Hand Foot Chemotherapy Induced Syndrome

Chemotherapy-induced acral erythema or palmoplantar erythrodysesthesia syndrome is a well-defined reaction to some of the chemotherapeutic agents such as methotrexate, cytarabine, doxorubicin, fluorouracil (5-FU), cytosine arabinoside and bleomycin.

More recently, HFS has been reported in association with regimens using targeted agents, in particular the multikinase inhibitors (MKI) sorafenib and sunitinib (1). The HFS associated with MKI has a different distribution and clinical appearance than the traditional disorder.

This reaction is characterized by symmetric, well-demarcated, painful erythema of the palms and soles, which may progress to desquamation or blisters.

It appears to be dose dependent. It is likely a direct toxic effect of the drug.

Tingling on the palms and soles is followed in a few days by painful, symmetric, well-defined swelling and erythema.

Histologically, the HFS is characterized by a toxic keratinocyte reaction. Furthermore, there is sub-basal edema with a tendency to bullae, dilated blood and lymph capillaries and usually only mild perivascular lymphocytic infiltration (2).

Depending on the severity, HFS requires dose reduction, interruption or switch in the antineoplastic chemotherapy (2-3).



(1) Degen A, Alter M, Satzger I, et al. The hand-foot-syndrome associated with medical tumor therapy- classification and management. J Dtsch Dermatol Ges. 2010 Sep; 8(9):652-61.

(2) Janusch M, Fischer M, Marsch WCh, et al. The hand-foot syndrome - a frequent secondary manifestation in antineoplastic chemotherapy. Eur J Dermatol. 2006 Sep-Oct; 16(5): 494-9.

(3) Habif TP. Clinical Dermatology. 5th edition. USA: Elsevier Science 2010.