Capecitabine
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Capecitabine Hand and foot syndrome: case report
A 77-year-old man developed grade 3 severe hand and foot syndrome (HFS) following treatment with capecitabine. The man tested positive for faecal occult blood in physical examination in February 2018. In April 2018, colonoscopy revealed that multiple polyp-like bulges were scattered in the ileocecal area and the ascending colon and biopsy pathology found carcinogenesis of hepatic polyps. On 21 May 2018, he underwent laparoscopic-assisted radical resection of the right colon and postoperative pathology showed the followings: colonic protruded moderately differentiated adenocarcinoma, penetration of carcinoma through the muscular layer to the subserosal layer, and tumour thrombus in the vessel, low-grade tubular adenoma in the surrounding intestinal mucosa, with no lymph node metastasis, pT3N0M0, stage IIA, and stage B in Dukes staging. He started receiving postoperative adjuvant chemotherapy with oral capecitabine 1.5g twice a day in June 2018, day 1-14, q21d. One month later, in July 2018, scattered blisters were seen on the soles of the feet which gradually aggravated. Blisters on the soles of the feet fused into pieces, and were ulcerated and suppurated, which made the healing difficult. The lateral sides of the heels were ulcerated with bleeding, the skin at the sole was keratinised and desquamated. Her feet were swollen, the toes were black and loose, and the nail groove bleeding was painful. The man discontinued capecitabine treatment after 3 weeks of treatment on 17 August 2018 due to severe skin reactions. One week after drug discontinuation, the ulceration and suppuration of the skin at the sole was slightly relieved than before. On 29 August 2018, he presented to an outpatient clinic. He reported that, he had severe pain in both feet, with slight itching and numbness, and was unable to walk and resisted touching there. He soaked the feet in traditional Chinese medicine (TCM) decoction "self-made prescription 1" (containing Scutellaria baicalensis, Lithospermum, Portulaca oleracea [Purslane], Corydalis yanhusuo [Rhizoma corydalis], Geranium wilfordii, Campsis radicans) for 2 weeks. During the return visit on 12 September 2018, the skin ulceration and suppuration at the sole was reduced significantly less than before, and the sole of the foot was no longer ulcerated and the skin was dry and peeled off. Small blisters were seen scattered on the dorsum of the foot. The swelling of the feet had improved than before. The pain of both feet was better than before, and the feet were able tolerate slight touching, but the itching at the area where the ulceration had been healed was worse than before. His TCM "self-made prescription 1" was replaced with "selfmade prescription 2" (containing Lithospermum, Corydalis yanhusuo, Campsis radicans, Carthamus tinctorius [Safflower], Ligusticum wallichii, Astragalus propinquus [raw astragalus], and Carica papaya [Papaya]). During the follow-up visit on 10 October 2018, the skin ulceration at both feet was healed, no blist
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