Sorafenib-asssociated hand-foot syndrome treated with topical calcipotriol

INTRODUCTION Sorafenib is a multitargeted potent antiangiogenic tyrosine kinase inhibitor. Sorafenib has antiproliferative and antineoplastic effects in addition to antiangiogenic effects. According to research, the use of sorafenib is effective in the treatment of advanced hepatocellular carcinoma. However, sorafenib has several side effects including hand-foot skin reaction, alopecia, and Stevens-Johnson syndrome. Dermatologic side effects are the most common side effects of sorafenib, accounting for more than 10%. The most common ones are maculopapular exanthema, hand-foot syndrome, facial erythema, xerosis, and alopecia. These side effects are usually mild to moderate in severity and may reduce with appropriate therapy, dose reduction, or discontinuation of sorafenib treatment. The sorafenib-associated hand-foot syndrome is characterized by symmetric painful erythematous plaques in the palmoplantar areas, which include the dorsum of hands and feet and periungal areas. Vesicles and peeling may occur in severe cases. These patients may complain of a tingling sensation, intolerance of contact with hot objects, difficulty walking, and difficulty holding objects. Histopathologic examination finds epidermal hyperplasia, nonspecific inflammatory cell infiltration, and dilate dermal veins in the dermis. The following treatment is recommended in patients with sorafenib-associated hand foot syndrome: moisturizers, topical or systemic steroids, tazarotene 0.1% cream, nicotine patch, vitamin E, pyridoxine, and cyclooxygenase inhibitor 2 for severe reactions.