Table I.

Characteristics of serpentine supravenous hyperpigmentation (SSH) and hand-foot syndrome (HFS)

	Serpentine supravenous hyperpigmentation	Hand-foot syndrome
Cause	Peripheral infusion of certain chemotherapeutic agents	Adverse chemotherapy reaction; may be exacerbated by pressure, friction, or UV exposure
Onset	1 day to 2 weeks postinfusion	Variable onset; days to weeks postinfusion
Location	Occurs at infusion site and extends proximally along venous pathways	Palms and soles with most antineoplastic agents Dorsal hand involvement with docetaxel; palms may be affected simultaneously
Appearance	Erythematous/hyperpigmented patches with branching configuration along superficial venous pathways	Erythema, edema, and/or scaling of palms and soles
Proposed pathogenesis	Drug leakage and local toxicity to epidermal keratinocytes and melanocytes	Direct toxic effect on epidermis
Histopathology	Epidermal atrophy, sparse basal vacuolar alteration with necrotic keratinocytes, hyperpigmentation of basal epidermis	Epidermal dysmaturation, keratinocyte atypia, bizarre mitotic figures, basal vacuolar change, necrotic keratinocytes
Management	Emollients, topical steroids, cool compresses, administer chemotherapy through central venous catheter	Emollients, topical steroids, cooling therapy to hands and feet, limb elevation, high-dose vitamin D, alteration or cessation of chemotherapy regimen