Hand Foot Syndrome: Everything You Need To Know

Hand foot syndrome (HFS) is a clinical picture that often occurs in connection with chemotherapy or immunotherapy. When it develops in children, it is often a sign of sickle cell disease. Typical symptoms are redness and swelling on the palms of the hands and soles of the feet. Read more about the topic here!

ICD codes for this disease: L27

Quick overview

  • What is Hand Foot Syndrome? Painful redness and swelling on the palms of the hands and soles of the feet
  • Treatment: Skin care, cooling the affected areas, avoiding mechanical stress, ointments, painkillers, possibly changing to another active ingredient, treating the cause
  • Causes and risk factors: Reaction of the skin to chemotherapy or immunotherapy with certain active substances. The risk of developing HFS is increased when two drugs are combined. In children, possibly sickle cell anemia.
  • When to the doctor? Once your palms and soles (or those of your child) are red and swollen – whether you (or your child) are undergoing chemotherapy or not!
  • Diagnostics: Visual diagnosis in cancer patients, blood analysis and molecular genetic tests in suspected sickle cell anemia.
  • Prevention: It is not possible to prevent hand foot syndrome.
  • Disease course and prognosis: HFS is usually mild and disappears a few weeks after treatment is stopped. Permanent damage, such as the loss of a fingerprint, is rare.

What is Hand Foot Syndrome?

Hand foot syndrome (HFS, palmar-plantar erythrodysesthesia) is not a disease in its own right, but rather a skin reaction to chemotherapy or immunotherapy in cancer patients. When it occurs in children not receiving cancer treatment, it indicates sickle cell anemia.

Typical of hand foot syndrome are painful redness and swelling on the palms of the hands and soles of the feet. Other symptoms include sensory disturbances such as numbness, tingling or burning. The hands are often more affected than the feet. In cancer patients, it usually occurs within four to 17 days of starting therapy and resolves within two weeks in many cases. It occurs in both adults and children.

Whether and how severe the symptoms occur depends on the type of medication used, as well as the dose and duration of treatment. Hand-foot syndrome occurs more frequently with certain chemotherapy and immunotherapies used to treat cancer. Cancer patients are usually given information about possible side effects such as hand-foot syndrome before starting therapy.

Hand foot syndrome that occurs in children is often the first sign of sickle cell disease. It is a congenital blood disease that can be life-threatening if left untreated.

Be sure to have your child examined if you discover redness and swelling on the palms of your hands! The pediatrician will determine the cause and initiate appropriate treatment.

Is HFS contagious?

Hand foot syndrome develops either as a side effect of cancer treatment or as an accompaniment to a congenital blood disorder (sickle cell disease) and is therefore not contagious.

Due to the similar designation, it is sometimes confused with the term “ hand, foot and mouth disease ”. This is a highly contagious viral disease that mostly affects children! It also causes skin changes on hands and feet.

What helps against that?

Treatment of hand foot syndrome depends on its severity. In mild cases, the following tips will bring relief.

What can you do yourself?

Care of hands and feet: Always use greasy skin ointments during cancer therapy. Care for your hands and feet several times a day with creams containing five to ten percent urea (urea).

Cold water bath: Bathe your hands and feet in cold water several times a day.

Flaxseed bath: Another way to relieve the symptoms of hand-foot syndrome is a hand and foot bath with flaxseed. To do this, boil three tablespoons of ground flaxseed in 2.5 liters of water for five minutes and allow the mixture to cool to a comfortable temperature. Then move your hands and feet in it for five to ten minutes. Then rinse off the flaxseed mucus with lukewarm water.

Personal care: avoid disinfectants and only use mild personal care products (no soap, no alcohol, pH-neutral). If you prefer products that are free of parabens and fragrances, use moisturizing care products if possible. After showering, dab the skin with a soft towel, do not rub or scrub!

Avoid hot water: Avoid hot water – for example when cleaning or washing dishes – and prolonged contact with cleaning products. For such activities, wear cotton gloves and waterproof protective gloves.

Sun Protection: Avoid direct sunlight and heat.

Clothing: Avoid tight shoes or tight underwear. Prefer natural fabrics like cotton.

Mechanical stress: If possible, avoid friction and pressure on your hands and feet, for example by lifting and carrying heavy loads or long walks. Do not kneel or lean on your elbows for long periods of time . Avoid straining your hands, such as clapping or doing manual work. Do not open screw caps with bare hands.

Treating skin diseases: Have existing pre-existing conditions such as athlete’s foot or skin wounds examined and treated by a doctor.


If the course is severe, the doctor will prescribe an ointment containing cortisone. Cortisone has a strong anti-inflammatory effect and reduces swelling in the affected areas.

Wound dressing

In the case of severe complaints – especially on the soles of the feet – wound dressings with hydrocolloids can help. They promote wound healing. Hydrocolloids (Greek hydro = water, kolla = glue) are substances that produce a gel-like consistency when combined with liquid. These gel-like particles lie on the wound like a second layer of skin, absorb the wound secretion and bind it to the tissue. The wound fluid is drained to the outside and evaporates. Doctors speak of “moist wound healing”.


In the case of severe pain and inflammation of the skin, the doctor prescribes painkillers or anti-inflammatory drugs.

Causes and risk factors

Redness and swelling on the palms of the hands and soles of the feet have various possible causes. Hand-foot syndrome most commonly occurs as a side effect of cancer chemotherapy or immunotherapy, and less commonly is a sign of sickle cell anemia.

Side effect of chemotherapy or immunotherapy

Chemotherapy is used for many types of cancer, including colon cancer, breast cancer, and liver cancer. These drugs, also known as cytostatics, destroy cancer cells or stop them from multiplying. So-called immunotherapies specifically attack cancer cells and thus destroy the tumour. In addition to the effect on the cancer cells, certain active ingredients also trigger side effects such as hand-foot syndrome. How pronounced it is depends not only on the type of drug, but also on the dose and duration of treatment.

The following active substances can trigger hand-foot syndrome:

  • Capecitabine (especially as a tablet)
  • 5-fluorouracil
  • Doxorubicin
  • Cyclophosphamide
  • Cytarabine
  • Docetaxel
  • Oxaliplatin
  • Paclitaxel
  • Sorafenib
  • Sunitinib
  • Axitinib
  • Cabozantinib
  • Dabrafenib
  • Lenvatinib
  • Regorafenib
  • Tivozanib
  • Vemurafenib
  • Bevacizumab

The risk of developing hand foot syndrome is increased when two of the substances mentioned are combined. This applies, for example, to the active ingredients doxorubicin and docetaxel as well as sorafenib and bevacizumab.

Why do the typical skin changes occur?

During cancer treatment with chemotherapy or immunotherapy, some of the active ingredients escape with the sweat on the skin’s surface. Contact with air creates so-called free radicals, which damage the skin cells. Since the skin on the palms of the hands and the soles of the feet is particularly thick, the substance of the drug immediately penetrates into the corneal layer and collects there like in a sponge. Therefore, skin damage is most severe in these areas.

Signs of sickle cell anemia

Hand foot syndrome also occurs as a symptom of what is known as sickle cell anemia (sickle cell disease). It is an inherited disease in which the red blood cells deform and clog blood vessels. The first symptoms often appear in infancy or early childhood: These include pain, redness and swelling of the hands and feet.


The symptoms usually appear with the first chemotherapy, they rarely develop until the course of treatment. The first signs are numbness, tingling or burning in the hands and feet, which increases over time. Hand foot syndrome develops within four to 17 days.

The following symptoms can occur, their severity varies from patient to patient:

  • Redness and swelling of the palms and soles of the feet
  • Numbness, tingling, burning
  • Damp scales (desquamation) and blisters on the affected skin areas
  • Pains
  • In severe cases, the skin changes spread to the backs of hands and feet.
  • Other skin regions such as knees and elbows, armpits or the underbust area are rarely affected.
  • If the HFS is very strong, it can hinder everyday activities and thus severely impair everyday life.

Classification according to degrees of severity

HFS is usually mild and goes away on its own after stopping therapy. Depending on how severe the symptoms are, there are three grades.

Grade 1: Slight redness and swelling, no pain
Grade 2: Blisters, bleeding or swelling, pain, restricted daily activities
Grade 3: Severe skin changes with blisters, bleeding, swelling, pain, everyday activities can hardly be carried out, those affected are dependent on outside help

Examination and diagnostics

The testing required depends on whether HFS is occurring as part of cancer treatment or as a sign of sickle cell disease.

When to the doctor?

Tell your doctor right away if your (or your child’s) palms and soles are red and swollen – whether you (or your child) are undergoing chemotherapy or not!

Examination in cancer patients

If HFS occurs during chemotherapy or immunotherapy, the doctor treating you (oncologist) is the first point of contact. The typical clinical picture is easy to recognize and requires no further examinations.

Testing in patients who are not receiving cancer treatment

Redness and swelling of the palms of the hands and soles of the feet in children give the doctor the first indication of sickle cell anemia. Since sickle cell anemia is a hereditary disease, the doctor will ask, among other things, whether the disease runs in the family. For further clarification, the pediatrician usually refers the patient to a specialist in internal medicine who specializes in blood diseases (haematologist).

The most important tests to diagnose sickle cell anemia are blood tests and molecular genetic tests. The diagnosis is made when the sickle-shaped red blood cells typical of the disease are found in the blood and the triggering gene change (mutation) is detected.


Not everyone who receives cancer treatment with certain drugs will develop HFS. Therefore, prevention in the narrower sense is not possible. If severe symptoms occur during therapy, it is possible for the doctor to interrupt the treatment or use one or more other active ingredients.

The same applies to hand foot syndrome, which occurs in sickle cell anemia. Since this is a genetic condition, it is not possible to prevent it.

Course of the disease and prognosis

HFS usually develops just a few days after the start of the first chemotherapy; it rarely occurs until the course of treatment. In most cases, hand foot syndrome is mild. Symptoms usually go away within a few weeks after treatment with the cancer drug has ended.

Permanent damage such as fingerprint loss from the HFS is rare but does happen –

especially if the patient is receiving the drug dapecitabine. In some cases, the lines on the fingertips have changed so much that the fingerprint is no longer the same. In these cases, it is advisable, especially when traveling abroad, to carry a medical certificate with you.

Hand foot syndrome is usually the first sign of sickle cell disease. It is short-lived and disappears after a few days.

Dr. Ashwani Kumar is highly skilled and experienced in treating major and minor general medicine diseases.