Stéphane, 40 years old, Foot and hand lesions and desquamation in oncology
Written with the participation of FDVF (Future Dermatologists and Venereologists of France) interns.
Related topics
- Oncodermatology
- 40-year-old patient
- Diagnosed with colorectal cancer treated with capecitabine
- After his 3rd course of chemotherapy, he starts to observe painful fissuring lesions on the hands and feet with clear desquamation
- He does not have pruritus
- He has no personal or family history of dermatological disease
Quiz
12 respondents
Question of 1
What is your diagnosis? (only one correct response)
Palmoplantar psoriasis
Wrong answer!
It was hand-foot syndrome.
Let’s rule out differential diagnoses:
- Psoriasis:
The diagnosis of psoriasis can in theory be ruled out given the absence of scales and psoriasiform lesions on the rest of the tegument and the lack of a personal history of psoriasis.
- Eczema:
The diagnosis of eczema can in theory be ruled out due to the absence of pruritus and the lack of a dermatological history.
- Mycosis:
Mycosis can in theory be ruled out given the immediate involvement of both hands and both feet with a sensation of pain.
Eczema
Wrong answer!
It was hand-foot syndrome.
Let’s rule out differential diagnoses:
- Psoriasis:
The diagnosis of psoriasis can in theory be ruled out given the absence of scales and psoriasiform lesions on the rest of the tegument and the lack of a personal history of psoriasis.
- Eczema:
The diagnosis of eczema can in theory be ruled out due to the absence of pruritus and the lack of a dermatological history.
- Mycosis:
Mycosis can in theory be ruled out given the immediate involvement of both hands and both feet with a sensation of pain.
Hand-foot syndrome
Hand-foot syndrome
It is indeed hand-foot syndrome.
Let’s rule out differential diagnoses:
- Psoriasis:
The diagnosis of psoriasis can in theory be ruled out given the absence of scales and psoriasiform lesions on the rest of the tegument and the lack of a personal history of psoriasis.
- Eczema:
The diagnosis of eczema can in theory be ruled out due to the absence of pruritus and the lack of a dermatological history.
- Mycosis:
Mycosis can in theory be ruled out given the immediate involvement of both hands and both feet with a sensation of pain.
Mycosis
Wrong answer!
It was hand-foot syndrome.
Let’s rule out differential diagnoses:
- Psoriasis:
The diagnosis of psoriasis can in theory be ruled out given the absence of scales and psoriasiform lesions on the rest of the tegument and the lack of a personal history of psoriasis.
- Eczema:
The diagnosis of eczema can in theory be ruled out due to the absence of pruritus and the lack of a dermatological history.
- Mycosis:
Mycosis can in theory be ruled out given the immediate involvement of both hands and both feet with a sensation of pain.
- Hand-foot syndrome should be suspected when faced with hand and/or foot lesions in patients undergoing chemotherapies known to induce this syndrome.
- Hand-foot syndrome is graded based on the severity of the damage:
- Grade 1: Mild swelling, redness and tingling but they do not interfere with everyday life.
- Grade 2: Redness, swelling, bullae, and sensations of pain and burning but the patient can still walk or hold objects.
- Grade 3: The patient suffers a lot. The skin is very dry; it thickens and peels. They can no longer carry out their daily activities.
N.B: There can also be grading based on the impact on (basic/instrumental) daily activities
- In the early stages, treatment is based on good moisturisation with an unscented nourishing and soothing dermo-cosmetic balm.
- In the more advanced stages with lesions and pain affecting quality of life, this may be combined with topical corticosteroids or even oral corticosteroid therapy.
- Cold can relieve hand-foot syndrome.
- Pedicures can remove calluses and thus limit the manifestations of hand-foot syndrome.
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