Hand Foot Syndrome Related to Chemotherapy

What is Hand Foot Syndrome (HFS)?

Hand Foot Syndrome is a reaction of the skin on the palms of the and soles of the feet related to chemotherapy. Certain chemotherapeutic agents are known to cause Hand Foot Syndrome, including 5-FU, Capecitabine, Docetaxel, Cytarabine, Doxorubicin and Liposomal Doxorubicin. 

Following administration of chemotherapy, small amounts of drug leak out of very small blood vessels called capillaries in the palms of the hands and soles of the feet. Exposure of your hands and feet to heat as well as friction on your palms and soles increases the amount of drug in the capillaries and increases the amount of drug leakage. This leakage of drug results in redness, tenderness, and possibly peeling of the palms and soles. The redness, also known as palmar-plantar erythema, looks like sunburn. The areas affected can become dry and peel, with numbness or tingling developing. Hand-foot syndrome can be uncomfortable and can interfere with your ability to carry out normal activities.

Hand Foot Syndrome begins as a sensation of tingling or numbness on the soles of the hands and feet and may progress to swelling, redness and peeling skin. It can also lead to dry, cracked, painful, irritated skin.  

What causes Hand Foot Syndrome?

Current theory of the cause of Hand Foot Syndrome is that small amounts of the chemotherapeutic agent leak out of the capillaries and small blood vessels present in the extremities. These damage surrounding tissues and cause pain and discomfort that can affect the person's quality of life.

Nursing tips to manage hand foot syndrome

● Evidence base recommendations from the American Society of Clinical Oncology are listed below and you can find the patients support brochure link here ASCO answers hand foot syndrome.

● If you notice early signs of Hand Foot Syndrome, or if you notice your symptoms worsening, call your doctor’s office. Your health care team may need to change your treatment or help you manage the symptom. The following tips may help:
 
● Limit the use of hot water on your hands and feet when washing dishes or bathing.

● Take cool showers or baths. Carefully pat your skin dry after washing or bathing.

● Cool your hands and feet. Use ice packs, cool running water, or a wet towel for 15 to 20 minutes at a time. Avoid applying ice directly to the skin.

● Avoid sources of heat, including saunas, sitting in the sun, or sitting in front of a sunny window.

● Avoid activities that cause force or rubbing on the hands or feet during the first 6 weeks of treatment. This includes jogging, aerobics, and racquet sports.

● Avoid contact with harsh chemicals used in laundry detergents or household cleaning products.

● Avoid using rubber or vinyl gloves without a liner to clean with hot water. Rubber traps heat and sweat against your skin. Try using white cotton gloves underneath rubber gloves.

● Avoid using tools or household items that require you to press your hand against a hard surface. Examples include garden tools, knives, and screwdrivers.

● Gently apply skin care creams to keep your hands moist. Avoid rubbing or massaging lotion into your hands and feet. This type of movement can create friction.

● Wear loose fitting, well-ventilated shoes and clothes so air can move freely against your skin.

● Try not to walk barefoot. Use soft slippers and thick socks to reduce friction on your feet.

● Consider visiting a podiatrist to remove any thick calluses and thick nails before you begin cancer treatment. A podiatrist is a doctor who specializes in conditions of the feet. He or she can also recommend products that lower friction and put less pressure on the feet.

Choosing Hand Foot Syndrome Skin Care Cream

It is important to choose a lotion for Hand Foot Syndrome that contains skin moisturizers like aloe vera and shea butter. Another consideration when choosing a cream for Hand Foot Syndrome is to choose a natural, organic, plant-based, paraben and chemical free lotion. It is also recommended to choose an oncology cream that is sulfate, paraben, phthalate and dye free and contains anti-inflammatory, wound-healing and skin-soothing ingredients that encourage repair and healing of compromised skin.

Dermavitality created natural and organic cream for managing Hand Foot Syndrome. Our hand foot calming cream was formulated by an oncology nurse and a cancer survivor. It contains natural, organic and herbal ingredients. Dermavitality Hand Foot Calming Cream is formulated with powerful skin moisturizers to help soothe and hydrate dry, cracked painful skin during chemotherapy treatment. Our Hand Foot Calming Cream helps comfort painful, swollen, dry, itchy, irritated skin and calms Hand Foot Syndrome. Carefully selected anti-inflammatory plant botanicals calm inflammation. Helps relieve pain and tenderness and maintains beautiful, healthy skin throughout treatment. 

Organic Calendula Flower Extract

CALMS IRRITATED SKIN

Calendula has been used for centuries to help support wound healing and help calm irritated skin, Calendula is derived from the flower of the Marigold plant. Calendula is used to help calm tissue injury and reduce painful swelling and irritation.

Roman Chamomile

SOOTHING AND ANTI-INFLAMMATORY

This natural essential oil has skin repairing, regenerating, and strengthening properties. It also help calm any kind of irritation your skin might be experiencing and helps hydrate and moisturize your skin.

Bergamot

NATURAL CLEANSER

Bergamot Essential Oil is a natural cleanser. It's particularly good for oily skin, helping to unclog pores and balance sebum levels. For skin that leans on the dry side, look to Chamomile oil to purify and nourish the skin.

References

Hand-foot syndrome or palmar-plantar erythodysesthesia. American Society of Clinical Oncology Web site. 
http://www.cancer.net/patient/All+About+Cancer/Treating+Cancer/Managing+Side+Effects/Hand-Foot+Syndrome+or+Palmar-Plantar+Erythrodysesthesia

Kwakman, J. J. M. et al. 2020. Management of cytotoxic chemotherapy-induced hand-foot syndrome. Oncology Reviews.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232019/.

Management of cytotoxic chemotherapy-induced hand-foot
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232019/

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