ABSTRACT
Secondary hyperkeratotic reactions have been frequently reported with systemic anticancer treatments. They are usually observed with tyrosine kinase inhibitors, but occurrence of hyperkeratotic lesions have been also described in association with cytotoxic chemotherapeutic agents and even with newly approved immune checkpoint inhibitors. Hand-foot skin reaction (HFSR) represents the most frequent, dose-limiting, and clinically significant dermatological adverse event for patients treated with multikinase angiogenesis inhibitors targeting both vascular endothelial growth factor receptors (VEGFRs) and platelet-derived growth factor receptors. HFSR generally starts with prodromal symptoms of tingling, burning, numbness, dysesthesia, or intolerance to contact. Disruption of the repair mechanisms of endothelial cells, especially at the pressure and friction zones consequent to VEGFR inhibition may predispose patients to develop HFSR. Appropriate education and counseling as well as preventive measures are required to reduce incidence and severity of HFSR. Avoidance of excessive pressure and repeated friction is the cornerstone of HFSR prevention.
