Prevention of palmar-plantar erythrodysesthesia with an antiperspirant in breast cancer patients treated with pegylated liposomal doxorubicin (SAKK 92/08)

Breast. 2014 Jun;23(3):244-9. doi: 10.1016/j.breast.2014.02.005. Epub 2014 Mar 20.


Background: Elevated concentrations of doxorubicin are found in eccrine sweat glands of the palms and soles. We therefore evaluated an antiperspirant as preventive treatment for palmar-plantar erythrodysesthesia (hand-foot syndrome) in patients with metastatic breast cancer treated with pegylated liposomal doxorubicin.

Patients and methods: An antiperspirant containing aluminum chlorohydrate or placebo cream was applied to the left or right hand and foot in a double-blinded manner (intra-patient randomization). The primary endpoint was the rate of grade 2 or 3 palmar-plantar erythrodysesthesia. A secondary endpoint was the patient-reported symptom burden (tingling, numbness, pain, or skin problems). Using McNemar's matched pairs design, 53 patients were needed to detect a 20% difference between the treatment and placebo sides with a significance level of 5% and power of 90%.

Results: Grade 2 or 3 PPE occurred in 30 (58%) of 52 evaluable patients; in six patients adverse effects occurred on the placebo side but not on the treatment side, whereas one patient developed palmar-plantar erythrodysesthesia on the treatment side only (P = 0.07). Four patients developed grade 2 or 3 palmar-plantar erythrodysesthesia on their foot on the placebo side but not on the treatment side (P = 0.05). In the cohort with grade 2 or 3 palmar-plantar erythrodysesthesia there was a trend towards fewer dermatologic symptomatologies with the active treatment (P = 0.05), and no difference for other adverse events.

Conclusion: Using topical aluminum chlorohydrate as an antiperspirant appears to reduce the incidence of grade 2 or 3 palmar-plantar erythrodysesthesia following pegylated liposomal doxorubicin chemotherapy for metastatic breast cancer.

Keywords: Antiperspirant; Breast cancer; Hand–foot syndrome; Palmar–plantar erythrodysesthesia; Pegylated liposomal doxorubicin; Prevention.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Aged
  • Aluminum Hydroxide* / pharmacology
  • Aluminum Hydroxide* / therapeutic use
  • Antiperspirants / pharmacology
  • Antiperspirants / therapeutic use
  • Breast Neoplasms* / drug therapy
  • Breast Neoplasms* / pathology
  • Chlorides* / pharmacology
  • Chlorides* / therapeutic use
  • Double-Blind Method
  • Doxorubicin / administration & dosage
  • Doxorubicin / adverse effects
  • Doxorubicin / analogs & derivatives*
  • Drug Monitoring / methods
  • Female
  • Hand-Foot Syndrome / prevention & control*
  • Humans
  • Middle Aged
  • Neoplasm Staging
  • Polyethylene Glycols / administration & dosage
  • Polyethylene Glycols / adverse effects
  • Severity of Illness Index
  • Skin Cream
  • Treatment Outcome


  • Antiperspirants
  • Chlorides
  • liposomal doxorubicin
  • Polyethylene Glycols
  • aluminum sesquichlorohydrate
  • Aluminum Hydroxide
  • Doxorubicin