Hand-foot syndrome occurs more frequently in the context of treatment with cytostatics. The feet and hands of the patients become red, scaly and painful or are affected by sensory disturbances. Hand-foot syndrome is treated symptomatically with painkillers and creams.
What is Hand Foot Syndrome?
Therapeutic drug treatments are usually associated with different side effects and health risks. Phenomena such as hand-foot syndrome have been observed as side effects of cytostatics. Whether the indication for the administration of a certain drug exists despite these risks depends on the context. Cytostatics, for example, cause many side effects and are associated with relatively high risks for the patient.
Since they are used in the life-sustaining treatment of malignant cancer, the benefits for the patient ultimately outweigh the negative. The indication of the means is thus guaranteed despite all the risks and side effects. Also called HFS, petechial hand-foot syndrome, glove-sock syndrome, or palmar-plantar erythrodysesthesia, the syndrome causes erythema in the hands and feet.
Redness of the skin that is visible to the naked eye and is due to local hyperemia of the skin tissue is referred to as erythema. Both children and adults can be affected by the drug-related phenomenon. There are different degrees of severity of the phenomenon. In the most serious case, the skin on the hands and feet blisters in addition to the redness and the limbs are impaired in their function due to severe pain.
The exact cause or development of hand-foot syndrome is not yet clear. In most cases, hand-foot syndrome occurs after administration of capecitabine, doxorubicin, or 5-fluorouracil. A causal relationship appears to exist with the metabolites of fluorouracil. Drugs such as cyclophosphamide, oxaliplatin, cytarabine, paclitaxel, docetaxel, sunitinib and sorafenib can also cause the side effect.
The hand-foot syndrome is thus often interpreted as an accompanying reaction of antineoplastic chemotherapy. On the other hand, the phenomenon can also occur in the context of blood disorders such as sickle cell anemia. The exact mechanisms underlying the formation of the characteristic erythema are still a matter of discussion and speculation.
Although hand-foot syndrome is observed relatively frequently after administration of the drugs mentioned, it does not necessarily occur. Why some patients develop erythema and others do not remains unclear. So far, the same has applied to the factors that favor particularly severe cases.
Symptoms, Ailments & Signs
The hands and soles of patients with hand-foot syndrome become intensely red and abnormally tender. Scales often form in the affected areas. In addition, numbness is common. Paresthesias or dysesthesias also occur. The severity of the syndrome can vary.
Depending on the severity, HFS can be clinically divided into three degrees of severity:
- Grade 1 is painless erythema associated with dysesthesia or paresthesia and does not represent a disability.
- Grade 2 of the syndrome is painful erythema with swelling that interferes with daily activities to some extent.
- The most severe grade is grade 3. In this grade of severity, there is moist scaling or peeling of the skin. Blisters form with severe pain. A hand-foot syndrome of the third degree of severity leads to significant impairments of the hands and feet, which hinder the patient in carrying out everyday activities and thus make it difficult for him, for example, to walk or grip.
Hand-foot syndrome is diagnosed by the doctor on the basis of the clinical symptoms and against the background of the patient’s medical history. In the context of diagnostics, the question of whether the syndrome was triggered by current medication or a disease such as sickle cell anemia is particularly important. Patient prognosis depends on the severity of the syndrome and the treatability of the cause.
Hand-foot syndrome causes serious problems in the patient’s feet and hands. In most cases, paralysis and sensory disturbances can become noticeable. These disturbances limit the everyday life of those affected, and restrictions in movement may also occur. The pain and limitations often lead to psychological problems and depression.
The skin also turns red, it can be affected by itching. It is not uncommon for the skin to flake as well. Hand-foot syndrome can also lead to sleep problems and general irritability due to pain at rest. The paralysis may lead to severe limitations in everyday life, so that the patient is dependent on a wheelchair or on the help of other people in order to be able to continue to cope with everyday life.
When treating hand-foot syndrome, the primary goal is to alleviate the symptoms. A causal treatment is only possible if the syndrome is triggered by medication. As a rule, there are no special complications during treatment. However, it cannot be predicted whether the course of the disease will be positive and whether all symptoms can be completely resolved.
When should you go to the doctor?
As a rule, hand-foot syndrome does not heal itself. For this reason, the syndrome should be treated by a doctor to avoid worsening symptoms and further complications. The doctor should be consulted if the hands or feet of the affected person are very sensitive to pain. They may also be scaly or red. Numbness is often an indication of hand-foot syndrome and should also be examined by a doctor.
However, the severity of the symptoms can be very different. Restrictions in movement or in ordinary and fatal processes can also indicate the disease. If the symptoms persist for a longer period of time and do not go away on their own, you should definitely consult a doctor. Early diagnosis always has a positive effect on the course of the disease.
As a rule, hand-foot syndrome can be examined by a dermatologist or by a general practitioner. However, further treatment depends on the exact symptoms and is carried out by the respective specialist.
Treatment & Therapy
A causal therapy of a drug-related hand-foot syndrome can only be carried out by changing the medication. If a change is not an option, the syndrome is usually treated symptomatically. In this case, for example, uridine creams can be used for treatment. Vitamin B6 administration has also been able to improve the symptoms in the past.
If pain is present, patients are also given painkillers such as acetaminophen. Another therapeutic approach is given by the local supply of the skin with glucocorticoids. Creams containing betamethasone are used for this local therapy. Creams containing urea can also promise improvement under certain circumstances. In addition, patients are instructed to cool the affected skin regions.
Cooling usually relieves the symptoms only temporarily. As a rule, the treating physicians use prophylactic measures as part of the administration of cytostatics, which ideally prevent the symptoms or at least alleviate the symptoms. These measures include a whole series of easy-to-implement steps.
Outlook & Forecast
A uniform prognosis for hand-foot syndrome cannot be given. This syndrome is less an independent disease than a side effect of a therapy that should not be interrupted.
Since the symptoms develop during cancer therapy, the primary disease must be cured and treated. In these cases, it is more important to heal the patient from the potentially life-threatening disease or, if desired, to take life-prolonging measures.
The hand-foot syndrome is treated symptomatically within the initiated therapy for the cancer. As long as the treatment of the tumor disease continues, it is almost impossible to heal the existing skin changes. The active ingredients that trigger hand-foot syndrome also alleviate the cancer.
After successful treatment of the cancer, more attention can be paid to the healing process of hand-foot syndrome. The patient’s immune system must be gradually rebuilt. Various creams are applied locally to care for the skin and thus minimize symptoms on the hands and feet.
In addition, various aids help to protect hands and feet. The healing process takes several months. Depending on the patient’s overall health, recovery can take several years. For some of those affected, only relief from the symptoms of hand-foot syndrome is achieved.
In order to prevent hand-foot syndrome in the context of cancer therapy, the application of greasy skin ointments is an important step. Patients should avoid contact with hot water during therapy. The same applies to heavy mechanical loads on the palms of the hands. For example, scratching and clapping should be avoided, as should the use of hand tools.
Ideally, cold water baths should be taken every day to cool hands and feet. These baths may be used up to four times per day. In general, extraordinary stress on the body during therapy with cytostatics is not recommended, since the organism is already exposed to high stress due to the drug load.
In the case of hand-foot syndrome, aftercare measures are severely limited in most cases. A purely symptomatic treatment can be carried out with the help of creams or painkillers, which can certainly alleviate the symptoms. However, the underlying disease of the syndrome must also be treated correctly so that there are no further complications or a further deterioration of these symptoms.
As soon as the first symptoms or signs of the disease appear, the affected person should consult a doctor. When using the creams or other medication, the patient should always follow the doctor’s instructions. It is also important to ensure regular use and the right dosage to counteract the symptoms.
In the case of hand-foot syndrome, contact with other people affected by the disease can often be very useful, as this can lead to an exchange of information. Since the illness often leads to psychological upsets or depression, intensive and loving conversations with one’s own family or friends are very helpful.
In serious cases, however, intensive psychological therapy is necessary. As a rule, hand-foot syndrome does not negatively affect the life expectancy of the patient.
You can do that yourself
It has not yet been clarified where the unpleasant changes in the skin come from and so the treatment options and measures to combat the symptoms are also limited.
Vitamin B6 and creams containing uridine can alleviate the sometimes severe consequences. Simply cooling the relevant areas can have a preventive and healing effect with regard to the extent of the impairment. Therefore, it makes sense to always have cooling pads in the freezer. Too warm and hot water, on the other hand, leads to a significant worsening of the symptoms and harms the general feeling.
In the evening, before going to bed, it makes sense to take cool hand and foot baths and then apply moisturizing creams, ointments or Vaseline and possibly wear thin protective cotton gloves. Gloves also help in everyday work. Whenever possible, these should be part of everyday clothing. Shoes must not constrict the sore feet and should not contribute to aggravating the symptoms.
In general, excessive strain on the hands and feet should be avoided. Time for regeneration is important, even if everyday life is restructured as a result. Hand-foot syndrome is reversible, so you should temporarily avoid sporting activities. When the disease breaks out, it can be discussed with the treating doctor to what extent a reduction in the dose of the medication or a break in therapy can be helpful.