{"entity":{"id":"hand-foot-syndrome","kind":"term","name":"Hand-foot syndrome and hand-foot skin reaction","aka":["hand-foot","hand-foot syndrome","hand foot syndrome","hand-foot skin reaction","HFSR","HFS","palmar-plantar erythrodysesthesia","PPE","palmar-plantar","plantar-palmar"],"tldr":"Redness, peeling, pain and cracking of the palms and soles caused by certain chemotherapy pills and by kinase inhibitors that block blood vessel growth. Rarely dangerous but can stop patients walking or using their hands.","summary":"Hand-foot syndrome from capecitabine, 5-FU infusion and liposomal doxorubicin is a diffuse painful erythema; hand-foot skin reaction from VEGFR multikinase inhibitors (sorafenib, regorafenib, cabozantinib, lenvatinib) is more localised hyperkeratotic callus over pressure points. Both are dose-dependent, managed by dose interruption and reduction, urea creams, and avoiding friction and heat; celecoxib and pyridoxine have weak evidence. It is one of the most common reasons for dose reduction of oral therapies and a leading contributor to quality-of-life loss on long-term TKIs.","asOf":"2026-09-09","wikipedia":"https://en.wikipedia.org/wiki/Chemotherapy-induced_acral_erythema","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Chemotherapy-induced_acral_erythema"},{"label":"Masuda et al., adjuvant capecitabine after preoperative chemotherapy, CREATE-X (NEJM 2017)","url":"https://doi.org/10.1056/NEJMoa1612645"},{"label":"Macmillan: FOLFIRINOX","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/folfirinox"},{"label":"Macmillan: GemCap (gemcitabine and capecitabine)","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/gemcap"},{"label":"Macmillan: capecitabine","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/capecitabine"},{"label":"Bowel Cancer UK: long term and late side effects","url":"https://www.bowelcanceruk.org.uk/about-bowel-cancer/living-with-and-beyond-bowel-cancer/long-term-and-late-side-effects/"}],"tags":[],"related":["rash-skin-toxicity","dose-modification","tki-term"],"cancers":["tnbc","pancreatic","colorectal"],"sections":["supportive-care"],"technologies":[],"targets":[],"drugs":["sorafenib","regorafenib","cabozantinib","lenvatinib"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Capecitabine for residual triple-negative breast cancer after chemotherapy: in CREATE-X hand-foot syndrome affected 73.4% of people taking it. Report sore, red or peeling palms and soles early, because doses are adjusted rather than stopped.","Fluorouracil (in FOLFIRINOX) and capecitabine (in GemCap and chemoradiotherapy) can cause sore, red or peeling palms and soles; Macmillan says to contact the 24-hour line, especially with broken skin or if walking is difficult, and to moisturise, wear gloves for housework and loose cotton socks.","Capecitabine (in CAPOX and as a single tablet after surgery) and infused fluorouracil can make the palms and soles sore, red, dry or peeling. Macmillan says to keep hands and feet cool by washing in cool water, to moisturise gently and regularly, and to contact the hospital on the 24-hour number if the skin around the nails becomes sore and swollen, which may be a sign of infection."],"category":"Side effects"},"route":"/terms/hand-foot-syndrome/","neighbours":{"term":[{"id":"antiangiogenic-toxicities","kind":"term","name":"Anti-VEGF class toxicities (hypertension, proteinuria, bleeding, perforation)","route":"/terms/antiangiogenic-toxicities/"},{"id":"dose-modification","kind":"term","name":"Dose reduction, interruption and discontinuation","route":"/terms/dose-modification/"},{"id":"chemotherapy-side-effects-pancreatic","kind":"term","name":"Living with FOLFIRINOX, NALIRIFOX and gemcitabine with nab-paclitaxel","route":"/terms/chemotherapy-side-effects-pancreatic/"},{"id":"chemotherapy-side-effects-colorectal","kind":"term","name":"Living with FOLFOX, CAPOX, FOLFIRI and the EGFR antibodies","route":"/terms/chemotherapy-side-effects-colorectal/"},{"id":"tnbc-symptom-control-palliation","kind":"term","name":"Palliation in advanced triple-negative breast cancer: brain, bone, pleura, skin and end of life","route":"/terms/tnbc-symptom-control-palliation/"},{"id":"rash-skin-toxicity","kind":"term","name":"Rash and skin toxicity (acneiform rash, paronychia)","route":"/terms/rash-skin-toxicity/"},{"id":"tki-term","kind":"term","name":"Tyrosine kinase inhibitor (TKI)","route":"/terms/tki-term/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"section":[{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"drug":[{"id":"cabozantinib","kind":"drug","name":"Cabozantinib","route":"/drugs/cabozantinib/"},{"id":"lenvatinib","kind":"drug","name":"Lenvatinib","route":"/drugs/lenvatinib/"},{"id":"regorafenib","kind":"drug","name":"Regorafenib","route":"/drugs/regorafenib/"},{"id":"sorafenib","kind":"drug","name":"Sorafenib","route":"/drugs/sorafenib/"}],"trial":[{"id":"create-x","kind":"trial","name":"CREATE-X","route":"/trials/create-x/"},{"id":"sysucc-001","kind":"trial","name":"SYSUCC-001","route":"/trials/sysucc-001/"}],"technology":[{"id":"dpyd-genotyping","kind":"technology","name":"DPYD genotyping and DPD phenotyping before fluoropyrimidines","route":"/technologies/dpyd-genotyping/"}]}}