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Hand-Foot Syndrome from Chemo: Causes, Prevention, and Care

When your hands and feet feel sore, it can touch everything: buttoning a shirt, walking the dog, or holding someone's hand. Hand-foot syndrome is common with certain cancer drugs, and it's very manageable when you catch it early. Here's what it is, which drugs cause it, and the simple steps that help you stay comfortable.

ℹ️ General information to help you and your loved ones talk with your care team, not medical advice. Read our disclaimer.

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What it is

Palmar-plantar erythrodysesthesia (hand-foot syndrome) happens when small amounts of some drugs leak out of tiny blood vessels in the palms and soles, where daily pressure and rubbing are highest. It usually starts with tingling, numbness, or burning, then redness and swelling. It can lead to dry, peeling, or cracked skin and, in more severe cases, blisters and pain that make it hard to walk or use your hands.

Which drugs can cause it?

Xeloda (capecitabine) (an oral chemo pill), one of the most common causes
5-FU (fluorouracil), especially as a long, continuous infusion
Adriamycin (doxorubicin), especially the liposomal form, Doxil (doxorubicin liposomal)
Taxotere (docetaxel) and cytarabine, less often

Hand-foot skin reaction from targeted pills

Some targeted drugs called multikinase inhibitors, for example, Stivarga (regorafenib), Nexavar (sorafenib), Sutent (sunitinib), and Cabometyx (cabozantinib), cause a related problem called hand-foot skin reaction (thick, painful calluses). It often appears in the first weeks and tends to form thick, tender patches on pressure points like the heels. The care steps below help both.

How severity is graded

Doctors use a standard scale from the National Cancer Institute (the CTCAE) to decide what to do next:

Grade 1 (mild): skin changes like redness, swelling, or mild peeling, without pain.
Grade 2 (moderate): changes with pain, such as peeling, blisters, or swelling, that make everyday tasks like cooking or shopping harder.
Grade 3 (severe): severe changes with pain, such as blisters, bleeding, or deep cracks, that make it hard to take care of yourself, for example, bathing, dressing, or walking.

Grade 2 or higher often means your team will pause or lower the dose until your skin heals. Telling them at grade 1 gives you the most options.

🏠 Prevention and skin care at home

Keep heat and friction low

Use lukewarm, not hot, water for showers and dishes, and pat skin dry.
Skip hot tubs, saunas, and long hot baths.
Avoid hard rubbing, such as gardening without gloves, using tools, typing for long stretches, or long walks and jogging.
Wear soft, roomy shoes with cushioned insoles and loose cotton socks. Go barefoot less.

Pamper your skin

Moisturize hands and feet several times a day with a thick, fragrance-free cream, and put on cotton gloves or socks at night.
Ask your team about urea or ammonium lactate creams, which can soften thick skin.
Cool your hands and feet with a cool, damp cloth or cool water for a few minutes (not ice directly on skin).
Avoid tight rings, tight shoes, and adhesive bandages on sore spots.

🩺 Treatments your care team may offer

Pausing or lowering the drug dose until your skin heals
Prescription creams, such as steroid creams, or numbing creams for pain
Pain relief that's safe for you
A podiatrist or dermatologist for thick calluses or blisters

Your team will decide what fits you. We never list doses; follow your own care plan.

Call your care team now if you have:

Blisters, open sores, bleeding, or deep cracks on your hands or feet
Pain that makes it hard to walk, hold things, or take care of yourself
Signs of infection, such as spreading redness, warmth, pus, or a fever of 100.4°F (38°C) or higher
Any new skin change, even mild, if you're on capecitabine or another drug listed above

If you're not sure, call. Early changes are easier to treat.

💜 How loved ones can help

Help with jobs that are hard on hands and feet, such as dishes, yard work, and carrying groceries.
Help rub in moisturizer, especially on the feet.
Pick up soft socks, cotton gloves, and cushioned slippers.
Help them check their hands and feet daily and take a photo to show the team.

Questions people often ask

Is hand-foot syndrome the same as a rash?

No. It mostly affects the palms and soles, where there is pressure and friction, and it often starts with tingling and redness before turning painful or peeling. A general rash can show up anywhere. Our skin rash guide covers other skin changes.

Does hand-foot syndrome go away?

For most people, it gets better within a few weeks once the drug dose is lowered, paused, or finished. Your team may adjust treatment so you can keep going comfortably.

Can I prevent it?

You can lower the chance and how bad it gets by avoiding heat and friction on your hands and feet, moisturizing often, and wearing soft, roomy shoes. Some teams suggest urea-based creams. Ask yours what they recommend.

Will changing my dose make treatment work less well?

Dose changes for side effects are common and planned for. Your team adjusts treatment to balance comfort and benefit, so tell them early rather than pushing through.

Why do my fingerprints look faded?

With some drugs, such as Xeloda (capecitabine), the skin on fingertips can thin or peel and fingerprints may fade for a while. This usually improves after treatment.

Written by the Cancer Side Effects Guide team from FDA labels and leading cancer centers. Not medical advice. · Last updated: October 15, 2026 · How we write

Not medical advice. This page is general information to help you talk with your care team. It can't replace advice from your doctor or nurse. If you have a fever of 100.4°F (38°C) or higher during treatment, or any symptom that worries you, call your care team now. In an emergency, call 911.

Sources

Last updated: October 15, 2026. We summarize these sources in our own words.