Grading the Severity of the Hand-Foot (HF) Syndrome Following Administration of Polyethylene Glycol-coated Liposomal Doxorubicin

Description

The Hand Foot Syndrome (HF Syndrome, toxic acral erythema, palmar-plantar erythrodysthesia syndrome) is the most common toxic skin reaction to administration of polyethylene glycol-coated doxorubicin. This may range from a minor reaction to a serious and disabling condition.

The Hand Foot Syndrome may present as erythema of the palms, fingers and soles of the feet that later may become edematous and violaceous. The lesions may either dry out and desquamate, or blister with ulceration.

Additional patterns of skin reactions seen with liposomal doxorubicin:

(1) diffuse, follicular rash

(2) intertrigo-like eruption

(3) melanotic macules

Appearance	Functional Impairment	Grade
none	none	0
asymptomatic and mild erythema, swelling or desquamation	does not interfere with normal physical activity	I
painful erythema, swelling or desquamation	does not interfere with normal physical activity	II
local blistering, ulceration, or swelling	interferes with regular physical activities	III
diffuse blistering or ulceration; local blistering and ulceration causing infection	marked interference with physical activities or bedridden	IV

modified from Toxic Effects Scale, page 1476

where:

• Regular physical activities includes the ability to wear clothing.

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Description

Specialty

ICD-10