Hand foot skin reaction with multikinase inhibitor sorafenib - A rare case report

Various metastatic solid tumors including renal cell carcinoma are treated with multikinase inhibitors like sorafenib and sunitinib which produce various cutaneous side effects. We report a case of sorafenib induced hand foot skin reaction, in a 75 year old female presented with complaints of bullae over palms and soles preceded by pain and burning sensation after first cycle of sorafenib chemotherapy 400mg BD for metastatic renal cell carcinoma. On examination, multiple tense, well defined tender bullae with surrounding erythema and with yellowish tinge on both palms and soles. She was advised for dose reduction of sorafenib to 200mg BD, topical clobetesol propionate and to avoid friction. She completed five cycles of sorafenib with said dose and was doing well. HFSR is a dose limiting cutaneous toxicity occurs within 3-6 weeks of treatment, dose reduction and simple treatment are sufficient to overcome. As the drug is excreted in the sweat glands it results in dose dependant direct skin toxicity .The differential diagnosis were hand foot syndrome, erythema multiforme, chemotherapy induced raynaud's disease, erythromelalgia, other cutaneous drug reactions. Awareness about the adverse cutaneous reaction to sorafenib is important to alert the clinicians which can be tackled successfully.