hand - foot syndrome ( hfs ) , acral erythema , or palmo plantar dysesthesia is a dermatological toxicity caused by many anticancer drugs . the most common drugs implicated for this toxicity are capecitabine , liposomal doxorubicin , geftinib , and sunitinib . a 45-year - old female with breast cancer received adjuvant chemotherapy with three cycles of fec100 regimen ( 5-flurouracil , epirubicin , and cyclophosphamide ) followed by docetaxel 75 mg / m four cycles . the premedications used prior to docetaxel infusion were ranitidine 50 mg , dexamethasone 16 mg , and ondansetron 8 mg . she developed painful erythema of both the hands when she came for follow - up after 10 days for the interim count . this was followed by desquamation of skin over the dorsum of hand and palms [ figures 1 and 2 ] . the patient was diagnosed as a case of grade ii hfs and was treated conservatively with emollients , and analgesics . the further cycles of docetaxel were continued at usual interval without further worsening of lesions and symptomatic treatment of hfs . palmar surface showing typical desquamated epithelium with redness characteristic of docetaxel - induced hfs dorsum of hand with desquamation , black discoloration as seen in established hfs there are many case reports of docetaxel - induced hfs . in most of the case reports , the hfs is more common at higher doses of docetaxel such as 100 mg / m or a dose - dense regimen . series of five patients , all the patients developed hfs at doses of 100 mg / m or if the docetaxel was given in a dose - dense manner . the peculiarity of our case is the development of hfs at a dose of 75 mg / m , and she successfully completed all the cycles of chemotherapy . in a retrospective chart analysis of 2186 patients who received chemotherapy , 44 cases of acral erythema were identified . the most commonly implicated drugs were infusional 5-fluroruracil ( 5-fu ) ( 22.7% of all cases of acral erthema ) , bolus 5-fu ( 13.6% ) , docetaxel ( 13.6% ) , liposomal doxorubicin ( 11.3% ) , and vinorelbine ( 9% ) . capecitabine has now become more common in view of more wider uses as compared to infusional 5-fu . the exact pathogenetic mechanism is not known for hfs , but the most commonly accepted effect is a direct toxic effect on epidermal cells . in a retrospective observation analysis from japan , the use of h2 blockers has been implicated as a cause of severe dermatological toxicity of hfs . the inhibition of this enzyme decreases the metabolism of docetaxel and therefore increases the toxicity such as myelosuppression and skin toxicity . the limitation of this study is retrospective nature , no pharmacokinetic data and doses used for h2 blockers were based on institutional policy and were not standardized . the management revolves around reduction in the dose , drug withdrawal , changing the administration intervals . recently , one randomized controlled trial has disproved this and no proven therapy is currently available for the management of hfs . in conclusion , docetaxel - induced hfs is a common toxicity and all physicians must be aware of this side effect . the important point of discussion is that it can occur at any dose of docetaxel , any schedule ( dose dense or three weekly ) , not associated with concurrent administration of filgrastim . correlation of hfs with docetaxel with premedications such as h2 blockers requires more prospective studies .
docetaxel is an important chemotherapeutic agent used in the management of many solid tumors . 
 the most important side effect of this drug is myelosupression . 
 we report a case of carcinoma breast that developed severe hand - foot syndrome at 75 mg / m2 doses of docetaxel . 
 the exact mechanism of this side effect in not known . 
 all the physicians using this drug must be aware of this side effect .