This case highlights the occurrence of hand-foot syndrome due to the use of an antimetabolite group of drugs, capecitabine, which was used in the chemotherapy of a 56-year-old male patient who was diagnosed with rectosigmoid carcinoma. The patient was diagnosed with rectosigmoid carcinoma two months ago and underwent laparoscopic lower anterior resection and colorectal anastomosis. Subsequently, the patient commenced chemotherapy treatment with a combination of oxaliplatin and capecitabine. The patient presented to us with complaints of loose stools for the past three days, and discoloration of the palms, soles, and tongue was noted and subjected to a biopsy, which revealed features compatible with chronic, nonspecific dermatitis. The occurrence of such palmar-plantar erythrodysesthesia with capecitabine is yet to be extensively studied.

BACKGROUND: Hand-Foot Syndrome (HFS), also known as palmar-plantar erythrodysesthesia, is a common reaction to Tyrosine Kinase Inhibitors ( TKIs), which can often lead to discontinuation of the drug. Lenvatinib is a recently approved drug for the treatment of endometrial carcinoma, which has been proven to provide a better overall survival rate and longer duration of progression-free survival among patients with advanced endometrial cancer. Herein, we have reported a case of carcinoma endometrium with metastasis who had to discontinue the use of lenvatinib due to the adverse drug reaction.
METHODS: A 60-year-old female patient with carcinoma endometrium with metastasis, post radical hysterectomy with bilateral salpingo-oophorectomy with omentectomy, was started on tablet lenvatinib 8 mg once daily orally for 15 days. After 12 days of treatment, the patient noticed painful lesions with reddish-black discoloration over the left forearm and dorsal aspect of the left hand and fingers, and was diagnosed with lenvatinib-induced hand-foot syndrome. Lenvatinib was discontinued and tab. prednisolone 30mg was taken orally. The reaction subsided after five days.
CONCLUSIONS: Hand-foot syndrome is one of the commonest ADRs due to the use of lenvatinib. Lenvatinib is an oral formulation that patients can take at their homes. Hence, educating patients regarding the HFS is important so that they report it to the treating physicians on time. It is also essential to educate patients regarding the precautions to be taken to avoid hand-foot syndrome. This will help the physicians with the early discontinuation and appropriate treatment with corticosteroids, which will help in improving the quality of life of the patients already suffering from cancer.

BACKGROUND: Mercaptopurine (6MP) and methotrexate (MTX) are commonly used for maintenance chemotherapy for acute lymphoblastic leukemia (ALL). These medications have been associated with various side effects such as myelosuppression, colitis, and thyroiditis in addition to numerous cutaneous adverse events. Cutaneous side-effects most reported include mucositis, alopecia, xerosis, and pruritus. We report an interesting case of hand-foot syndrome to 6MP in a child on maintenance therapy for B-cell ALL from an alteration in medication metabolism.
METHODS: We report a 10-year-old male on maintenance chemotherapy for pre-Bcell ALL who presented to the hospital with worsening oral lesions and erythematous, fissured plaques on the palms and soles. Maintenance therapy consisted of IV vincristine and 5-day pulse of steroids every 12 weeks, daily 6MP, and weekly MTX, which were increased to  ≥ 150% of standard dosing due to persistent absolute neutrophil counts  > 1500. Metabolites obtained on admission demonstrated elevated 6MMP metabolites at 35,761 (normal < 5700). TPMT and NUDT15 enzyme activity were normal and no alterations in genotyping were discovered.
RESULTS: Patient\'s oral chemotherapy, including both 6MP and MTX, were stopped and allopurinol 100 mg daily was initiated, which lead to overall improvement.
CONCLUSIONS: Clinical findings of acute mucositis and worsening of hand-foot syndrome, in the setting of inadequate myelosuppression in a child on maintenance therapy for ALL should raise concerns to consider altered metabolism pathway leading to toxic metabolite buildup. Allopurinol can play in improving cutaneous manifestation and chemotherapeutic dosing in patients with altered metabolism.

Paclitaxel is a drug frequently used in the treatment of gynecological cancers. Its cutaneous side effects are fairly well documented. A subtype of hand-foot syndrome, periarticular erythema of the thenar eminences with onycholysis, is rarer. Here, we present a case of a woman treated with paclitaxel for recurrent ovarian cancer who developed periarticular thenar eminence erythema with onycholysis syndrome. Involvement presented as an erythematous rash on the top of the left hand progressing up the arm. A lesion was also present on the right lower limb and on the dorsal surface of the right foot with onycholysis. Edema was present in the fingers, hands, forearms, and feet. A punch biopsy and pathological analysis confirmed the diagnosis of periarticular thenar eminence erythema with onycholysis syndrome. Rapid identification and treatment with topical corticosteroids limited irreversible damage.

An 11-year-old neutered male Miniature Poodle with a stage 3 apocrine gland adenocarcinoma was started on chemotherapy with toceranib phosphate after surgery. Beginning on day 10 of toceranib, the dog\'s foot pads became erythematous and hyperkeratinized. The dog complained of pain, inability to walk, depression, and loss of appetite. The symptoms resolved when toceranib was discontinued and reappeared when toceranib was resumed. Grade 3 palmar-plantar erythrodysesthesia was identified as an adverse event of toceranib based on the VCOG-CTCAE and Naranjo scale. Although very rare in veterinary medicine, clinicians should consider that palmar-plantar erythrodysesthesia can occur after toceranib administration.

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Chemotherapy drugs can be responsible of several side effects such as hand-foot syndrome (HFS). This syndrome is also called \"palmar-plantar erythrodysesthesia\" and \"acral erythema.\" Without proper management, it can deteriorate the quality of life of a patient, leading to temporary or definitive stop of chemotherapy.
To identify the epidemiological and clinical characteristics of patients, the risk factors for occurrence and worsening of this syndrome, and the drugs most likely to be responsible of HFS.
Our study was retrospective, including 42 patients with HFS secondary to a chemotherapy drug. These cases were notified to the National Center of Pharmacovigilance over 7 years. The severity of HFS has been classified according to the NCI-CTCAE v4.0 classification.
Our population was composed of 40 women and 2 men. The mean age was 51 years. Docetaxel was the main drug associated with this adverse effect. Hands were involved in all cases and were sometimes associated with other skin surfaces apart from feet. Erythema of the hands and/or feet was present in all patients; it was associated with edema in more than half of the cases. The distribution of different grades according to the NCI-CTCAE classification among the patients was almost equal: 28% Grade 1, 36% Grade 2, and 36% Grade 3. HFS occurred mainly after the first course of chemotherapy with a mean period of 3-4 days. The regression of HFS occurred more rapidly for Grade 1 and Grade 2 compared with Grade 3, especially when assisted by symptomatic treatment. The recurrence rate of HFS for those patients with decreased doses, spacing of cures, and/or symptomatic and prophylaxis treatment was 25%.
An early detection of HFS, associated with preventive measures, enables patients to continue the chemotherapy.

Capecitabine, a prodrug of 5-fluorouracil, is an FDA-approved drug for adjuvant treatment of colon, metastatic colorectal, and breast cancer. A variety of mucocutaneous adverse effects has been recognized with capecitabine. The pathogenesis of such manifestations still remains an enigma though various theories have been proposed. Here, we report two such cases. A 59-year-old female with carcinoma of the sigmoid colon on palliative therapy developed localized cutaneous hyperpigmentation of the palms and soles secondary to capecitabine in her 2nd cycle. Another case was of a 42-year-old female with stomach adenocarcinoma, who developed similar adverse effects after administration of capecitabine in her 4th cycle. Since these drugs have been widely used in recent years due to their relative ease in administration, the relative unawareness of Hand-foot syndrome (HFS) caused due to this drug makes it a prudent topic to be reported.

Hand-foot syndrome (HFS) is a frequent adverse effect of various anti-tumour drugs, such as capecitabine, that affects their dose-limiting toxicity. The mechanism of HFS remains unknown and there are currently no effective strategies to treat HFS, except for cessation. The current study presented a female case where one hand, affected by brachial plexus infiltration due to the subclavian lymph node metastasis of breast cancer, exhibited not only pain and partial motor paralysis but also anhidrosis, oedema and skin colour changes. The patient met the diagnostic criteria for complex regional pain syndrome (CRPS). After treatment with capecitabine, their anhidrosis hand completely prevented HFS. The other hand and both feet demonstrated typical symptoms of HFS, which improved consequent to capecitabine cessation. The CRPS-affected hand remained normal. Considering the limited presentation of HFS concomitant with anhidrosis, the exocrine release of condensed capecitabine through sweat glands might be a promising mechanism of HFS induction.