What is hand-foot syndrome?

Hand-foot syndrome is also known as palmar-plantar erythrodysesthesia (PPE), and the exact cause isn’t known, but some of these theories may explain why it possibly happens.

Drugs given to treat kidney cancer work in several ways. Some targeted medicines inhibit a growth factor protein also present in skin cells, which may hinder normal skin cell growth.

Other drugs attack another growth factor that tumours use to build blood vessels. It is thought that these drugs may injure small blood vessels and surrounding tissue in the hands and feet, causing hand-foot syndrome.

Other theories about the syndrome’s cause suggest that some treatment drugs may:

• Accumulate in certain sweat glands and ducts, such as the ones in the hands and feet
• Concentrate in the soles and feet
• Interact to cause skin cells to die

Cancer treatment drugs may trigger a variety of skin problems, including, but not limited to:

Allergic reactions

• Dermatitis
• Eczema

Some drugs, notably targeted therapies, may cause a related side effect called hand-foot skin reaction (HFSR).

HFSR may manifest as blisters or excess skin in areas subject to friction, pressure and flexing. Unlike hand-foot syndrome, which tends to affect the palms of the hands more than the soles of the feet, HFSR lesions appear more often on the soles rather than the palms.

The reaction to drugs to treat kidney cancer will vary from patient to patient, and many may not develop hand-foot syndrome. It tends to be a problem during the first six weeks of targeted therapy and after two to three months of systemic treatment.

In many cases, hand-foot syndrome improves considerably or goes away two weeks after drug treatment stops.

Symptoms that may present as hand-foot syndrome

Hand-foot syndrome symptoms could include:

• Numbness
• Tingling or burning sensations
• Red skin
• Hyperpigmentation (skin darkening)
• Hyperkeratosis (skin thickening)
• Tenderness or swelling
• Calluses and blisters and more severe manifestations, such as cracked and peeling skin, blisters and ulcers, and strong pain

Severe symptoms may be disabling to the patient. In addition to the palms, soles, the backs of the hands and feet the knees and elbows, or other areas subject to friction and pressure may be affected.

The National Cancer Institute rates the degree of symptom severity by a scale of grades of 1 to 3.

• Grade 1: Mild inflammation, hyperkeratosis or other skin changes with no pain
• Grade 2: Blisters, bleeding, hyperkeratosis, flaking skin with swelling and discomfort that slightly limits activity
• Grade 3: Severe painful lesions, hyperkeratosis, and swelling of palms and soles that limit daily life activities

Can you prevent hand-foot syndrome?

Patients may limit potential problems by going to a podiatrist before cancer treatment begins and having large calluses and thick nails removed or trimmed down.

Treatment for hand-foot syndrome

After treatment starts, let your medical team know if symptoms appear and if they get worse. Clear and early communication with your team is key—early treatment of symptoms may help prevent them from becoming severe. Avoid friction, pressure and heat on affected areas.

The following steps may help prevent symptoms from worsening.

Don’t:

• Take hot showers or baths or clean dishes with hot water
• Sunbathe or sit in a sauna
• Do vigorous exercise or household chores that cause rubbing of the hands or feet
• Expose the skin to harsh detergents and chemicals
• Walk barefoot

Do:

• Wear white cotton gloves underneath rubber gloves when cleaning
• Wear thick socks or soft slippers
• Take cool showers or baths and pat the skin with a towel afterwards- don’t scrub the skin dry
• Use laundry detergents free of dyes and perfumes, and mild bath and hand soaps and shampoos
• Use ice packs (not directly on skin) and cool, wet towels for relief
• Wear clothing that is loose and well-ventilated, and shoes that fit
• Use moisturising creams, but don’t rub them in

If symptoms progress from grade 1 to grades 2 or 3, your medical team may:

• Change your medication dose
• Change the cancer drug being used
• Pause treatment until the syndrome symptoms lessen or disappear
• Treatment may be stopped completely if moderate to severe symptoms return when the drug treatment is resumed at a lower-than-recommended dosage.

To reduce discomfort, your medical team may suggest:

• A moisturising exfoliant cream containing urea, salicylic acid or ammonium lactate to moisturise the skin
• Topical pain relievers containing lidocaine, a mild anaesthetic, to partially numb sore non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, for inflammation and pain
• Prescription-strength corticosteroid creams for inflammation
• Petroleum and lanolin ointments for eroded areas

If you have any concerns, always speak to your medical team and ask for their recommended treatments to help alleviate any pain or discomfort you may be experiencing.