What is Chemotherapy Acral Erythema (hand-foot syndrome, toxic erythema of the palms and soles)?
Acral erythema is a medical condition also known as Palmar-plantar erythrodysesthesia (PPE), palmoplantar erythrodysesthesia, toxic erythema of the palms and soles, hand-foot syndrome (HFS), or Burgdorf reaction. This condition generally occurs as a side effect of many traditional chemotherapy drugs and newer targeted therapies.
What happens in acral erythema is that there is intense, painful redness (erythema) that appears on the palms of the hands and the soles of the feet. Over time, this could worsen, leading to the formation of blisters or large, fluid-filled sacs (vesicles or bullae). Chemotherapy is often the cause of Acral Erythema, and it’s important to recognize this as a potential side effect.
What Causes Chemotherapy Acral Erythema (hand-foot syndrome, toxic erythema of the palms and soles)?
Doxorubicin, cytarabine, docetaxel, capecitabine, and 5-fluorouracil are common medications that can often cause a skin condition known as acral erythema or redness of the hands and feet.
Other drugs that can cause this type of skin redness include bleomycin, cisplatin, cyclophosphamide, daunorubicin, doxifluridine, etoposide, fludarabine, gemcitabine, hydroxyurea, idarubicin, ixabepilone, methotrexate, mitotane, paclitaxel, tegafur, thiotepa, and vinorelbine.
It’s also believed that certain genetic traits affecting the processes our bodies use to break down some drugs like Capecitabine can make a person more likely to develop this skin condition.
The likelihood of developing acral erythema seems to be connected to the dose of the drug you’ve taken. So, both how much of a drug you take at once and how much you’ve taken overall can affect whether you experience this issue. Drugs that stay at a steady level in your bloodstream over time can also make acral erythema more likely to occur.
Medications that affect multiple targets at the same time, especially those related to blood vessel formation, are known to be connected to reactions affecting the skin of the hands and feet. But, how these reactions appear and their underlying causes can vary from the typical redness seen with most cytotoxic or cell-damaging drugs.
Risk Factors and Frequency for Chemotherapy Acral Erythema (hand-foot syndrome, toxic erythema of the palms and soles)
The total number of hand-foot syndrome (HFS) cases isn’t fully recorded. Still, we know that about 60% of people getting treatment with a medication called capecitabine develop the condition.
Signs and Symptoms of Chemotherapy Acral Erythema (hand-foot syndrome, toxic erythema of the palms and soles)
This condition often starts with unusual sensations such as tingling in the palms of your hands or the soles of your feet. The skin then becomes red and painful in a balanced and clearly-defined way. Over time, these areas can develop blisters, and the skin might peel off, erode or develop sores. After receiving specific high-dose medications, some individuals, especially children, can experience a severe form of this disorder where the outer layer of skin dies and peels off.
While it’s not common, this condition can also occur on the penis and scrotum.
A presumed variation of this condition is associated with the intravenous injection of a medication called docetaxel. This version of the disorder leads to the development of a single, unchanging red patch that does not affect the palms or soles. This patch usually peels off over 5 to 6 weeks, leaving behind a patch of skin that is darker than the surrounding area.
- The condition often starts with unusual feelings like tingling in the palms or soles
- The skin then becomes symmetrically red and painful
- The affected areas can develop blisters, and the skin might start to peel, erode or form ulcers
- After receiving certain medications, some individuals, especially children, can experience a severe version where the skin completely peels off
- This condition can also occur on the penis and scrotum, although this is rare
- A variation of this condition, associated with an intravenous drug, leads to a single, unchanging red patch, not affecting the palms or soles
- This patch usually peels off over a period of 5 to 6 weeks, leaving a patch of skin darker than the surrounding area
In cases related to the use of the drug capecitabine, this condition can lead to the temporary loss of fingerprints. This can cause issues with identification.
Testing for Chemotherapy Acral Erythema (hand-foot syndrome, toxic erythema of the palms and soles)
If a patient undergoing chemotherapy has painful red swelling on their feet and hands, this can indicate a certain condition. Diagnosing this can be tricky and requires careful attention, especially in patients who are on chemotherapy. This issue can also appear in patients who have had bone marrow transplants. The symptoms can look similar to skin conditions seen in graft-versus-host disease, a potentially dangerous condition that can occur after a transplant.
It’s important to tell apart graft-versus-host disease from a condition known as palmar-plantar erythrodysesthesia, which is less severe. In patients with graft-versus-host disease, the symptoms will spread to other parts of the body, while in palmar-plantar erythrodysesthesia, the symptoms stay in the hands and feet. To help distinguish between the two conditions, doctors may carry out repeated skin biopsies every 3 to 5 days.
Treatment Options for Chemotherapy Acral Erythema (hand-foot syndrome, toxic erythema of the palms and soles)
The main way to treat adverse drug reactions is to stop taking the problem medication and focus on easing symptoms. This can help alleviate any discomfort, reduce swelling, and prevent additional skin infections. Caring for the affected skin areas, applying moisturizers that do not contain alcohol, lifting swollen areas, and taking pain relievers are all methods of managing symptoms. This also allows for the affected skin to naturally shed its outermost layer and begin healing.
Often, if it isn’t possible to completely stop using the medication, it may be necessary to adjust the dosage or switch to a different drug or treatment for cancer.
The issues usually improve within 2 to 4 weeks of stopping the drug.
If a severe reaction occurs (rated as grade 3), it is important to reduce further doses of chemotherapy to avoid another occurrence. Depending on how well the patient is otherwise doing, it might be necessary to switch to a different treatment plan if there’s a high risk that the skin reaction will happen again.
What else can Chemotherapy Acral Erythema (hand-foot syndrome, toxic erythema of the palms and soles) be?
There are several medical conditions that may share similar symptoms. These include:
- Graft versus host disease (GVHD)
- Steven Johnson Syndrome (SJS)
- Toxic epidermal necrolysis (TEN)
- Fixed drug eruption
Possible Complications When Diagnosed with Chemotherapy Acral Erythema (hand-foot syndrome, toxic erythema of the palms and soles)
Personal protective equipment (PPE) can greatly affect a person’s daily lifestyle. In most cases, it doesn’t have any long-lasting side effects. However, one may develop a skin condition called palmoplantar keratoderma if acral erythema, a condition that causes redness on the hands and feet, persists for a long time. The loss of fingerprints is another side effect, but this is usually reversible and returns to normal once the person stops using the PPE.
Common Side Effects:
- Impact on daily lifestyle
- Potential for developing palmoplantar keratoderma due to long-term acral erythema
- Loss of fingerprints, which is typically reversible after discontinuing PPE use
