erythrodysesthesia

Erythrodysesthesia, commonly referred to as palmar-plantar erythrodysesthesia or hand-foot syndrome, is a cutaneous syndrome characterized by redness, swelling, and discomfort of the palms and soles, sometimes extending to the backs of the hands and feet. Patients may experience burning, tingling, numbness, and pain, with or without blistering or peeling of the skin. The condition is usually symmetrical and can limit daily activities.

The most frequent cause is exposure to certain chemotherapy agents and targeted therapies. Capecitabine, 5-fluorouracil, and liposomal doxorubicin are classic associations, but other drugs, including some tyrosine kinase inhibitors, can also trigger erythrodysesthesia. The underlying mechanism is not completely understood, but it is thought that drug excretion in sweat glands leads to acral skin toxicity, amplified by mechanical stress, friction, and pressure. Microvascular injury and inflammation may contribute to symptom development.

Clinical presentation typically progresses from mild redness and tenderness to more pronounced pain, swelling, and dysesthesia. In severe cases, the skin may crack, blister, or peel, and functional impairment of the hands or feet can occur. Diagnosis is clinical and often graded using established toxicity criteria (for example, CTCAE), which guide management.

Management centers on reducing or discontinuing the offending agent when possible, alongside supportive care. This includes topical moisturizers and barrier creams, gentle cleansing, avoidance of heat and friction, cooling measures, pain control, and, when needed, dose modification or treatment breaks. Prevention focuses on patient education, early detection, and proactive dose scheduling. Prognosis generally improves with that approach, though symptoms may recur with re-exposure to the changing agent.