Prognosis is generally good and symptoms usually resolve within 1 – 2 weeks after stopping the causative chemotherapeutic agent. If left untreated, palmar plantar erythrodysesthesia (PPE) can progress rapidly. PPE is not life-threatening, but it can be very debilitating and can significantly impair quality of life.

• The symptoms of palmar plantar erythrodysesthesia (PPE) usually develop 1 – 21 days after higher-dose pulse therapies and up to 2 – 10 months after continuous low-dose therapies.
• PPE development appears to be dependent on the dose of the drug.
• Both peak drug concentration and total cumulative dose determine its occurrence since both bolus infusions and continuous low-dose administration can cause a dose-dependent drug reaction.^{[1] [2][3] [4]}
• In addition, combined administration of two chemotherapeutic drugs, both capable of causing palmar plantar erythrodysesthesia (PPE), usually results in an increased frequency of occurrence and severity of PPE.

• PPE is not life-threatening, but it can be very debilitating and can significantly impair quality of life.
• If chemotherapy is continued despite the development of the PPE:
  • The lesions deteriorate, and tenderness and edema may restrict the fine movements of the fingers ^[5]
  • The erythema becomes darker or violaceous and spreads to involve the entire surface of the palms and soles.
  • The pain may be severe enough to limit activities of daily living (ADL).
  • In some patients, lesions may evolve into a palmoplantar keratoderma. ^{[6] [5]}

• If the causative chemotherapeutic agent is stopped within a few days of the development of PPE:
  • Areas of pallor with blisters develop, and eventually desquamate with extensive but superficial cracking and exfoliation.
  • A gradual clearing of symptoms will occur over a period of 2 weeks.
  • Rarely, long term sequelae may occur despite cessation of chemotherapy, with persistence of abnormal sensation of the affected digits. ^[7]
• If appropriate management is not implemented rapidly, PPE can rapidly progress.
• Re-exposure to the causative agent with similar dosage has resulted in the reaction to recur in the majority of the patients.^{[8] [9][10] [11]}