Pharmacy employees
Pharmacy employees
Specific to cancer treatments, the hand-foot syndrome also called palmar-plantar erythrodysesthesia syndrome (PPES) occurs on the palms of the hands and the soles of the feet¹. This side effect observed on the skin is characterized by: redness, swelling, blisters, hypersensitivity, hyperkeratosis, and peeling².
What is hand-foot syndrome?
Specific to cancer treatments, the hand-foot syndrome also called palmar-plantar erythrodysesthesia syndrome (PPES) occurs on the palms of the hands and the soles of the feet¹. This side effect observed on the skin is characterized by: redness, swelling, blisters, hypersensitivity, hyperkeratosis, and peeling².
The 3 grades of hand-foot syndrome³
Grade 1
Minimal skin changes or dermatitis (e.g., erythema, edema, or hyperkeratosis) without pain
Grade 2
Skin changes (e.g., peeling, blisters, bleeding, fissures, edema, or hyperkeratosis) with pain; limiting instrumental ADL
Grade 3
Severe skin changes (e.g., peeling, blisters, bleeding, fissures, edema, or hyperkeratosis) with pain; limiting self-care ADL
Treatments that cause hand-foot syndrome²
It is observed particularly in:
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patients receiving chemotherapy including 5FU (IV or oral administration), doxorubicin, docetaxel… ;
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patients receiving specific targeted therapies, including BRAF inhibitors, VEGFR inhibitors…
Advice on caring for your patient²
Podiatrists as foot care experts can see patients before (preferred) or during treatment to treat predisposing factors.
To support your patient, here are some preventative and skincare tips²:
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before starting cancer treatment, the patients must have calluses and ingrown toenails treated by a podiatrist
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wear shoes and loose clothing
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to avoid any rubbing, do not walk barefoot. Instead, the patients have to wear soft slippers or socks (change them every day)
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the patient has to avoid contact with household cleaning products and other chemical agents that can produce stress (skin irritants, solvents, or disinfectants).
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the patient has to limit contact with hot water on the hands and feet (hot baths and prolonged showers) and avoid sources of heat in general, including the sun
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avoid activities that put pressure on or rub your hands or feet
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the patients should moisturize their hands or feet one to two times per day with emollient or healing creams (alcohol-free skin moisturizers), avoiding rubbing or massaging
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wear cotton gloves
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refresh your feet with cold thermal spring water or ice (avoid direct contact with your skin). Skin cooling (e.g. cold gloves or socks) has been proven to significantly reduce the frequency and severity of PPES for chemotherapy given as an infusion, such as paclitaxel, docetaxel, and liposomal doxorubicin.
Therapeutic management of hand-foot syndrome²:
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Interruption/dose reduction of anti-cancer agent is usually required.
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A topical agent for hand-foot syndrome or cooling may permit consistent dosing.
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Hyperkeratosis is treated with keratolytic (e.g. topical creams or ointments containing salicylic acid 5%- 10% or urea 10%-40%)
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Skin inflammation is treated with high-potency topical corticosteroids
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Erosions and ulcerations may be treated with antiseptic solutions (e.g. silver sulfadiazine 1%, polyhexanide 0.02%-0.04%)
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Lidocaine 5% cream or patches may be used for analgesia on painful areas in feet and hands, in order to enable activities of daily living
According to the severity of this toxicity, the patient can be referred to a dermatologist or to the oncology team. Podiatrists can also play an important role.
Recommended treatment
 Xeracalm lipid-replenishing balm |
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