Medical Oncologist
Skin side effects
Hand-foot syndrome
A reaction in the palms and soles caused by certain drugs, starting as tingling, tenderness or redness and progressing to swelling, peeling, cracks, blisters and pain that can stop somebody walking. It is manageable and often preventable, but only when patients know about it in advance and report the first tenderness.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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The short answer
What is hand-foot syndrome during chemotherapy?
It is a reaction in the palms of the hands and the soles of the feet caused by certain chemotherapy drugs. It starts as tingling, tenderness or redness, and can progress to swelling, peeling, cracking, blisters and pain bad enough to stop somebody walking or holding a cup. It is common with capecitabine tablets, with some infusional drugs, and with a few targeted treatments.
It is manageable, and much of it is preventable, but only if patients know about it before it starts and report it early. When it is caught at the tender, red stage, your team can adjust the dose or pause a drug, and the skin usually recovers. When patients push through to blistering, the treatment often has to stop for longer.
Ask whether your drugs cause it
If they do, start protecting your hands and feet from the first day of treatment, not after the soreness appears.
Report the first tenderness or redness
Especially if you are taking tablets at home. Your team may want you to pause or change the dose, and they can only do that if they know.
Heat, friction and pressure make it worse
Hot water, tight shoes, long walks, gripping tools and scrubbing all push more drug into the skin of the palms and soles. Reduce them.
Never keep taking chemotherapy tablets through painful blistering without speaking to your team.How it progresses
What it looks and feels like at each stage
- Early: tingling and tenderness
- Palms and soles feel sensitive, tight or prickly, sometimes before anything is visible. This is the best moment to report it and start extra care.
- Redness and warmth
- The skin of the palms and soles turns pink or red, or darker on darker skin, and may feel warm or swollen. Walking and gripping become uncomfortable.
- Dryness, thickening and peeling
- Skin becomes rough, thick in pressure areas, and starts to flake or peel. Fingerprints can become faint.
- Cracks and splits
- Painful fissures at the fingertips, heels and creases. These can become infected, particularly when counts are low.
- Blisters and severe pain
- Blistering, open areas, or pain that stops walking, cooking or holding things. This needs your team the same day and usually a pause in treatment.
- Recovery
- With the dose adjusted or paused and good skin care, the skin usually heals over weeks. Darkening of the palms and soles can take longer to fade.
Not sure whether this applies to you?
Ask an oncologistPractical
Looking after hands and feet day to day
Cool, cushioned, moisturised, and spared from pressure.
Moisturise often
A thick, unperfumed moisturiser on hands and feet several times a day, especially after washing. Ask your team whether a urea-based cream is suitable for you.
Tip
- Cotton gloves or socks over cream at night
- Avoid perfumed lotions and scrubs
Keep them cool
Lukewarm rather than hot water for bathing and washing up. Cool compresses or resting hands and feet on a cool, damp cloth can ease burning. Do not apply ice directly.
Reduce friction and pressure
Loose, soft, cushioned footwear and cotton socks. Avoid long walks, standing for long periods, tight gloves, and gripping heavy tools or bags.
Avoid
- Walking barefoot on hot floors
- Hand washing clothes and scrubbing vessels
Protect cracks and blisters
Do not pop blisters or peel skin. Keep cracks clean and covered as your team advises, and watch for signs of infection, especially when counts are low.
Ask for pain relief
If it hurts to walk or hold things, tell your team. They can advise on pain relief and on whether treatment needs adjusting.
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Contact your team the same day, or go to hospital, for any of these
Blisters, open sores or peeling that leaves raw skin · pain that stops you walking, cooking or holding a cup · swelling of the hands or feet that is getting worse · redness, heat, pus or red streaks spreading from a crack or blister · a fever at or above your team's threshold, which needs the nearest emergency department immediately · diarrhoea, mouth sores or chest pain at the same time while taking chemotherapy tablets. Do not keep taking the tablets through these without advice.
Being straight with you
What this page cannot tell you
It cannot tell you whether you should pause or reduce your tablets, or by how much. That decision depends on your drug, how severe the reaction is, and the aim of your treatment, and it belongs to your oncologist. What this page can do is help you recognise it early enough for that decision to protect your skin.
It also cannot promise the reaction will not come back. It often returns with later cycles if the dose and precautions stay the same, which is why reporting each time matters.
Adjusting the dose is common and expected
Changes for hand-foot reactions are routine with certain drugs. Ask what a change means for the aim of your treatment rather than keeping quiet to avoid one.
Darker skin can make redness harder to see
On darker skin the palms and soles may look darker, shiny or tight rather than red. Go by how they feel, and report tenderness even if nothing looks obviously wrong.
Diabetes needs extra foot care
Patients with diabetes may notice injuries late and heal more slowly. Check the feet daily and mention diabetes to your team at the start.
Keep a simple record between cycles
Note the day the tenderness started, how far it progressed, and what helped. Bring the note to your next appointment. It lets your team judge whether the next dose needs adjusting before the reaction returns.
What to do next
Ask whether your drugs cause hand-foot reactions. If they do, moisturise from day one, keep hands and feet cool, wear soft cushioned footwear, and reduce pressure and friction. Report the first tenderness or redness, and never push through blistering or pain on chemotherapy tablets.
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Commonly believed
Four beliefs about sore palms and soles
"Sore feet are just from walking to the hospital."
On certain drugs, tender red palms and soles are a known reaction. Report it early, because the team may need to adjust the dose before it progresses to blisters.
"I should keep taking the tablets and put up with it."
Pushing through painful blistering usually means a longer pause later. Speak to your team; they may adjust or pause treatment to let the skin recover.
"Soaking the feet in hot water will help."
Heat tends to make it worse. Use lukewarm water and cool compresses instead, and keep hands and feet cool through the day.
"Oil massage and scrubbing will soften the skin."
Rubbing and scrubbing add friction to fragile skin. A gentle, unperfumed moisturiser applied without vigorous rubbing is kinder.
Questions we are asked
Common questions about hand-foot syndrome
Which drugs cause hand-foot syndrome?
Most commonly capecitabine tablets, some infusional drugs, and certain targeted treatments. Ask your team whether your own treatment carries this risk.
What are the first signs?
Tingling, tenderness or tightness in the palms and soles, sometimes before anything is visible, followed by redness or darkening and swelling. Report it at this stage.
Can it be prevented?
Often reduced. Moisturising from day one, keeping hands and feet cool, soft cushioned footwear, and avoiding pressure and friction all help, alongside early reporting.
Should I stop my tablets if my hands are sore?
Ring your team straight away for advice rather than deciding alone. If there are blisters or pain stopping daily tasks, they will usually advise pausing until they review you.
Will my skin go back to normal?
Usually, over weeks once the dose is adjusted or paused. Darkening of the palms and soles can take longer to fade after treatment ends.
What cream should I use?
A thick, unperfumed moisturiser, applied often. Ask your team whether a urea-based cream suits you, and avoid perfumed products and herbal pastes on broken skin.
Can I keep working?
Often, with adjustments. Jobs involving long standing, heavy gripping, hot water or friction may need changes while the skin is sore. Ask your team for a note if needed.
Is it an infection?
No, it is a drug reaction. But cracks and blisters can become infected, especially when counts are low. Spreading redness, pus or fever needs medical help the same day.
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Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
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Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- American Cancer Society — Skin Problems
- Macmillan Cancer Support — Skin changes
- National Cancer Institute — Chemotherapy and You: Support for People With Cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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