Acral erythema, also known as palmoplantar erythrodysesthesia and hand-foot syndrome, has been described following treatment with several systemic chemotherapeutic agents. The exact pathogenic mechanisms of this disorder are still unknown. Typically, the eruption involves the hands and feet and often occurs within the first week of treatment. Common provoking agents include cytarabine (cytosine arabinoside), 5-fluorouracil, doxorubicin (particularly pegylated liposomal doxorubicin), hydroxyurea, capecitabine, and mercaptopurine.

Reactions may occur sooner (24 hours to 3 weeks) and more severely with bolus chemotherapy than with low-dose continuous infusion and are usually reproducible with challenge.

Acral erythema may occur as part of a broader eruption, known as toxic erythema of chemotherapy, in which acral and intertriginous areas are involved. It is characterized by a painful erythematous rash, often with associated edema located on the palms, fingers, and soles preceded by dysesthesia.