Hand-foot syndrome, also called palmar-plantar erythrodysesthesia, is a side effect of certain types of chemotherapy medicines, as well as other medicines used to treat cancer.
It’s not clear how hand-foot syndrome develops. One theory suggests that hand-foot syndrome happens when a small amount of medicine leaks out of the capillaries (small blood vessels) in the palms of the hands and the soles of the feet and forms free radicals, which are molecules that damage cells. These free radicals then damage the surrounding tissue.
Another theory suggests that the medicine collects in the sweat glands in the palms of the hands and soles of the feet. When a person sweats in these areas, the medicine enters the top layer of the skin and forms free radicals, which then damage the surrounding tissue.
In either case, hand-food syndrome can be painful and can affect day-to-day life. Symptoms include:
- tingling, burning, or itching
- cracked, flaking, or peeling skin
- blisters or sores
Right now, there is no medicine that prevents hand-foot syndrome. Doctors recommend that people being treated with chemotherapy avoid exposing their hands and feet to heat and avoid putting pressure on their hands and feet for up to a week after receiving chemotherapy to help avoid the syndrome.
A study has found that a 10% urea cream helps prevent hand-foot syndrome better than a new antioxidant ointment called Mapisal in people who’ve been treated with the chemotherapy medicine Xeloda (chemical name: capecitabine).
The research was published online on June 29, 2015 by the Journal of Clinical Oncology. Read the abstract of “Mapisal Versus Urea Cream as Prophylaxis for Capecitabine-Associated Hand-Foot Syndrome: A Randomized Phase III Trial of the AIO Quality of Life Working Group.”
Xeloda commonly is used to treat advanced-stage breast and other cancers, usually in combination with other medicines. Xeloda is a pill taken by mouth and is known to cause hand-foot syndrome.
Antioxidants are compounds found in fruits, vegetables, nuts, grains, and some meats, poultry and fish. Common antioxidants are vitamin C, vitamin E, and beta carotene. Antioxidants help protect cells from free radicals.
Mapisal is a medical ointment developed by the German pharmaceutical company Medac. Mapisal contains a number of antioxidants and oil extracts. Because hand-foot syndrome seems to be caused by free radicals, it makes sense that an antioxidant ointment might help prevent the syndrome.
Earlier research suggested that urea cream could help prevent hand-foot syndrome. Urea helps break down dead and scaly skin and promotes skin healing. Urea cream is commonly used to treat eczema, corns, and calluses. Urea creams can range from 10% to 40% for skin use and up to 50% urea for use on damaged or ingrown nails.
So the researchers wanted to know which would work better to prevent hand-foot syndrome: Mapisal or 10% urea cream.
In the study, 152 people who had been diagnosed with either breast or gastrointestinal cancer that was going to be treated with Xeloda were split into two groups:
- 76 people were told to use Mapisal 3 times per day, as well as after they washed their hands, for 6 weeks
- 76 people were told to use 10% urea cream 3 times daily, as well as after they washed their hands, for 6 weeks
The characteristics of the people in each group were evenly matched. About 40% of the people in the Mapisal group and about 45% of people in the urea cream group had been diagnosed with breast cancer. Overall, 96 of the 152 people in the study were women.
The people in the study kept a diary of any hand-foot syndrome symptoms, as well as a rating of their quality of life.
Overall, 47 people in the study developed hand-foot syndrome:
- 39.7% (30 people) of the people using Mapisal developed the syndrome
- 22.4% (17 people) of the people using urea cream developed the syndrome
People using the urea cream also had a longer time before hand-foot syndrome developed than the people using Mapisal.
The results of this study strongly suggest that 10% urea cream is better than Mapisal at preventing hand-foot syndrome during the first 6 weeks of Xeloda treatment.
This is good news because 10% urea cream doesn’t require a prescription and can be purchased over-the-counter. Right now, Mapisal appears to be available only in Germany.
If you’ve been diagnosed with breast cancer and will be starting Xeloda treatment, you might want to talk to your doctor about this study. Ask about your risk of developing hand-foot syndrome and whether using 10% urea cream 3 times per day to prevent the syndrome makes sense for your unique situation.
If you’re being treated with chemotherapy and have already developed hand-foot syndrome, there are steps you can take to help ease the pain and other symptoms, including:
- elevating your hands and feet when you’re sitting or lying down
- wear slippers or loose, well-ventilated shoes
- pat your skin dry after bathing rather than rubbing with a towel
For more information, visit the Breastcancer.org Hand-Foot Syndrome page.