Palmar-plantar erythrodysesthesia (PPE): a literature review with commentary on experience in a cancer centre

Eur J Oncol Nurs. 2007 Jul;11(3):238-46. doi: 10.1016/j.ejon.2006.10.004. Epub 2007 Mar 9.


Palmar-plantar erythrodysesthesia (PPE) or hand-foot syndrome (HFS) is a relatively common side effect of cytotoxic chemotherapy. Many cytotoxic drugs have been reported to cause the condition but it is more frequently associated with 5 fluorouracil (5FU), liposomal doxorubicin and cytarabine. The oral 5FU precursor, capecitabine is frequently associated with PPE and with the recent extension of its use to adjuvant treatment, the incidence of PPE is likely to increase. The initial symptoms are dysesthesia and tingling in the palms, fingers and soles of feet and erythema, which may progress to burning pain with dryness, cracking, desquamation, ulceration and oedema. Palms of the hands are more frequently affected than soles of the feet. This condition is painful and distressing to patients and in some incidences it results in patients not being able to work or perform normal daily activities. It can also result in treatment interruptions which impact on the efficacy of the treatment regimen. Effective and appropriate patient education from a specialist nurse prior to treatment is an essential part of patient management which will facilitate early identification of the symptoms and therefore prevent treatment delays and PPE progression. This article reviews current knowledge of the condition, including classification, and discussion of the findings of a clinical audit in a cancer centre. It includes the incidence, grading, management and impact of PPE on normal daily activities.

Publication types

  • Review

MeSH terms

  • Activities of Daily Living
  • Antineoplastic Agents / adverse effects*
  • Cancer Care Facilities
  • Cryotherapy
  • Cytarabine / adverse effects
  • Doxorubicin / adverse effects
  • Drug Monitoring / nursing
  • England / epidemiology
  • Erythema / chemically induced*
  • Erythema / epidemiology
  • Erythema / therapy
  • Fluorouracil / adverse effects
  • Foot Dermatoses / chemically induced*
  • Foot Dermatoses / epidemiology
  • Foot Dermatoses / therapy
  • Hand Dermatoses / chemically induced*
  • Hand Dermatoses / epidemiology
  • Hand Dermatoses / therapy
  • Humans
  • Incidence
  • Nurse's Role
  • Nursing Assessment
  • Nursing Audit
  • Nursing Evaluation Research
  • Oncology Nursing
  • Paresthesia / chemically induced*
  • Paresthesia / epidemiology
  • Paresthesia / therapy
  • Patient Education as Topic
  • Risk Factors
  • Severity of Illness Index
  • Skin Care / methods
  • Skin Care / nursing
  • Syndrome


  • Antineoplastic Agents
  • Cytarabine
  • Doxorubicin
  • Fluorouracil