Capecitabine induced hand-foot syndrome

Abstract

Introduction Hand-foot syndrome (HFS), also known as palmoplantar erythrodysesthesia or acral erythema, is a well-known adverse reaction to systemic chemotherapy. Clinical presentation includes palmoplantar pain, dysesthesia, or numbness, and is frequently followed by demarcated erythema, edema, fissuring, or scaling. High-grade events may include blistering and ulceration. The most common culprit medications include liposomal doxorubicin, docetaxel, 5-fluorouracil, and its prodrug capecitabine. Case report An 81-year-old male presented to the dermatology department due to severe pain and lesions in soles of both feet. From documentation it was discovered that the patient was diagnosed with stage III sigmoid colon adenocarcinoma and had received a 7th course of capecitabine chemotherapy two days prior. Upon clinical examination, sharply demarcated erythema and complete plantar desquamation was seen. A grade 4 capecitabine-induced hand-foot syndrome was diagnosed. The patient was started on a 30mg prednisone taper and wound treatment with topical chlorhexidine irrigation and paraffin gauze dressing applications every two days. Upon improvement, the patient was discharged and outpatient treatment with hydrocolloid dressings was recommended. The case was discussed in a multidisciplinary tumor board and further adjuvant treatment was discontinued. There were no HFS exacerbations after withdrawal of capecitabine, with a continuous reduction in HFS severity and improvement in the patient’s Activities of Daily Living (ADL). Conclusion HFS is a common side effect of capecitabine and can rarely present as a high-grade adverse event, requiring prompt treatment and modification of systemic chemotherapy regimens. Anticipation and early diagnostics can ensure a reduction in morbidity and an improvement in patients’ quality of life.