Is Vitamin B6 Effective for Hand Foot Syndrome?

This article addresses a thoughtful question that was submitted by one of our website participants. This person asked, “I noticed my hands and feet itching last night and this morning. I called my doctor's office and they said it was hand foot syndrome. I saw online that vitamin B6 can help with this condition. Is this true?” This is an excellent question, because hand foot syndrome, a possible side effect of certain cancer treatments, should not be ignored. If it occurs, proper management of this side effect is important to your overall wellbeing as well as to your ability to complete cancer treatment as planned and on time.

Hand Foot Syndrome

Hand foot syndrome is referred to by several names including plantar palmar toxicity, palmar plantar erythrodysesthesia (PPE), palmoplantar keratoderma, and cutaneous toxicity. Regardless of the name, hand foot syndrome should not be ignored.

This is a potentially serious complication of certain chemotherapy treatments. Mild cases cause the palms of the hands and the soles of the feet to itch. More serious cases can cause the skin on the hands and feet to peel, which opens you up to infection and other complications.

If a person experiences a severe case of hand foot syndrome, chemotherapy treatment may need to be stopped or the dose of chemotherapy reduced to allow the hands and feet to heal.

For all of these reasons, if you experience itching of your hands and feet or peeling of the skin in these areas, talk to your medical team right away. They can help you develop a plan to best care for and manage this side effect. Your doctor or nurse can instruct you on how to minimize the discomfort of hand foot syndrome and give you guidance on how to avoid infections or other complications of unmanaged, severe hand foot syndrome.

Vitamin B6 for Hand Foot Syndrome

In addition to working with your medical care team to best manage hand foot syndrome, many people may want to try vitamin B6 as a way to reduce the occurrence and severity of this side effect. There are no controlled clinical trials or studies that prove that vitamin B6 will prevent or treat hand foot syndrome. However, there are animal studies, case reports, and other small studies which suggest that taking vitamin B6 may help prevent and treat hand foot syndrome (1-8).

Without well-controlled studies, we can’t know for certain that vitamin B6 is effective. The good news is that the small studies that are available tell us that vitamin B6 is safe and well tolerated when taken for short periods of time. It appears to be effective for preventing hand foot syndrome in at least some individuals who experience this side effect.

The important thing to remember is that the high dose of vitamin B6 that is suggested as a way to help manage hand foot syndrome only should be used for a short period of time, approximately one to three months. It is not a good idea to use high doses of vitamin B6 for longer periods of time. Long term use of very high doses of vitamin B6 may create other side effects or health problems or it may interfere with your body’s absorption and use of other important nutrients.

How much vitamin B6 is enough?

The small amount of available research suggests that a dose of 50 to 150 milligrams (mg) of vitamin B6 per day can help lessen the severity of chemotherapy-related hand foot syndrome. This amount of vitamin B6 is approximately 35 to 115 times the recommended dietary allowance (RDA). This is a very high dose of vitamin B6. This dose should only be used under a doctor's supervision and for a short period of time, as needed to manage hand foot syndrome.

Ask Your Doctor First

Be sure to talk to your doctor first, before you try vitamin B6 to manage hand foot syndrome. It is important that you share this information with your medical care team so they can work with you to give you the best care. In general, short term use of high dose vitamin B6 is considered safe for most people, but some dietary supplements can interfere with cancer treatment and other medications. For this reason, discuss your use of vitamin B6 and any other supplements with your health care team.

References

1. Mangili G, Petrone M, Gentile C, De Marzi P, Viganò R, Rabaiotti E. Prevention strategies in palmar-plantar erythrodysesthesia onset: the role of regional cooling. Gynecol Oncol. 2008;108:332-35.
2. Saif MW, Elfiky A, Diasio R. Hand-foot syndrome variant in a dihydropyrimidine dehydrogenase-deficient patient treated with capecitabine. Clin Colorectal Cancer. 2006;6:219-23.
3. Gressett SM, Stanford BL, Hardwicke F. Management of hand-foot syndrome induced by capecitabine. J Oncol Pharm Pract. 2006;12:131-41.
4. Nagore E, Insa A, Sanmartín O. Antineoplastic therapy-induced palmar plantar erythrodysesthesia ('hand-foot') syndrome. Incidence, recognition and management. Am J Clin Dermatol. 2000;1:225-34.
5. Vail DM, Chun R, Thamm DH, Garrett LD, Cooley AJ, Obradovich JE. Efficacy of pyridoxine to ameliorate the cutaneous toxicity associated with doxorubicin containing pegylated (Stealth) liposomes: a randomized, double-blind clinical trial using a canine model. Clin Cancer Res. 1998;4:1567-71.
6. Vukelja SJ, Baker WJ, Burris HA 3rd, Keeling JH, Von Hoff D. Pyridoxine therapy for palmar-plantar erythrodysesthesia associated with taxotere. J Natl Cancer Inst. 1993;85:1432-33.
7. Fabian CJ, Molina R, Slavik M, Dahlberg S, Giri S, Stephens R. Pyridoxine therapy for palmar-plantar erythrodysesthesia associated with continuous 5-fluorouracil infusion. Invest New Drugs. 1990;8:57-63.
8. Vukelja SJ, Lombardo FA, James WD, Weiss RB. Pyridoxine for the palmar-plantar erythrodysesthesia syndrome. Ann Intern Med. 1989;111:688-89.