Palmar Erythema
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Synonym: liver palms
Palmar erythema is a reddening of the skin on the palmar aspect of the hands, usually over the hypothenar eminence. It may also involve the thenar eminence and fingers. It can also be found on the soles of the feet, when it is termed plantar erythema.
Palmar erythema
The condition can be:
- Primary (or physiological).
- Secondary (to various disease states).
It is probably a manifestation of a number of underlying pathophysiological processes, the balance of which varies between different causes. These processes include:
- Increased cardiac output/hyperdynamic circulation.
- Capillary dilatation in the palms, due to local factors or systemic mediators.
- Localised inflammation.
- High circulating oestrogen levels.
Epidemiology
- Around 30% of pregnant women develop palmar erythema[1].
- 23% of those with liver cirrhosis develop palmar erythema[1].
- Palmar erythema may be found in up to 60% of people with rheumatoid arthritis[1].
Causes
Primary palmar erythema
Secondary palmar erythema[1]
- Liver cirrhosis and its many causes including alcohol abuse[4]. (Palmar erythema develops as a result of abnormal oestradiol levels.)
- Hereditary liver disease such as Wilson's disease and hereditary haemochromatosis .
- Rheumatoid arthritis (associated with a favourable prognosis) .
- Systemic lupus erythematosus[5].
- Thyrotoxicosis[6].
- Diabetes mellitus .
- Sarcoidosis[7].
- Gestational syphilis .
- Human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy.
- Neoplastic disease (as a paraneoplastic disorder), particularly primary or metastatic brain neoplasms . However, also associated with ovarian carcinoma[8].
- Drug-induced (amiodarone, gemfibrozil, cholestyramine, topiramate and salbutamol have all been implicated).
- Smoking.
- Chronic mercury poisoning.
- Polycythaemia.
Investigations
These will depend on the underlying condition(s) suggested by the overall clinical picture. Idiopathic palmar erythema should be a diagnosis of exclusion.
Management
There is no specific treatment for palmar erythema. If an underlying disease process is found to be the cause, this will dictate management. If a drug is thought to be responsible, this should be discontinued if possible.
Further reading and references
Dermnetz; Palmar Erythema
Serrao R, Zirwas M, English JC; Palmar erythema. Am J Clin Dermatol. 20078(6):347-56.
Henry F, Quatresooz P, Valverde-Lopez JC, et al; Blood vessel changes during pregnancy: a review. Am J Clin Dermatol. 20067(1):65-9.
Walker I, Chappell LC, Williamson C; Abnormal liver function tests in pregnancy. BMJ. 2013 Oct 25347:f6055. doi: 10.1136/bmj.f6055.
Liu SW, Lien MH, Fenske NA; The effects of alcohol and drug abuse on the skin. Clin Dermatol. 2010 Jul-Aug28(4):391-9. doi: 10.1016/j.clindermatol.2010.03.024.
Raynal M, , et al. Infective dermatitis-like lesions as a novel skin manifestation of systemic lupus erythematosus. Clin Case Rep. 2019;8(1):51-54. Published 2019 Dec 21. doi:10.1002/ccr3.2525
Hyperthyroidism; NICE CKS, February 2020 (UK access only)
Makkar RP, Mukhopadhyay S, Monga A, et al; Palmar erythema and hoarseness: an unusual clinical presentation of sarcoidosis. Med J Aust. 2003 Jan 20178(2):75-6.
Preda VA, Frederiksen P, Kossard S; Indurated reticulate palmar erythema as a sign of paraneoplastic palmar fasciitis and polyarthritis syndrome. Australas J Dermatol. 2009 Aug50(3):198-201.