Anti-cancer therapy related hand-foot syndrome in patients with systemic sclerosis: Case series and literature review

•Hand-foot syndrome due to chemotherapy is common, and can be exacerbated in patients with systemic sclerosis due to overlap of pathologic changes in the skin of the hands.•Supportive measures that may be utilized for patients with both hand-foot syndrome and systemic sclerosis includes maximizing vasodilating medications, appropriate wound care, and limiting hand cooling.•Multi-disciplinary teams including oncologists, dermatologists, and rheumatologists are needed to optimally manage chemotherapy side effects in patients with underlying rheumatologic disease. Hand-foot syndrome (HFS) is a common chemotherapy side effect, typically managed with supportive care including preemptive cooling. Systemic sclerosis (SSc) is an autoimmune disease characterized by vascular dysfunction and fibrosis of multiple organs, including the hands, which can result in acro-osteolysis and sclerodactyly. Here we discuss the management of two patients with SSc and concomitant HFS: A woman in her 70′s with pancreatic cancer treated with paclitaxel and gemcitabine, and a woman in her 40′s with breast cancer treated with capecitabine. Potential strategies for managing HFS in patients with SSc include maximizing vasodilation (with calcium channel blockers or phosphodiesterase type 5 inhibitors), excellent wound care and potentially antibiotics if finger ulcerations develop, considering limiting hand cooling during taxane treatments, and possible dose reduction of chemotherapy due to HFS if finger ulcerations and pain become dose-limiting.