hand and foot syndrome
A big sister came to the outpatient clinic today, and the big sister looked a little anxious. After some communication, I finally figured out that my elder sister unfortunately suffered from breast cancer and , and the surgery, chemotherapy and radiotherapy were all relatively smooth. At present, the stage of breast cancer chemotherapy, bilateral hand peeling occurs after chemotherapy, burning pain. Although it is not life-threatening, it is also quite painful, seriously affecting the patient's daily life and quality of life, and even affecting the progress of tumor chemotherapy plans. What's going on?
1. What is hand-foot syndrome
Hand-foot syndrome (HFS or handfootskin reaction, HFSR), also known as redness and swelling of the palm and foot, is an across erythema or Burgdorf reaction caused by anti-tumor drugs. The incidence rate ranges from 6% to 64%. It was found to be related to the use of mitotane in October 1973. In 1984, Lokin and Moore of Haval Medical School first reported on hand and foot syndrome. Its incidence may be related to the type of medication used by the patient, the dosage and the number of medications given, and the method of administration, which may cause skin and nerve damage when the dose accumulates to a certain extent.
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2. Causes of hand and foot syndrome
is usually a skin adverse reaction caused by anti-tumor drugs, and its severity varies slightly depending on the type of drug. The more common drugs include capecitabine , 5-fluorouracil (5-FU), cytarabine, liposomal doxorubicin and targeted drugs, such as apatinib, sorafenib , etc. Among them, the incidence of hand and foot syndrome caused by liposome doxorubicin and capecitabine is the highest, at 40%~50% and 50%~60% respectively. Targeted drugs such as sorafenib and pazopanib will cause skin reactions in the hands and feet. The incidence of sorafenib-induced hand and feet syndrome is 10% to 62%, the incidence of bevacizumab combined with sorafenib-induced hand and feet syndrome can reach 79%, and the high-grade hand and feet syndrome can reach 57%.
Although HFS will not endanger the patient's life, the occurrence of hand and foot syndrome not only leads to an increase in the treatment cost of the patient and a longer hospital stay, but also increases the physical and mental pain of the patient, further seriously affecting the patient's quality of life index and daily activities, and ultimately affecting the patient's treatment compliance and treatment effect. The exact mechanism of the occurrence of hand and foot syndrome is not yet determined. One view believes that the occurrence of HFS is related to the inflammatory response of hand and foot blood vessels. The occurrence of this inflammatory response-dermal cytotoxicity may be related to COX-2 overexpression.
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3. What are the clinical manifestations of hand and foot syndrome
The main clinical manifestations of hand and foot syndrome are numbness of the hands and (or) feet, dullness and abnormality, such as acupuncture sensation, burning sensation, painless or painful erythema swelling, dryness, desquamation, pain, and in severe cases ulcers, blisters, epidermal loss, peeling, desalination, bleeding, severe pain, and accompanied by difficulties in walking and grabbing objects, affecting daily work and life.
symptoms mostly occur 2-21 days after the use of chemotherapy drugs, and some of them also appear after 10 months of use of the drugs. The patient initially felt that the palms and sole sensation was dull and numb, and after a few days it progressed to tingling and burning pain. His sense of pain and temperature decreased, but his muscle strength, light touch and body sense did not change. The boundaries are clearly visible locally with distinct palmatinous erythema and edema, and the lesions are often on the outside of the fat pad at the distal end of the finger, or accompanied by nail changes. The condition further develops, and local erythema develops into blisters, which will then desquamate, erode, and ulcer. Repeated cervical syndrome can lead to hypertrophy of the palm and plantar keratosis-like keratosis.
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4. How to prevent and treat.
The focus of hand and foot syndrome is to prevent the occurrence. Preventive measures mainly include physical intervention, including local cold compress, avoiding hot water for bathing, avoiding strenuous exercise, and avoiding tight clothes and shoes during drug infusion; drug interventions mainly include celecoxib, pyridoxine , urea cream, antiperspirant, etc.
The most effective way to deal with hand and foot syndrome is to interrupt, delay chemotherapy or reduce the intensity of anti-tumor drugs. The symptoms usually improve after 1-2 weeks of discontinuation of the drug. In response to the local inflammatory reactions that occur in hand and foot syndrome, locally use highly effective steroid hormones to alleviate the inflammatory reaction. In addition, local use of dimethyl sulfoxide , nicotine patch, oral vitamin E and cytoprotective agent amifostin can also be considered, but the efficacy has not been confirmed by studies.
References:
[1] Zuehlke RL. Erythematous eruption of the palms and soles associated with mitotane therapy. Dermatologica. 1974;148(2):90-92. doi:10.1159/000251603
[2] Zhu Xiaojuan, Li Jie. A brief analysis of the clinical treatment methods of traditional Chinese medicine for hand and foot syndrome [J]. Chinese Journal of Traditional Chinese Medicine, 2015, 30(11):4032-4035.
[3] Peng Xue, Yang Wenbo, Zhang Han, Li Hongmei, Zu Lian. Progress in diagnosis and treatment of hand and foot syndrome induced by anti-tumor drugs [J]. Modern Oncology Medicine, 2019, 27(08):1461-1464.
[4] Huang Yu, Wang Shaoxia. Progress in domestic and foreign research on hand and foot syndrome caused by malignant tumor chemotherapy [J]. Clinical Research of Traditional Chinese Medicine, 2018, 10(03):86-89.
[5] Li Peng, Wang Bingsheng, Li Yongmin. Progress in the diagnosis and treatment of hand and foot syndrome caused by anti-tumor drugs [J]. Journal of Practical Tumor, 2016, 31(05):473-477.DOI:10.13267/j.cnki.syzlzz.2016.05.019.
[6] Dong Yuange, Lu Zhenqi, Yang Rong. Progress in nursing of capecitabine caused by hand and foot syndrome [J]. Nursing Research, 2016, 30(03):275-278.
Author: Zhu Tao Associate Chief Physician Jiaozuo People's Hospital's
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