Table 3.

Recommended supportive measures to prevent or manage hand–foot skin reaction

Purpose	Intervention	Timing
Control of calluses	Check condition of hands and feet Suggest a manicure/pedicure to remove hyperkeratotic skin Recommend pumice stone use for callus or ‘rough spot’ removal	Before initiating treatment with regorafenib
	Avoid pressure points Avoid items that rub, pinch, or create friction	During regorafenib treatment
Moisturizers	Nonurea-based creams or ointments	Apply liberally when needed, especially after hand washing
Keratolytic creams	10%–40% urea-based 5%–10% salicylic acid	Use sparingly and only to affected (hyperkeratotic) areas
Pain control	Topical analgesics, e.g. lidocaine 2%–4%	As needed
Management of grade 2–3 symptoms	Topical corticosteroids, e.g. clobetasol 0.05% Avoid systemic steroids	Twice daily
Cushioning/protection of tender areas	Use socks/gloves to cover moisturized areas Wear well-padded footwear Use insole cushions or inserts (e.g. silicon, gel) Foot soaks with tepid water and Epsom salts	As needed