Hand-foot syndrome (HFS)

, also known as palmar-plantar erythrodysesthesia, is a dose-dependent cutaneous toxicity associated with numerous cytotoxic antineoplastic agents and some targeted therapies. Its incidence ranges from 6% to 64%, with capecitabine and pegylated liposomal doxorubicin being the most frequently implicated drugs. The pathogenesis combines direct cytotoxicity on keratinocytes and eccrine glands of the palms and soles, areas rich in microvasculature and subject to mechanical pressure. Clinically, it begins with dysesthesias that progress to well-defined erythema, edema, and scaling; CTCAE criteria help grade severity and determine dose adjustments. Management integrates prophylaxis (emollients, regional cooling) and symptomatic treatment with high-potency topical corticosteroids, analgesics, and keratolytics. Severe cases may require reduction or deferral of chemotherapy to preserve quality of life and therapeutic continuity.

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