# Chemotherapy-related hand–foot syndrome and hand–foot skin reaction: a review of management and possible approaches for Asian patients by the Japanese pharmacist-led oncodermatology study team

## TL;DR

This review addresses hand-foot syndrome in Asian cancer patients, offering tailored prevention and treatment strategies based on their unique skin characteristics.

## Contribution

Provides evidence-based recommendations for managing hand-foot syndrome in Asian patients, considering their distinct skin type.

## Key findings

- Topical diclofenac is suggested as a novel prevention strategy for capecitabine-induced hand-foot syndrome.
- High-potency topical steroids and antiseptic solutions are not recommended for Asian patients.
- Asian skin differences necessitate tailored treatment approaches compared to European and American guidelines.

## Abstract

Hand–foot syndrome (HFS) and hand–foot skin reaction (HFSR) are adverse effects induced by cytotoxic chemotherapeutic agents, such as capecitabine, pegylated liposomal doxorubicin, and multi-kinase inhibitors. HFS/HFSR can significantly reduce patients’ quality of life and impact cancer treatment intensity due to severe pain in the hands and feet. Although several recommendations and guidelines have been published, most focus on European and American populations, with no management guidelines specifically addressing Asian patients. Given that Asian skin types differ from those of Europeans and Americans, treatment recommendations tailored to Asian populations are needed.

A narrative review of published articles retrieved following a systematic search of PubMed, the Cochrane Library, Medical Online, and Ichushi-Web between January 2000 and March 2025 was conducted. The search strategy targeted clinical trials using keywords related to HFS, palmar–plantar erythrodysesthesia, HFSR, prevention, therapy, and relevant anticancer agents. The review adhered to the PRISMA 2020 guidelines; However, formal quality assessment tools such as GRADE or the Cochrane risk-of-bias tool were not applied.

In total, 53 articles were included in this review, which found different recommendations from European countries due to the differences in skin type. Among the recommended treatments was topical diclofenac, suggested as a potential and novel prevention strategy for capecitabine-induced HFS. However, high potent topical steroids, such as lidocaine patches, or antiseptic solutions, were not recommended.

This review provides evidence-based recommendations for the prevention and treatment of HFS/HFSR in Asian patients, taking into account their unique skin characteristics.