Palmar erythema
No treatment is indicated for primary palmar erythema.
What Is Palmar Erythema?
Palmar erythema is a rare skin condition where the palms of both hands become reddish. This change in color usually affects the base of the palm and the area around the bottom of your thumb and little finger. In some cases, your fingers may also turn red.
The degree of redness can vary depending on:
- temperature
- pressure applied to your hands
- your emotional state
- if you’re holding your arms up
You may feel warmth or a burning sensation in your hands, but the affected areas shouldn’t be itchy.
This condition can be hereditary. It can also result from specific conditions, such as pregnancy, or diseases, such as liver cirrhosis. There isn’t a standard treatment or cure for the redness itself. If the palmar erythema is caused by an underlying condition, your symptoms may clear after treatment for the root cause.
Palmar erythema is also called liver palms, red palms, or Lane’s disease. Keep reading to learn more.
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Palmar erythema can be:
- hereditary
- caused by an underlying condition
- of unknown origin
If the condition is inherited, pregnancy-related, or of unknown origin, it’s considered to be primary palmar erythema. If it’s caused by an underlying medical condition or environmental factors, it’s considered secondary palmar erythema.
Primary palmar erythema
Hereditary palmar erythema is very rare , with just a few cases described in the medical literature. In these cases, the redness is present at birth and remains lifelong. It’s generally benign, meaning there’s no pain or inflammation. The redness comes from blood vessels dilated under the skin.
Pregnancy-related palmar erythema occurs in about 30 percent of pregnancies. This may be due to vascular changes related to the increase in estrogen levels during pregnancy.
In some cases, the condition isn’t hereditary or related to any known condition or disease.
Secondary palmar erythema
Palmar erythema is a symptom of many different conditions. Its appearance is often the first sign of an underlying medical concern.
For example, palmar erythema is associated with several forms of liver disease. About 23 percent of people who have cirrhosis of the liver also experience palmar erythema.
Other liver diseases associated with palmar erythema include Wilson’s disease, which occurs when there’s too much copper in your body, and hemochromatosis, which occurs when there’s too much iron in your body.
Clear associations have also been made for the following conditions:
- Diabetes: An estimated 4.1 percent of people who have diabetes experience palmar erythema.
- Autoimmune diseases: More than 60 percent of people who have rheumatoid arthritis experience palmar erythema.
- Thyroid disease: About 18 percent of people with too much thyroid hormone have palmar erythema.
- HIV: A case of palmar erythema associated with HIV was first reported in 2017.
Other possibilities include:
- skin conditions, such as atopic dermatitis, eczema, and psoriasis
- viral or bacterial infections, such as Rocky Mountain spotted fever, coxsackievirus (hand, foot, and mouth disease), and syphilis
- chronic obstructive pulmonary disease
- brain tumors that are malignant or have metastasized
Environmental causes, such as medications, can also lead to palmar erythema. For example, if your liver function is normal, drugs like topiramate (Topamax) and albuterol (Proventil) may cause symptoms.
If your liver function is impaired, palmar erythema may appear if you’re taking amiodarone (Cordarone), cholestyramine (Questran), or gemfibrozil (Lopid).
Other environmental causes include:
- smoking
- excessive drinking
- mercury poisoning
Palmar erythema
Author: George Shand, final year medical student, University of Auckland. Chief Editor: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, September 2015.
Table of contents
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What is palmar erythema ?
Palmar erythema is redness involving the heel of the palm, and occasionally the fingers.
What are the characteristics of palmar erythema?
The characteristics of palmar erythema include:
- Symmetrical (both hands)
- Non-painful
- Non-itchy
- Slightly warm.
The degree of redness varies with emotional states, elevation of the hand, temperature and pressure on the palm.
Palmar erythema
What are the causes of palmar erythema?
The redness of palmar erythema is due to increased dilatation of surface capillaries in the hand. The degree of redness is often related to the severity of any underlying disease (if present). In many cases, this can be related to the amount of circulating oestrogen .
Palmar erythema may be completely normal for an individual ( primary ) or be a sign of underlying disease (secondary).
Primary palmar erythema
Primary palmar erythema is classified as:
- Hereditary
- Pregnancy – 30-70% of pregnant women will develop palmar erythema
- Unknown cause ( idiopathic )
Secondary palmar erythema
Causes of secondary palmar erythema include:
- Liver disease: cirrhosis (23% of people with liver cirrhosis develop palmar erythema), Wilson disease, haemochromatosis
- Endocrine /nutritional: 18% of people with thyrotoxicosis and 4% of people with diabetes develop palmar erythema
- Autoimmune diseases: over 60% of people with rheumatoid arthritis develop palmar erythema
- Drug-induced palmar erythema: drugs include topiramate and salbutamol if the liver is functioning normally, or amiodarone, cholestyramine and gemfibrozil if there is liver impairment
- Other: including infections , atopic dermatitis , primary or metastatic brain cancer , smoking and chronic obstructive lung disease
In children, the most common causes of palmar erythema are:
- Hereditary palmar erythema
- Poisoning
- Kawasaki disease
- Congenital syphilis
- Wilson disease
- Hepatopulmonary hypertension .
How is the underlying cause of palmar erythema determined?
The following work-up is recommended for all patients presenting with palmar erythema:
- Complete history and physical examination
- Complete blood count
- Liver function and blood urea nitrogen/creatinine
- Hepatitis B and C virus serology
- Ferritin
- Fasting glucose
- Thyroid stimulating hormone
- Chest x-ray.
In addition to these tests, a clinician may consider ordering ceruloplasmin, proalbumin, albumin, rheumatoid factor, Cyclic Citrullinated Peptide Antibodies (CCPA), ANA, SSA, SSB, MRI brain, CT chest/abdomen/pelvis or a bone marrow biopsy .
What is the treatment of palmar erythema?
No treatment is indicated for primary palmar erythema.
If the cause of the palmar erythema is thought to be secondary to a drug, then it may be advisable to stop it. Treatment of an underlying cause of the palmar erythema may or may not lead to improvement of the redness.
Red Palms
Red palms are also known as palmar erythema in the medical literature. This condition can be caused by various medical problems, each having its own range of severity. In a lot of patients, red palms have no identifiable cause and they are presented under primary palmar erythema. However, there are many cases in which the red palms are a symptom of another disease, being presented as secondary palmar erythema.
It is important to contact the doctor if you have noticed that your palms have gotten red, as this can be an early sign of an underlying medical condition. As specialists tell us, it seems that palms are directly related to the proper functioning of the circulatory system, the hormonal system and especially the thyroid. So, when you have red palms, this can be a symptom of another disease and you need to see a doctor.
Symptoms of Red Palms
These are the most common symptoms associated with red palms:
- The palms have a reddish tinge
- The area of the palm most affected is the hypothenar eminence
- Can also appear on the thenar eminence and the fingers
- Can be accompanied by red soles (plantar erythema)
- The skin in the affected areas can be warm to the touch
- No itchiness, scaling or pain
Possible Causes of Red Palms
These are the most common causes that lead to the appearance of red palms:
- Pregnancy – one of the most encountered causes of red palms; during pregnancy, the estrogen levels increase and the circulatory system also goes through a change.
- Heredity (role in the onset of red palms but has only been identified in rare cases)
- Idiopathic (unknown cause, no identified triggers)
- Liver disease – hepatitis, hereditary liver disease (Wilson’s disease, hereditary haemochromatosis), cirrhosis. In chronic liver disease, the estrogen and or the oestradiol present abnormal levels. Moreover, it seems that there is a dysfunction in the arteriovenous anastomoses.
- Problems with the adrenal glands
- Cancer – leukemia, brain cancer, metastases, liver cancer, ovarian cancer. A growing tumor will always cause the estrogen levels to rise, causing red palms to appear among other symptoms.
- Thyroid problems – thyrotoxicosis, hyperthyroidism. The patients present an increased level of estradiol, leading to their palms becoming red.
- Circulatory problems – polycythemia vera
- Shoulder-hand syndrome – this is also known as reflex sympathetic dystrophy. It affects the upper extremities of the body and it is accompanied by pain and rigidity in the shoulder, hand and fingers. Red palms accompany this syndrome as well.
- Rheumatological disease – lupus erythematosus, rheumatoid arthritis. The exact link between rheumatoid arthritis and red palms has not been identified yet but this symptom appears in almost 60% of the patients with rheumatoid arthritis.
- Diabetes mellitus – patients describe their palms as being hot and red. In some patients, the palms might not be entirely red, but rather present red spots.
- Certain medication – amiodarone (antiarrhythmic agent), gemfibrozil (oral drug used for the reduction of lipid levels), cholestyramine (bile acid sequestrant), topiramate (anticonvulsant), albuterol (anti-asthma medication, recommended for bronchospasms).
- Smoking – prolonged smoking can lead to circulatory problems, including in the hands area, hence the red palms.
- Chronic mercury intoxication – it is a well-known fact that the chronic poisoning with mercury leads to the appearance of neurological and cutaneous symptoms. Among those symptoms, you will find the red palms.
- Oral contraceptives (high levels of estrogen) – as with pregnancy, the high levels of estrogen lead to the appearance of red palms in women.
- Alcohol abuse – prolonged and excessive alcohol drinking has a negative effect on the health of the liver, leading to abnormal levels of estrogen and oestradiol. It is the same mechanism as in the case of liver disease.
- Sarcoidosis – this is a multi-systemic inflammatory disease, accompanied by a wide range of symptoms, including red palms.
- Gestational syphilis – getting infected with the syphilis virus during pregnancy can lead to red palms, among other symptoms.
- Myelopathy – this is a degenerative condition that leads to the pinching of the spinal cord and circulatory problems, with red palms included.
Treatment
At the present, there is no specific treatment for red palms and often times this symptom disappears when the primary cause is correctly identified and treated. However, you must remember that red palms can appear without any identified cause or medical history as well. If there are no other medical conditions associated with the red palms, then the condition might disappear on its own.
Pictures of Red Palms
Here are some of the pictures of red palms and fingers…
