Chapter 14 – Neuropathy caused by chemotherapy for cancer treatment

Some cancer drugs, especially certain chemotherapy agents like multikinase inhibitors, can cause significant side effects on the skin and nails of the hands and feet. These drugs may lead to dryness, thickening, cracking, or blistering of the skin, and can also cause the toenails to become discolored, thickened, and brittle. As a result, toenails may become ingrown and painful, increasing the risk of infection—sometimes so severe that cancer treatment must be paused.

A well-known side effect is hand-foot syndrome, also known as palmar-plantar erythrodysesthesia (PPE). This condition can occur within a week or two of starting chemotherapy and is characterized by stinging, tingling, and redness of the palms and soles. In some cases, PPE progresses to blister formation or fluid accumulation under the nail plates, causing significant discomfort. Over time, the affected toenails may develop changes that resemble a fungal infection.

If you develop painful blisters or changes in your toenails, the main treatment is proper wound care. You should inspect the affected areas daily, wash them with a mild soap and water, and wear protective socks and shoes. Open sores should be kept covered with appropriate dressings. It is important to discuss any symptoms with your doctor, who may refer you to a podiatrist or wound care specialist. In some cases, medications such as prednisone or topical steroids may help manage the condition.

Dry skin is another common side effect of chemotherapy. While this dryness can range from mild to severe, it may lead to skin breakdown if not properly managed. To protect your skin, use a gentle cleanser—preferably a bar soap with fewer irritants than liquid soaps—and avoid harsh chemicals like alcohol, iodine, or peroxide on intact skin. After washing, thoroughly dry your skin, especially between your toes, since this is a common area for fungal or bacterial growth. Then, apply a moisturizer, such as plain petroleum jelly (e.g., Vaseline), or a keratolytic moisturizer containing lactic acid or urea (such as Amlactin, Keralac, or Eucerin).

Prevention is key when it comes to keeping your feet intact during chemotherapy. If you notice any signs of skin breakdown, consult your doctor immediately to avoid further complications.