingling, numbness, and a pins-and-needles type of pain.

Hand-foot syndrome happens as a reaction to certain chemotherapy drugs. Chemo agents known to cause hand-foot syndrome include:

  • Doxorubicin (Adriamycin, Doxil).
  • Capecitabine (Xeloda).
  • Fluorouracil (5-FU).
  • Cytarabine (Ara-C).
  • Sunitinib (Sutent).
  • Sorafenib (Nexavar).

Doctors don't know exactly what causes hand-foot syndrome, but it seems to occur when small blood vessels in the hands and feet break due to pressure or high temperature, allowing chemo drugs to leak into the tissues of the hands and feet. This leads to irritation and inflammation of the tissues.

Ways to Prevent Hand-Foot Syndrome

Notify the doctor. If you notice the signs of hand-foot syndrome after chemotherapy treatment, contact the doctor right away.

Ask if th e chemo dosage should be lowered. Studies show this can control hand-foot syndrome without reducing the effectiveness of chemo treatment. If a severe reaction develops, the doctor may even decide to postpone a chemo treatment.

Avoid exposure to heat or pressure. Because both heat and pressure can cause the blood vessels to break, avoid exposure to heat and any activity that squeezes or puts pressure on the hands and feet.

Other advice to patients:

  • Don't use really hot water when showering or washing up, and try not to immerse your hands in water any more than absolutely necessary.
  • Ask someone else to do the dishes! (Even using rubber gloves to wash dishes won't help, as the heat trapped inside the rubber can trigger a reaction.
  • Avoid rubbing or putting pressure on the skin of the hands and feet. Do this as much as possible for a week after treatment. Things to avoid include:
    • Washing vigorously.
    • Jumping or running.
    • Wearing tight shoes.
    • Using hand tools such as hammers, pliers, or screwdrivers around the house (the squeezing action can trigger HFS).
    • Working with garden tools such as clippers or trowels.
    • Chopping food.

How to Treat Hand-Foot Syndrome

Ice the hands and feet during and after treatment. This help prevent and ease the pain of hand-foot syndrome. Many cancer patients find using plastic bags of frozen corn or peas works better than hard blocks of ice, since they conform to the hands and feet better.

Moisturize the skin with aloe vera, lotion, or a healing balm. Good moisturizers can help prevent peeling. (But it's important not to rub vigorously when putting on the cream.) For inflammation, blistering, and peeling, hydrocortisone cream works well.

Try topical treatment with a prescription cream called DMSO (dimethyl-sulfoxide). DMSO has been found to be very effective at treating the pain and inflammation from hand-foot syndrome, but only recently has it become available, and not all doctors mention it. If you or someone you're caring for develops hand-foot syndrome, ask the doctor to prescribe DMSO. You can also ask chemo nurses about it during treatment sessions.

Consider vitamin B6. Some small studies suggest that taking vitamin B6 at a fairly high dose (50 to 150 mg) can help, but discuss this with the doctor before trying it. Some expert s suggest that people who are going to be taking chemo drugs such as Adriamycin, known to cause hand-foot syndrome, begin taking vitamin B6 preventively. In this case the dose is also 50 to 150 mg, which is higher than the dose contained in a conventional B vitamin, so it has to be purchased it separately.

Because hand-foot syndrome can worsen and actually lead to the postponement of chemo treatments, it's best to take it seriously. No matter how hard it is to leave dishes in the sink and resist favorite activities like gardening or exercising, it's worth giving your hands and feet a rest for a few days after chemo to prevent hand-foot syndrome.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio