Hand-foot syndrome, also known as acral erythema, is a distinctive and relatively common toxic reaction due to some anticancer drugs. It is characterized by a painful erythema on the palms and soles during chemotherapy, which is often preceeded by paresthesia. We report two cases of hand-foot syndrome induced by capecitabine, which is a relatively brand-new oral anticancer agent. Hand-foot syndrome is one of the most common complications of capecitabine, and is on the increase. Therefore, dermatologists should be aware of it.
Drug Therapy ; Erythema ; Hand-Foot Syndrome* ; Paresthesia ; Capecitabine

Chemotherapy-induced acral erythema ia a rare cutaneous reaction to high dose chemotherapy, clinically presenting with painful erythema on the palms and soles. Docetaxel-induced acral erythema is unique in that it usually occurrs on atypical sites, the dorsum of hands and peri-maleolar area. Recently, we experienced three patients with internal malignancy such as lung or ovary cancer who developed painful erythematous to violaceous patches of the dorsum of both hands and feet. The erythema began to develop 2~3 days after the 3rd~5th schedule of docetaxel chemotherapy and evolved to blister and desquamated over time. They didnt intake no other suspicious drug to induce cutaneous reactions and there was no symptom of herpes infection. Histopathological examination commonly revealed epidermal dysmaturation, vacuolar degeneration of basal layer, scattered necrotic keratinocytes and lymphohistiocytic infiltration in the upper dermis. Based on the recent medical history of docetaxel intravenous injection, the characteristic clinical features and histological findings, our three cases were all diagnosed with docetaxel-induced acral erythema. The skin lesion resolved with residual brownish discoloration after 2 weeks treatment with topical steroid.
Appointments and Schedules ; Blister ; Dermis ; Drug Therapy ; Erythema* ; Foot ; Hand ; Hand-Foot Syndrome ; Humans ; Injections, Intravenous ; Keratinocytes ; Lung ; Ovarian Neoplasms ; Skin

Given the growing number of cancer patients and the resulting increase in the administration of chemotherapeutic agents, convenient and effective methods for measuring the symptoms and quality of life associated with the hand-foot syndrome (HFS) are needed. Therefore, the aim of this study was to develop and validate the Korean version of the hand-foot skin reaction and quality of life questionnaire (HF-QoL-K), comprising a 20-item symptom domain and an 18-item daily activity domain. After we developed the HF-QoL-K, 209 Korean patients with gynecologic cancer who were undergoing chemotherapeutic agents relating the HFS were asked to fill in the questionnaire. The content validity, internal consistency reliability, and test-retest reliability were evaluated. The internal validity index, Cronbach’s alpha coefficient, and intra-class correlation coefficient of the HF-QoL-K were 0.90, 0.958, and 0.825 (95% confidence interval [CI], 0.774–0.865), respectively. The scatter plot (Pearson correlation coefficient, 0.826) and the Bland-Altman plot for test-retest reliability were also acceptable. The HF-QoL-K instrument is a valid and reliable questionnaire for the measurement of the symptoms and quality of life in Korean cancer patients suffering HFS.
Drug Therapy ; Hand-Foot Syndrome ; Humans ; Quality of Life* ; Reproducibility of Results ; Skin*

Sunitinib (SU11248) is a novel orally administered small molecule that inhibits multiple receptor tyrosine kinases so that can block tumor growth and angiogenesis. It was approved on 2006, for the treatment of advanced renal cell carcinoma and gastrointestinal stromal tumor. Various cutaneous adverse reactions induced by sunitinib have been reported, including hand-foot syndrome. We report two cases of hand-foot syndrome induced by sunitinib for treatment of advanced renal cell carcinoma.
Carcinoma, Renal Cell ; Gastrointestinal Stromal Tumors ; Hand-Foot Syndrome ; Indoles ; Phosphotransferases ; Pyrroles ; Tyrosine

Down syndrome is associated with a large number of abnormal skin features including syringoma. Milia-like idiopathic calcinosis cutis is one of the rare dermatoses associated with Down syndrome. It has been reported in children with Down syndrome and clinically suggested as milia. The histological features show small nodular foci of calcium within the papillary dermis and transepidermal elimination of calcium deposits occasionally. We describe a 14-year-old female affected by Down syndrome, who had whitish papules on both the dorsal hands and feet and periorbital syringomas. Histopathological findings of the papule on the dorsal hand showed calcium deposits as amorphous, basophilic masses in the upper dermis and focal discharge of calcium by means of transepidermal elimination.
Adolescent ; Basophils ; Calcinosis* ; Calcium ; Child ; Dermis ; Down Syndrome* ; Female ; Foot ; Hand ; Humans ; Skin ; Skin Diseases ; Syringoma*

Many chemotherapeutic agents induce both local and systemic cutaneous toxicity. Among them, Fluorouracil (5-FU) induces various cutaneous reaction, including hand-foot syndrome, hypersensitivity, hyperpigmentation and nail changes. We describe a male patient with rectal cancer, who developed combined features of hand-foot syndrome and nail changes during chemotherapy with 5-FU.
Drug Therapy ; Fluorouracil* ; Hand-Foot Syndrome* ; Humans ; Hyperpigmentation ; Hypersensitivity ; Male ; Rectal Neoplasms

PURPOSE: Capecitabine (Xeloda(R)), which is a systemic prodrug of 5-fluorouracil, can be used in oral formulation for treatment of advanced colorectal cancer as a 1st line or an alternative modality to I.V. 5-fluorouracil-based chemotherapy. One of the most common side effects of this drug is hand-foot syndrome (HFS), palmar-plantar erythrodysesthesia syndrome. We planned this study to clarify the incidence and the clinical course of severe hand-foot syndrome (WHO classification, grade 3 or 4) following capecitabine monotherapy for adjuvant treatment of colorectal cancer. METHODS: From August 2006 to August 2008, 45 colorectal cancer patients were treated with capecitabine, 1,250 mg/m2, orally administered twice daily for 2 wk, followed by 1 wk of rest, given as 3-wk cycles. Seven of them discontinued the drug within 3rd cycle due to poor performance status, gastrointestinal troubles, or other causes. We retrospectively analyzed the remaining 38 patients' medical records and defined the incidence and the clinical course of HFS. RESULTS: Of the 38 patients, 17 (44.7%) suffered severe HFS after capecitabine monotherapy. Of those 17, 5 (29.4%) had severe symptoms after the 1st chemotherapy cycle, and 14 patients (82.4%) had severe symptoms within the 4th cycle. Three of the 14 female and 14 of the 24 male patients complained of severe HFS, showing a statistical male predominance (P=0.043). Eventually, we had to decrease capecitabine to 75% of the daily dose in 12 patients and to 50% in one patient, and to discontinue its use in 4 patients. CONCLUSION: Capecitabine monotherapy very frequently provokes severe HFS, especially in the early cycles of chemotherapy and in males.
Capecitabine ; Colorectal Neoplasms ; Deoxycytidine ; Female ; Fluorouracil ; Hand-Foot Syndrome ; Humans ; Incidence ; Male ; Medical Records ; Retrospective Studies

Although gastric cancer is the most common cancer and the second leading cause of cancer deaths in Korea, the prognosis for advanced gastric cancer remains poor, and there is no established standard front-line chemotherapy for advanced stage. However, many clinical trials have been developed to improve the response rate and survival in patients with advanced gastric cancer. Novel oral fluoropyrimidines, capecitabine and S-1, are substituting inconvenient 5-FU continuous infusions. These oral fluoropyrimidines combined with docetaxel (1-hour infusion) lead to improve anticancer efficacy and convenience. Capecitabine and docetaxel combination regimens showed response rates 39~60% with median survival 9.5~12 months, and major adverse reactions were hand-foot syndrome and neutropenia. Also, S-1 and docetaxel combination regimens showed response rates 46~56% with median survival 14~14.9 months, and major adverse reaction was neutropenia. The combination of docetaxel and novel oral fluoropyrimidine is highly active and well tolerated in patients with advanced gastric cancer. Large randomized clinical trials are warranted to confirm the efficacy of those regimens. Also, we are looking forward to having the results from studies of new chemotherapeutic agents and modalities.
Capecitabine ; Drug Therapy ; Drug Therapy, Combination* ; Fluorouracil ; Hand-Foot Syndrome ; Humans ; Korea ; Neutropenia ; Prognosis ; Stomach Neoplasms*

Gitelman's syndrome is an autosomal recessive disorder characterized by hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria that has recently been reported to be linked to thiazide-sensitive Na-Cl cotransporter gene mutation. We have experienced one patient whose initial complaint was paresthesia of hand and feet, who had hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria. We report the case of Gitelman's syndrome with a brief review of related literature.
Alkalosis ; Foot ; Gitelman Syndrome ; Hand ; Humans ; Hypokalemia ; Paresthesia ; Receptors, Drug ; Sodium Chloride Symporters

Chemotherapy-induced acral erythema (CIAE) is an uncommon, self-limited local skin reaction that usually occurs after high-dose chemotherapy. There is no specific treatment for this disease and it disappears within three to five weeks. In this case report, we present a 16-year-old female with acute lymphoblastic leukemia who developed severe CIAE. The lesions appeared as a well-defined erythema of the hands, feet, and back with symmetrically well-defined borders 5 days after low-dose MTX treatment. The erythema progressed to bullae formation and desquamation. It resolved spontaneously within 2 weeks. CIAE is very uncommon in children; however we should consider acral erythema as a differential diagnosis when bullous skin reaction occurs in a patient who receives chemotherapy.
Adolescent ; Child ; Diagnosis, Differential ; Drug Therapy ; Erythema ; Female ; Foot ; Hand ; Hand-Foot Syndrome ; Humans ; Methotrexate ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Skin