This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on February 28, 2022.
Some drugs used to treat cancer may cause mild to severe skin problems, especially on the palms of the hands and soles of the feet. This side effect is called hand-foot syndrome, or palmar-plantar erythrodysesthesia. It’s also called Burgdorf’s syndrome and acral erythema.
Hand-foot syndrome is associated with both systemic and targeted cancer treatment medicines. (Systemic drugs affect cells throughout the body. Targeted therapies fight tumors by hampering the action of specific molecules.)
Cancers treated with drugs that have resulted in hand-foot syndrome include:
The exact cause of hand-foot syndrome isn’t known, but some theories may explain why it may happen.
Drugs given to treat cancer work in several ways. Some targeted medicines inhibit a growth factor protein that’s also present in the skin cells, so they may hinder normal skin cell growth.
Other drugs attack another growth factor that tumors use to build blood vessels. It’s thought 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 chemotherapy drugs may:
Cancer treatment drugs may spur a variety of skin problems, including, but not limited to:
Some drugs, notably targeted therapies including Inlyta® (axitinib) and Votrient® (pazopanib), 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 soles than palms.
Avastin® (bevacizumab) has been linked to HFSR and also has been shown to increase the occurrence and degree of hand-foot syndrome symptoms when given in combination with capecitabine for treatment of metastatic colorectal cancer. Capecitabine, a systemic chemotherapy drug, is linked to hand-foot syndrome.
Other targeted therapy drugs that may cause hand-foot syndrome are:
Systemic chemotherapy drugs associated with hand-foot syndrome include:
Reaction to treatment with any of these drugs varies from person to person. Patients may or 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 chemotherapy.
Symptoms often improve considerably or go away two weeks after drug treatment stops.
Hand-foot syndrome symptoms may include:
Severe symptoms may be disabling. In addition to the palms and 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
Patients may help curtail potential problems by going to a podiatrist before cancer treatment begins and having large calluses and thick nails removed or trimmed down.
After treatment starts, let the care team know if symptoms appear and if they get worse. Communication with the care 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:
Do:
If symptoms progress from grade 1 to grades 2 or 3, the care team may:
Chemotherapy 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, the care team may suggest: