HFS may also refer to hand-foot syndrome, a common side effect of chemotherapy. Some ways to reduce the development and severity of HFS include:
Background
Hand-foot syndrome (HFS), also called palmar-plantar erythrodysesthesia (PPE), is a cutaneous complication associated with continuous fluorouracil therapy, oral capecitabine, and liposomal doxorubicin. First reported in 1974, this complication was noted in patients receiving antimetabolites and some chemotherapy antibiotics.1 The median time to onset of HFS with capecitabine is approximately 79 days, ranging from 11 to 360 days. HFS is the most frequently reported side effect of oral capecitabine (> 50% of patients) and is the dose-limiting side effect for this agent.2,3
Pathophysiology
Although its exact pathophysiologic mechanism is not known, some researchers have theorized that HFS may be related to the crushing of deep capillaries in the soles of the feet and palms of the hands, which may cause drug extravasation into those same capillaries, causing the symptoms of this condition. Another report, by Lin et al,4 describes a different mechanism, in which HFS is the consequence of an inflammatory reaction, which might result from overexpression of COX-2. These researchers noted that COX-2 is upregulated with the administration of chemotherapy, possibly leading to a COX inflammatory-type reaction.4
Because the condition primarily affects the palms of the hands and the soles of the feet, researchers have also postulated that HFS is caused by the accumulation of drug in the eccrine sweat or the eccrine sweat glands of the hands and feet, causing the damage characteristic of this toxicity.1 Histologically, changes in keratinocytes and vacuolar degeneration of the basal layer are seen, with scattered necrotic areas noted.5 Dilated blood vessels and papillary edema may also be seen. More research is needed to determine the complete pathophysiology and pathobiology of this commonly seen cutaneous side effect.
Physical Presentation: Symptoms may include
- Numbness
- Tingling
- Swelling
- Dryness, cracking, edema
- Erythema
- Pain, blistering, or even desquamation
- Skin reactions may not be noted until the second week of therapy. To control or relieve symptoms, dose reduction or temporary drug cessation may be required
PRECAUTIONS
- Soaking the hands and feet in cold water for 15 minutes, 3–4 times per day
- Avoiding activities that cause excessive friction and rubbing of the skin
- Wearing cotton gloves and thick cotton socks
- Avoiding tight-fitting shoes
- Reporting any skin changes to a medical professional as soon as possible
- Avoid immersion in hot water, which could exacerbate symptoms
- Bathing or showering in lukewarm water
- Avoiding sun exposure
- Avoid activities that may increase pressure in affected areas, such as
- high-impact exercise
- Avoid tight clothing, vigorous skin rubbing, and sun exposure13
- Try cold compresses, which may be helpful
- Use topical emollients or other preparations containing urea or lanolin 2,3,14
- Gently applying an emollient to the hands and feet daily
- Use protective gloves if needed15
HAND-FOOT SYNDROME CASES IN VIETNAM
Hand, foot, and mouth disease (HFMD) is a disease that has been a leading cause of morbidity and mortality in Vietnam. In recent years, Vietnam has experienced several outbreaks of HFMD, including:
- 2011–2012: Over 200,000 hospitalizations and more than 200 deaths
- 2018: Over 130,000 hospitalizations and 17 deaths
- November 2023: Over 100,000 infections and 23 deaths
HFMD is a notifiable disease in Vietnam, and each year, the country reports around 50,000 to 100,000 cases.
