Concept
Hand-foot syndrome is a cutaneous toxic side effect that can occur in oncology patients receiving chemotherapy (e.g., capecitabine-Xyroda) or molecularly targeted therapy, mainly in the area of pressure, characterized by numbness, dullness, abnormal sensation, tingling, painlessness or tenderness, skin swelling or erythema, flaking, cracking, hard node-like blisters or severe pain. The median time to onset of hand-foot syndrome was 79 days (range from 11-360 days) in oncology patients receiving capecitabine monotherapy.
Grading
Grade 1 hand-foot syndrome is defined as the presence of any of the following: numbness, dullness/abnormal sensation, tingling sensation, erythema, and/or discomfort that does not interfere with normal activities in the hands and/or feet.
Grade 2 hand-foot syndrome is defined as painful erythema and swelling of the hands and/or feet and/or discomfort that interferes with the patient’s daily activities.
Grade 3 hand-foot syndrome is defined as wet flaking, ulcers, blisters or severe pain in the hands and/or feet and/or severe discomfort that prevents the patient from working or performing daily activities.
Capecitabine drug dose adjustment
1. Capecitabine should be suspended in the presence of grade 2 or 3 hand-foot syndrome until it returns to normal or its severity is reduced to grade 1.
2.After the occurrence of grade 3 hand-foot syndrome, the dose should be reduced when capecitabine is used again.
3, When capecitabine is combined with cisplatin, the use of vitamin B6 (pyridoxine) is not recommended for hand-foot syndrome to improve symptoms or for secondary prevention because it has been reported that vitamin B6 may reduce the efficacy of cisplatin.
Prevention and treatment
Clinical statistics show that most patients develop only grade 1 symptoms, some patients develop grade 2 symptoms, and very few patients develop grade 3 symptoms. The occurrence of hand-foot syndrome is not terrible, as long as the following points are done, more can be prevented and controlled.
1, try to avoid friction of hands and feet and contact with hot objects in daily life, such as patients should not wear tight and ill-fitting shoes, avoid friction and pressure on hands and feet, avoid intense sports and physical labor, reduce the number of times hands and feet are in contact with hot water, including washing dishes and hot baths, wearing dishwashing gloves does not reduce the damage, because rubber will store heat and damage the skin of the palms.
2.Use shoe insoles that can absorb shock, you can wear slippers at home, and put your hands and feet in a higher position when sitting or lying down can prevent hand-foot syndrome.
3.If necessary, take vitamin B6 and Xyloprim orally under the guidance of a doctor.
4.Keeping the skin of hands and feet moist can help prevent and make the lesion heal sooner. Soak hands and feet in warm water for 10 minutes and wipe dry, then apply skin cream, such as: Vaseline ointment, etc.. This can effectively adsorb the water on the skin.
5, avoid exposure to the sun. When there is hand-foot syndrome, you should go out and apply sunscreen with a sun protection index of at least 30, and in winter sunshine can only be in the sun behind a sunny window.
6, avoid eating spicy, irritating food.
7, in the hands and feet local application of cream containing lanolin can reduce skin flaking, ulcers and pain.
8.Use antifungal or antibiotic treatment if necessary under the guidance of a doctor.
9.If blisters appear, ask medical personnel to deal with them. Do not tear the skin by hand when peeling occurs, you can use sterilized scissors to cut off the lifted part.