Complications of oncology therapy: Hand-Foot Syndrome

Hand-Foot Syndrome or HFS is one of the most common side effects of chemotherapy. It is also known as palmar-plantar erythrodysesthesia (PPE) or chemotherapy-induced acral erythemia. HFS causes painful redness and swelling of the palms of the hands or soles of the feet.


What is HFS und what are the causes?

Hand-Foot Syndrome is a particularly unpleasant side effect of certain cytostatics. Depending on its severity, symptoms include redness of the skin, blisters, scabbing, painful swellings or numbness of the palms of the hand or soles of the feet. If left untreated, HFS can make everyday activities such as getting dressed or cooking very difficult, or even impossible. HFS is particularly common with capecitabin (xeloda), but can also occur with docetaxel, pegylated liposomal doxorubicin, 5-FU or sorafenib.

HFS occurs at different times in different patients, but can begin after just a few days of therapy.

Symptoms of different severity grades

Please see your doctor as soon as possible if your skin changes during chemotherapy, or if you feel pain or have numb or itchy hands and/or feet. HFS is the most likely cause for these symptoms. There are three different grades of HFS, as shown below.

Severity Symptoms
Grade I Painful redness, mild itching and/or numbness. Does not affect everyday activities.
Grade II Severe, painful redness with swellings. Affects everyday activities.
Grade III Moist scabbing, inflammation, open wounds, blisters, severe pain. Seriously affects everyday activities.

HFS should not be underestimated. In more severe forms, it can lead to dosage reductions or even discontinuation of therapy. As a result, it can endanger the success of the therapy – and ultimately, the patient’s life.

Hand-Foot Syndrome: prevention and relief

These relatively simple precautions can prevent HFS:

  • Avoid pressure, friction or heat
  • Avoid hot water when you shower or wash
  • Use pH-adjusted soap or shower oil (no irritants)
  • Wear rubber gloves when doing the dishes or cleaning
  • Wear wide, comfortable shoes
  • Leave hands and feet uncovered whenever possible (but use suntan lotion in direct sunlight)
  • Do not stick plasters on the skin
  • Apply a skin oil or cream several times a day (particularly after washing)
  • Avoid steam baths, saunas or any form of exercise that makes you sweat a lot
  • Avoid mechanical stress to the palms of your hands (e.g. scratching, clapping or use of hand tools).Leave hands and feet uncovered whenever possible (but use suntan lotion in direct sunlight)

It is essential to give patients timely, competent instructions on how to prevent HFS. The following treatment methods are possible:

  • Apply hempseed oil, moisturizing lotions / ointments, uridine creams
  • Consume hempseed oil and vitamin B6 to reduce or delay HFS
  • Take cool baths or baths with grape seed extract


In worst-case scenarios, HSF can lead to dosage reduction or to discontinuation of therapy. Although chemotherapy can be resumed after the symptoms abate, dosage must often be reduced; this can have a negative impact on the success of the therapy. In other words, the success of therapy and the patient’s quality of life can depend on the success of complementary treatment for side effects such as Hand-Foot Syndrome.

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