Hand-Foot Syndrome During Cancer Treatment

This page is for people whose cancer medicine can affect the skin of their hands and feet. It covers early signs, what helps, and when to call your care team.

Hand-foot syndrome is a skin reaction to a medicine, such as those used for cancer treatment. The skin on the palms of your hands and the soles of your feet becomes red, swollen, sore, or even starts to peel or crack. It is also called palmar-plantar erythrodysesthesia.

It usually starts during the first 2 to 6 weeks of treatment. Many people first notice tingling or warmth, and that feeling can get worse if nothing is done about it. Most people recover from hand-foot syndrome when treatment is adjusted or finished.

Chemotherapy medicines that can cause hand-foot syndrome include:

• capecitabine (Xeloda)
• liposomal doxorubicin
• fluorouracil (5-FU)
• gemcitabine
• cytarabine
• azacitidine and decitabine

Some targeted therapies can cause it too, particularly the group called angiogenesis inhibitors: bevacizumab (Avastin), sorafenib (Nexavar), sunitinib (Sutent), regorafenib (Stivarga), pazopanib (Votrient), and axitinib (Inlyta).

If one of these is part of your plan, ask at the start what to watch for. Then you can spot the first changes before walking hurts.

Early symptoms are easy to dismiss:

• dry skin
• redness
• tingling or itching
• mild pain or numbness
• mildly decreased sensitivity to touch, hot, and cold

If it is not treated and gets worse, symptoms can include:

• increased redness like a sunburn, with swelling
• cracked and peeling skin
• blisters
• more decreased sensitivity to touch, heat, and cold

That second list is what you are trying to avoid. The gap between the two stages is usually where reporting the symptom makes the most difference.

There is no single number you get told. In practice, severity follows that same path. Dry, red, tingling skin is at one end. Intense redness with swelling, cracks, peeling, and blisters is at the other. Two things matter most. Is the skin still whole? And how much do the symptoms limit what you can do? Severe hand-foot syndrome is the level that leads to a change in the cancer treatment itself.

Skin care and protection carry most of the weight:

• Apply a gentle, alcohol-free moisturizing lotion.
• Rest your hands and feet often, and elevate them when you can.
• Keep the skin clean, cool, and dry. Some people find cool packs soothing. Ask your team first if oxaliplatin is part of your plan.
• Wear well-fitting shoes with padding.
• Limit time in hot water, and avoid hot tubs.
• Wear sun-protective clothing.
• Ask for help handling sharp, hot, or cold objects.
• Do not puncture blisters, because that can let infection in.

Your care team may also prescribe treatment, such as:

• steroid creams or lotions containing urea
• steroid pills
• pain medicine
• skin-cooling gloves or socks
• special hand and foot soaks

Some ordinary habits make it worse. It helps to avoid:

• long walks or runs
• excessive gripping with your hands, chopping, and gardening
• prolonged pressure on your hands or feet
• manicures and pedicures
• extended contact with warm or hot water
• tight clothing and footwear
• sun exposure
• intense hand or foot activity

Popping a blister yourself is not a shortcut to relief. It is a route to infection.

If hand-foot syndrome is severe, your cancer care team might recommend a lower dose of your cancer treatment. Or they may suggest a short break from your cancer treatment. That is a normal, planned response to a side effect. It is not a sign that treatment has failed. It is also the main reason to report symptoms early. A small change made sooner is often enough.

Tell your care team if your hands or feet start to hurt or peel.

If a blister breaks on its own, contact your cancer care team.

At each visit, or as directed by your care team, report all symptoms. Say whether they have changed, and what helps and what does not. If your team has given you its own rule about when to call between visits or after hours, follow that rule.

This side effect is not only a skin problem. Severe hand-foot syndrome can make it hard to walk or hold things. It raises the risk of falls, burns, and wounds. Open sores can let infection in. Part of the reason is that you may feel touch, heat, and cold less. You may not feel a pan that is too hot, or a shoe that is rubbing a raw spot.

Practical adjustments follow directly from that. Sit down for tasks you would normally stand for. Break activity into shorter stretches with rest in between. Hand off the chopping, the gardening, and anything involving sharp or hot items. Choose padded, well-fitting shoes over anything tight.

The skin can peel so much that fingerprints go away for a while. The skin usually recovers in the weeks to months after treatment ends.

• Call your care team now, day or night, if you run a temperature of 100.4°F (38°C) or higher while on chemotherapy or targeted therapy. CDC treats a fever during chemo as a medical emergency. Fever may be the only sign of an infection, and an infection during chemotherapy can be life-threatening. If you cannot reach your team, go to the emergency room and tell the staff you are on chemotherapy with a fever.
• Call 911 or go to an emergency department if the fever comes with shaking chills, confusion, a racing heartbeat, shortness of breath, or clammy or sweaty skin. CDC lists these as possible signs of sepsis. Do not drive yourself.
• Call your care team the same day if a blister on your palm or sole breaks open on its own, or if a crack or raw patch starts to look infected without fever. Signs include spreading redness around the edge, yellow or cloudy drainage, or new warmth and swelling. Open skin on the hands and feet is the route infection takes. That is why ACS says to contact your team when a blister opens rather than waiting.
• Call your care team within a day or two if your palms or soles begin to hurt or peel, if walking or gripping has become difficult, or if numbness means you can no longer feel heat properly. These are the changes that let your team adjust the dose early, while a small adjustment is still enough.

Helpful next pages include Side Effects of Cancer Treatment, Immune-Related Side Effects, Low White Blood Cells During Chemotherapy, and Supportive Care.

• American Cancer Society, Hand-Foot Syndrome
• CDC, Fever and chemotherapy
• CDC, About sepsis