Hand-foot syndrome occurs more frequently during treatment with cytostatic drugs. Patients’ feet and hands become red, scaly, and painful or are affected by sensory disturbances. Hand-foot syndrome is treated symptomatically with analgesics and creams.
What is hand-foot syndrome?
Therapeutic drug treatments are usually associated with various side effects and health risks. In particular, phenomena such as hand-foot syndrome have been observed as side effects of cytostatic drugs. Whether there is an indication to administer a particular drug despite these risks depends on the context. For example, cytostatic drugs 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 risks. Thus, the indication of the agents is guaranteed despite all risks and side effects. The syndrome is also called HFS, petechial hand-foot syndrome, glove-sock syndrome, or palmar-plantar erythrodysesthesia and causes erythema in the hands and feet. Erythema is redness of the skin that is visible to the naked eye and is due to local hyperemia of the skin tissue. Both children and adults can be affected by the drug-induced phenomenon. There are different degrees of severity of the phenomenon. In the most severe case, in addition to redness, the skin on the hands and feet blisters and the limbs are impaired in function due to severe pain.
Causes
The exact cause or origin of hand-foot syndrome is still unclear. In most cases, hand-foot syndrome occurs after the administration of capecitabine, doxorubicin, or 5-fluorouracil. A causal relationship appears to exist to the metabolites of fluorouracil. Drugs such as cyclophosphamide, oxaliplatin, cytarabine, paclitaxel, docetaxel, sunitinib, and sorafenib can also cause the side effect. Thus, hand-foot syndrome is often interpreted as an accompanying reaction of antineoplastic chemotherapy. On the other hand, the phenomenon may also occur in the setting of blood disorders such as sickle cell disease. The exact mechanisms underlying the formation of the characteristic erythema are currently still a subject 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 the erythema and others do not remains unclear. The same is true so far for the factors that favor particularly severe cases.
Symptoms, complaints, and signs
The hands and soles of patients with hand-foot syndrome become very red and abnormally sensitive to pain. Scales often form in the affected areas. In addition, numbness often occurs. Paresthesias or dysesthesias also occur. The severity of the syndrome can show different manifestations. Depending on the severity, HFS can be clinically divided into three degrees of severity:
- In grade 1, there is painless erythema associated with dysesthesias or paresthesias and no impairment.
- Grade 2 syndrome is present with painful erythema with swelling that interferes with daily activities to some degree.
- The most severe grade is grade 3. In this degree of severity, moist scaling or detachment of the skin occurs. Blisters form under severe pain. A hand-foot syndrome of the third degree of severity leads to significant impairment of the hands and feet, which impede the patient in the performance of everyday tasks, making it difficult for him, for example, walking or reaching.
Diagnosis
Hand-foot syndrome is diagnosed by the physician on the basis of clinical symptoms and against the background of the patient’s medical history. As part of the diagnostic process, the most important question is whether the syndrome has been triggered by currently given medications or by a disease such as sickle cell anemia. The prognosis of patients depends on the severity of the syndrome and the treatability of the cause.
Complications
Hand-foot syndrome causes severe symptoms in the patient’s feet and hands. In most cases, paralysis and sensory disturbances may become apparent.Due to these disorders, the daily life of the affected person is restricted and, if necessary, movement restrictions may occur. Due to the pain and restrictions, it is not uncommon for psychological complaints and depression to occur. Likewise, the skin turns red and may be affected by itching. Not infrequently, the skin also scales. Due to pain at rest, the hand-foot syndrome can also lead to sleep problems and thus to a general irritability. Eventually, the paralysis leads to severe restrictions in everyday life, so that the patient is dependent on a wheelchair or on the help of other people to continue to cope with everyday life. Treatment of hand-foot syndrome is primarily aimed at alleviating the symptoms. Causal treatment is only possible if the syndrome is triggered by medication. There are usually no special complications during treatment. However, it cannot be predicted whether there will be a positive course of the disease and whether all complaints can be completely resolved.
When should one 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 of the 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 reddened. Frequently, numbness is also an indication of hand-foot syndrome and should also be examined by a doctor. However, the severity of the symptoms can vary greatly. Restrictions in movement or in ordinary and fatal processes can also indicate the disease. If the complaints persist over a longer period of time and do not disappear on their own, a doctor should be consulted in any case. An 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 a general practitioner. However, further treatment depends on the exact symptoms and is carried out by the respective specialist.
Treatment and therapy
Causative therapy of hand-foot syndrome caused by medication can only be achieved by switching the medication. If switching 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 improved the symptoms in the past. If pain is present, patients are also given painkillers such as paracetamol. Another therapeutic approach is the local application of glucocorticoids to the skin. Creams containing betamethasone are used for this local therapy. Creams containing urea can also promise improvement under certain circumstances. Patients are also instructed to cool the affected skin areas. However, cooling usually relieves the symptoms only temporarily. As a rule, the treating physicians already apply prophylactic measures during the administration of cytostatic drugs, which ideally prevent the symptoms or at least attenuate them. These measures include a whole series of easy-to-implement steps.
Outlook and prognosis
No single prognosis can be given for hand-foot syndrome. This syndrome is not so much a disease in its own right as a side effect of a therapy that has been carried out and should not be interrupted. Since the symptoms develop within a cancer therapy, the underlying disease must be cured and treated as a priority. In these cases, it is more important to cure the patient of the potentially life-threatening disease or to take life-prolonging measures if desired. Hand-foot syndrome is managed symptomatically within the initiated therapy of the cancer. As long as the treatment of the tumor disease continues, a cure of the existing skin changes is almost impossible. The agents that lead to the triggering of the hand-foot syndrome simultaneously alleviate the cancer disease. After successful treatment of the cancer has been completed, more attention can be devoted to the healing process of the hand-foot syndrome. The patient’s immune system must be gradually rebuilt. For the care of the skin and thus minimizing the discomfort of the hands and feet, various creams are applied locally.In addition, various aids to protect the hands and feet help. The healing process takes several months. Depending on the patient’s overall health, recovery can take several years. For some sufferers, only relief from the discomfort of hand-foot syndrome is achieved.
Prevention
To prevent hand-foot syndrome during cancer therapies, the application of oily skin ointments is considered an important step. Patients should avoid contact with hot water during therapy. The same applies to mechanically strong stress on the palms. Scratching and clapping, for example, should be avoided, as should the use of hand tools. Ideally, cold water baths should be taken daily to cool the hands and feet. If necessary, these baths are applied up to four times a day. In general, extraordinary stresses on the body are not recommended during therapy with cytostatic drugs, as the organism is already exposed to high loads due to the drug load.
Aftercare
In hand-foot syndrome, the measures of an aftercare are severely limited in most cases. In this case, a purely symptomatic treatment can be carried out with the help of creams or by painkillers, which can certainly relieve the discomfort. However, the underlying disease of the syndrome must also be properly treated to prevent further complications or further worsening of these symptoms. Therefore, already at the first symptoms or signs of the disease, the affected person should consult a doctor. When using creams or other medications, the patient should always follow the doctor’s instructions. Attention should also be paid to regular use and the correct dosage to counteract the symptoms. Frequently, in the case of hand-foot syndrome, contact with other sufferers of the disease can also be very useful, as this can lead to an exchange of information. Since the disease not infrequently leads to psychological upsets or depression, intensive and loving conversations with one’s own family or friends are very helpful. In severe cases, however, intensive psychological therapy is necessary. As a rule, hand-foot syndrome does not negatively affect the patient’s life expectancy.
What you can do yourself
It has not yet been clarified where the unpleasant changes in the skin come from, and so the therapeutic options and measures to combat the symptoms are also limited. Vitamin B6 and creams with uridine content can alleviate the sometimes severe consequences. Even the simple cooling of the corresponding areas can have a preventive and healing effect with regard to the extent of the impairments. It therefore makes sense to always have cooling pads in the freezer. Too warm and hot water on the other hand leads to a considerable aggravation of the symptoms and harms the general feeling. In the evening, it is advisable to take cool hand and foot baths before going to bed and then to apply moisturizing creams, ointments or Vaseline and, if necessary, to put on thin protective cotton gloves. Gloves also help in daily work. Whenever possible, these should be part of everyday clothing. Shoes should not constrict the sore feet and should not contribute to symptom aggravation. In general, too much stress on the hands and feet should be avoided. Time for regeneration is important, even if it restructures everyday life. Hand-foot syndrome is reversible, and so sporting activities should be temporarily avoided. If the disease breaks out, it can be discussed with the attending physician to what extent a reduction in the dose of medication or a break in therapy may be helpful.
