Saif, M.W., & Elfiky, A.A. (2007). Identifying and treating fluoropyrimidine-associated hand-and-foot syndrome in white and non-white patients. Journal of Supportive Oncology, 5, 337–343.

Guidelines & Recommendations

  • The author created an algorithm for the management of palmar-plantar erythrodysesthesia (PPE), which includes the following patient education prior to initiation of treatment with fluorouracil and capecitabine.
    • Skin care
      • Reduce friction and pressure, including kneeling for long periods of time; leaning on elbows; power walking, jogging, or regular walking for long periods of time; using hand tools; and gardening.
      • Wear sunscreen.
      • Avoid exposure to heat.
      • Use mild soap to bathe; pat (do not rub) skin to dry.
      • Keep shower and bath water lukewarm to cool; avoid hot tubs and long exposure to hot water.
      • Keep skin moist; gently apply moisturizing creams or topical emollients. Apply at night and wear loose-fitting cotton gloves.
      • Put hands and feet in cool water to relieve symptoms.
    • Clothes
      • Wear comfortable, loose-fitting clothes, shoes, and gloves.
      • Wear slippers when possible.
      • Avoid wearing rubber gloves (dishwashing gloves) because they retain heat.
    • Symptoms
      • Call when signs or symptoms first appear.
      • Do not wait and see whether symptoms worsen.
  • The algorithm provided guidelines for dose reduction and dose interruption for treatment with fluorouracil and capecitabine.
  • The author also recommended starting vitamin B6 (pyridoxine) at 50 mg TID.

Nursing Implications

Multiple interventions can be implemented to prevent or minimize PPE, including teaching patients to avoid friction and exposing their skin to heat.