Abstract: External Traditional Chinese Medicine (TCM) therapies act directly on hand-foot lesions by penetrating the stratum corneum, offering strong targeting capabilities and rapid onset of action. This article systematically reviews research on the use of external TCM therapies to manage targeted drug-associated hand-foot skin reactions (HFSR). It summarizes the core pathogenesis as the accumulation of heat-toxin in the skin, stagnation of qi and blood, and malnourishment of the skin; the progression of the condition follows the pattern of evolving from qi to blood and shifting from excess to deficiency. Based on therapeutic principles—clearing heat and resolving toxins, activating blood circulation and unblocking collaterals, and promoting tissue regeneration and wound healing—the article details the preparation characteristics, applicable syndrome types, and clinical advantages of five external dosage forms: ointments, washes, fumigations, oils, and pastes. It also reviews their multidimensional biological mechanisms of action. Furthermore, the article analyzes current deficiencies in the field regarding evidence-based data, formulation standardization, and research into the material basis of efficacy, aiming to provide a theoretical foundation for standardized integrated TCM-Western medicine treatment protocols and to offer insights for the development and clinical translation of novel external preparations.