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.

What causes palmar erythema and who is at risk?

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

How is palmar erythema diagnosed?

Although palmar erythema can be diagnosed on sight, your doctor will want to determine whether it’s a symptom of an underlying condition.

After reviewing your medical history and performing a physical exam, they may order one or more diagnostic tests to measure:

  • blood cell count
  • blood sugar
  • liver function
  • thyroid function
  • blood urea nitrogen
  • creatinine levels
  • iron levels
  • rheumatoid factor levels
  • copper levels

Further testing might include:

  • MRI of your brain
  • CT scan of your chest, abdomen, and pelvis
  • bone marrow biopsy
  • tests for other antibodies

Are there treatments for palmar erythema?

There aren’t any treatments available to reduce the redness itself.

With secondary palmar erythema, the redness may lessen as the root cause is treated. For example, if your palmar erythema is associated with an autoimmune disease, a short course of corticosteroid drugs may improve your symptoms.

If a drug you’re taking is causing the redness, talk with your doctor about alternative medications. You shouldn’t stop taking your prescribed medication without your doctor’s approval.

What can you expect?

It’s important to see your doctor if you have redness in your palms. The cause may be an underlying disease that should be treated as soon as possible, before any complications develop.

If secondary factors are causing your palmar erythema, your symptoms may fade over time. Women who are pregnant typically find that the redness goes away after delivery.

Symptoms may be ongoing in cases of hereditary palmar erythema.

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