<unk>  <unk> , also known as hand-foot syndrome, is a dermatological side effect of a number of chemotherapeutic drugs. In 1974, Zuehlke was the first to describe<unk>  <unk>  in a patient receiving mitotane for hypernephroma. A number of different classifications have been used for grading the severity of<unk>  <unk> . The classifications suggested by the National Cancer Institute (NCI), and the World Health Organization (WHO) are the two most commonly used. The exact pathogenesis of<unk>  <unk>  is not completely understood. It is thought that<unk>  is caused by direct toxic effect of the chemotherapeutic drugs against keratinocytes, excretion of the drugs in eccrine sweat glands, or type I allergic reaction. The pathological features of<unk>  are non-specific. However, since<unk>  involves a cytotoxic reaction primarily affecting keratinocytes, the histopathologic findings are similar to histologic manifestation of direct toxic reactions. Several different chemotherapeutic agents have been associated with<unk>  <unk> . Most frequently associated drugs include cytarabine, docetaxel, doxorubicin, liposomal-encapsulated doxorubicin, 5-fluorouracil, and capecitabine.<unk>  <unk>  must be differentiated from other skin disorders that involve palms and/or soles, such as Graft-versus-host disease, contact dermatitis, palmoplantar plaque psoriasis, dyshidrotic eczema, and palmoplantar pustulosis.<unk>  <unk>  has been reported to occur in 6 - 64% of patients treated with different chemotherapy regimens. However, the exact incidence of<unk>  is unknown, as most reports are isolated case reports or short case series. The most common and established risk factors are chemotherapeutic agents. The severity of the condition depends on the dose and frequency of the agent. There is insufficient evidence to recommend routine screening for<unk> . Prognosis is generally good and symptoms usually resolve within 1 - 2 weeks after stopping the causative chemotherapeutic agent. If left untreated,<unk>  <unk>  can progress rapidly.<unk>  is not life-threatening, but it can be very debilitating and can significantly impair quality of life. There is no single diagnostic study of choice for the diagnosis of<unk>  <unk> .<unk>  is primarily diagnosed based on the history and clinical presentation. The most common symptoms of<unk>  include tingling, burning pain, edema, and erythema. Less common symptoms of<unk>  include sensory impairment, paresthesia, and pruritus. Physical examination of patients with<unk>  depends on the grade of the disease. Determination of toxicity grading of<unk>  requires both visual assessment and patient description of symptoms. Skin findings include erythema, edema, hyperkeratosis, peeling, blisters, bleeding, and fissures. There are no diagnostic laboratory findings associated with<unk> . There are no ECG findings associated with<unk> . There are no x-ray findings associated with<unk> . There are no echocardiography/ultrasound findings associated with<unk> . There are no CT scan findings associated with<unk> . There are no MRI findings associated with<unk> . There are no other imaging findings associated with<unk> . There are no other diagnostic studies associated with<unk> . Dose reduction, lengthening the interval between dose administration, and ultimately drug withdrawal are the most effective strategies. Specific treatment strategies include cooling the extremities during drug administration, vitamin B6, topical and oral corticosteroids, and topical 99% dimethyl sulfoxide. Surgical intervention is not recommended for the management of<unk> . Avoiding excessive manual work and walking, wound care to prevent infection, limb elevation, cold compresses, avoiding extreme temperatures, analgesics, and creams/emollients are suggested to prevent, delay onset, and/or decrease the severity of<unk>  <unk> . There are no established measures for the secondary prevention of<unk> .
Palmar plantar erythrodysesthesia
Palmar Plantar Erythrodysesthesia​
Paraesthesia
Amychophobia
Toe pain and swelling
Pedal edema
Pustulosis palmaris et plantaris
Generalized weakness