"Navigating through a case of Capecitabine-Induced Hand-Foot Syndrome”

Abstract

Capecitabine, an oral prodrug of 5-fluorouracil (5-FU), is widely used for treating colorectal and breast cancers. One of its dose-limiting toxicities is Hand-Foot Syndrome (HFS), a dermatological adverse effect characterized by hyperpigmentation, erythema, and sensory disturbances of the palms and soles. Here, we present a case of Grade 1 HFS in a 48-year-old male with rectosigmoid adenocarcinoma (T3 N0 M0) following a Hartmann procedure. The patient was started on capecitabine 500 mg three times daily as part of adjuvant chemotherapy. Fifteen days after therapy initiation, the patient developed bilateral black discoloration of the palms and soles accompanied by mild sensory loss but no blistering, swelling, or ulceration. Physical examination confirmed Grade 1 HFS. A skin biopsy revealed chronic nonspecific dermatitis, and routine blood investigations were within normal limits. The diagnosis of capecitabine-induced HFS was established based on the temporal relationship to therapy and exclusion of other causes. The capecitabine dose was reduced, and supportive care with emollients, topical corticosteroids (betamethasone), and multivitamins was initiated. Over four weeks, the patient's symptoms improved significantly, allowing continuation of therapy without further complications. This case highlights the importance of early recognition and intervention in managing HFS to prevent symptom progression and ensure treatment adherence, thereby optimizing oncological outcomes.