What is hand-foot syndrome and how do doctors treat it?

HFS causes intense burning on the hands and feet. It is a rare condition in the general population but common among people receiving certain types of chemotherapy. Another name for the condition is palmar-plantar erythrodysesthesia syndrome.

HFS occurs due to small amounts of chemotherapy medication leaking out of the capillaries, which are small blood vessels present all over the body. The medication then damages the surrounding tissues, causing pain and discomfort that can affect a person’s quality of life to varying degrees.

The symptoms of HFS include:

• numbness
• tingling
• burning
• itching
• inflammation
• swelling
• tenderness

These symptoms typically affect the palms of the hands and soles of the feet, although they can affect the knees and elbows too. In severe cases, people may experience:

• cracked, flaky, or peeling skin
• blisters or sores
• severe pain
• difficulty using their hands or feet

The World Health Organization (WHO) uses four grades to categorize HFS symptoms based on their severity. They are:

• grade 1, which includes abnormal sensations or tingling in the hands and feet
• grade 2, which involves painless swelling or redness, and discomfort when walking or holding objects
• grade 3, which includes inflammation and painful swelling in the palms of the hands, soles of the feet, and around toenails and fingernails
• grade 4, which includes ulceration, scaling of the skin, severe pain, and blistering

HFS has two common causes:

Chemotherapy

HFS is often a skin reaction to systemic drug therapy, particularly certain types of chemotherapy. Whether HFS develops depends on the type of chemotherapy drug doctors have prescribed, the treatment schedule, and the course length. Chemotherapy that doctors administer continuously is more likely to cause HFS.

Some examples of chemotherapy drugs that can cause HFS include:

• doxorubicin (Adriamycin, Doxil)
• 5-fluorouracil (Adrucil)
• ixabepilone (Ixempra)
• capecitabine (Xeloda)

Some types of targeted therapy drugs for cancer may also cause HFS.

Sickle cell disease

HFS can develop in people with sickle cell disease. Sickle cell disease encompasses a range of red blood cell disorders. Red blood cells are usually round, but someone with sickle cell disease has red blood cells that become hard and form a C shape, resembling a sickle.

HFS may be an initial symptom of sickle cell anemia, typically developing in early childhood. It commonly occurs during a sickle cell crisis, which is when sickle-shaped blood cells become stuck inside blood vessels. This can block blood flow to the hands and feet, leading to swelling and fever.

For people who have HFS as a result of chemotherapy, there are several treatment options. A doctor may recommend:

• Over-the-counter pain medications: It may be possible for someone to take medications such as acetaminophen (Tylenol) to reduce pain and discomfort. Check with a doctor to find out if it is an option.
• Urea cream: Creams that contain 10% urea may help reduce HFS symptoms if a person applies them regularly every day. Urea creams can help with dryness, itching, and scaling.
• Steroid medications: People can apply steroid creams topically to the hands or feet, or take them orally, to reduce inflammation and pain.
• Altering the chemotherapy: It may be possible to lower the dosage of chemotherapy drugs, change the treatment schedule, or temporarily pause chemotherapy until a person’s HFS improves. But doing this may impact a person’s cancer treatment, so some doctors may not consider it an option.

For people with sickle cell disease, the most common treatment for HFS is pain medication and drinking plenty of fluids.

There are things people can do to reduce their chances of developing HFS while they have chemotherapy. BreastCancer.org suggests:

• avoiding prolonged exposure to heat, such as during baths, showers, or while washing dishes in hot water
• avoiding placing pressure on the feet or hands from activities such as massage, walking, jumping, or running
• avoiding the use of hand tools such as knives, screwdrivers, hammers, or gardening tools, as these create pressure and friction

If a person already has HFS, there are a number of home remedies and management techniques that can reduce discomfort. These include:

• applying ice packs wrapped in towels, a cold compress, to the hands or feet
• elevating the hands or feet when sitting or lying down
• gently patting the skin dry after washing, rather than rubbing
• wearing loose shoes with good ventilation and avoiding tight-fitting shoes
• avoiding contact with harsh chemicals, as these could make irritation worse

Some evidence suggests that certain natural extracts may also ease HFS. A 2017 pilot study found that silymarin, a compound that comes from milk thistle, reduced HFS symptoms when people applied it as a 1% strength gel to their feet twice daily for 9 weeks. Silymarin has antioxidant and anti-inflammatory properties.

HFS is not permanent. If caused by chemotherapy, it will usually begin to heal once treatment finishes. If the cause is sickle cell disease, the symptoms will typically last for a few weeks before easing on their own.

HFS most often develops anywhere between 2 days to 3 weeks after someone starts chemotherapy treatment. It can take time to fully resolve when treatment ends. In some cases, it may linger for up to 10 months after treatment has finished.

HFS can cause considerable pain and difficulty carrying out tasks, which can have an impact on a person’s quality of life. If someone is struggling with the symptoms, it is important to speak with a doctor, as there may be ways of reducing the discomfort through medications.

It is also important to talk with a doctor if a child develops swollen hands or feet or is finding it difficult to pick up objects. This may be an early indication of sickle cell disease.

For those about to begin chemotherapy, it is a good idea to ask a doctor about the probability of developing HFS based on the type of drug they will be receiving. Understanding the risk can help someone take action to help prevent or delay HFS early on.

Additionally, there are some predictors for developing grade 2 or higher HFS in people receiving antimetabolite chemotherapy, which a doctor can analyze through blood testing. These predictors include serum and red blood cell folate levels.

HFS is a common skin reaction to some chemotherapy drugs. It occurs when those drugs leak from the small blood vessels in the hands and feet. HFS can also develop as a result of sickle cell disease.

The symptoms of HFS include numbness, tingling, burning, pain, and swelling on the palms of the hands and soles of the feet. Treatment depends on the cause, and if relevant, the type of chemotherapy course a person is receiving.

No matter the cause of HFS, it is reversible and should heal with time. People who are struggling with the symptoms can seek help from a doctor.