Hand-foot syndrome, with fluorouracil

Fluorouracil Inhibition of the enzyme thymidylate synthase, the rate-limiting step in thymidine formation. Dose-limiting Myelosuppression and mucositis with bolus administration Diarrhea and hand-foot syndrome with continuous infusion Additional toxicities Skin discoloration, nail changes, photosensitivity, and neurologic toxicity... 

Capecitabine is used for the treatment of colorectal and breast cancers. It is contraindicated in patients with known hypersensitivity to capecitabine or any of its components or to 5-fluorouracil and in patients with known dihydropyrimidine dehydrogenase (DPD) deficiency. The use of capecitabine is restricted in patients with severe renal impairment. The drag can induce diarrhea, sometimes severe. Other side effects include anemia, hand-foot syndrome, hyperbilirubinemia, nausea, stomatitis, pyrexia, edema, constipation, dyspnea, neutropenia, back pain, and headache. Cardiotoxicity has been observed with capecitabine. A clinically important drag interaction between capecitabine and warfarin has been demonstrated. Care should be exercised when the drag is co-administered with CYP2X9 substrates. 

Fluorouracil, alone or in combination regimens, via continuous or intermittent infusions or bolus doses, has been associated with hand-foot syndrome or pahnar-plantar erythrodysesthesia, a rare syndrome of unknown cause, characterized by varjdng degrees of painful, erythematous, swollen palms of the hand and soles of the feet... 

Skin Cutaneous reactions to fluorouracil include photosensitivity, erythema, maculo-pamlar rashes, and hyperpigmentation [8 ]. Alopecia is uncommon. Hand-foot syndrome affects about 50% of patients but it is usually mild. It occurs after a median of nine cycles of treatment and necessitates dosage reduction or delay in 15% of patients [90 ]. It is less frequent with bolus doses than infusions [83 ]. 

Skin Hand-foot syndrome is significantly more common with capecitabine than fluorouracil-I-leucovorin, perhaps because of more prolonged drug exposure [104 ]. It is characterized by painless or painful swelling, erythema, and desquamation of the palms and soles. It affects 54% of patients (any grade) and is severe in 17% [102 ]. Dosage modification may be required. 

---