Palmar Erythema: What It Is, Causes, Pictures, Treatment (2023)

  • Palmar erythema is a rare skin condition that causes the palms of the hands to turn red
  • It is most often associated with pregnancy but is also linked to a wide range of health conditions such as liver cirrhosis
  • When not a result of an underlying condition, there is no established treatment
  • When identified as a secondary symptom, the primary cause must be identified and treated

Palmar erythema, also known as liver palms, red palms or Lane’s disease is characterized by a red rash on the palms of the hands that can sometimes extend to the fingers. It can be accompanied by a feeling of warmth or a burning sensation.

This redness is caused by dilated blood vessels beneath the skin and is linked to higher levels of the female hormone estrogen. Increased levels of estrogen is associated with pregnancy and liver disease, as well as a wide range of health conditions.

Contents

What Is Palmar Erythema?

Palmar erythema is an often overlooked physical symptom that occurs from an unknown or uncertain cause; or is a symptom of an underlying disease such as liver disease or a change in health status. It also has a genetic component.

Estrogen has a profound impact on vascular function, and is well understood to cause palmar erythema during pregnancy and as a result of liver cirrhosis.

In general, women are affected almost three times more than men. It can be present at birth or develop later on in life. While definite links have been established, the exact cause is not well understood.

(Video) Gynacomastia and palmar erythema in liver disease

Symptoms of palmar erythema

Palmar erythema manifests as a red rash that develops on both hands simultaneously and may sometimes feel warm. The palms are affected as well as the base of the thumb and little finger or pinkie. Sometimes this redness extends to all fingers.

This redness is asymptomatic, solid or mottled, and can become more pronounced with worsening of disease.

Primary and Secondary Palmar Erythema

Palmar erythema can be categorized into two distinct groups and is based on cause.

Primary palmar erythema

Primary palmar erythema describes situations where there are no known associated health conditions causing the redness. This would include pregnancy, which raises estrogen levels or due to an inherited condition.

It is common in pregnancy, affecting at least 30% of women, and usually manifests in the first trimester. This redness typically resolves 3 weeks after delivery.

Secondary palmar erythema

Secondary palmar erythema is linked to a wide range of health conditions and diseases and is often the first sign of a health issue. Smoking and specific drugs also fall within this category as they are identifiable causes.

Causes and Risk Factors

Autoimmune diseases: This condition can manifest in immunocompromised individuals. Two examples are rheumatoid arthritis, with more than 60% of people reporting signs of palmar erythema as well as up to 4% of people with lupus.

Cancer: Palmar erythema has been linked to cancer including brain and stomach cancer, as well as lymphoma. In one study of patients with brain tumors, researchers found 18.5% had mild and/or localized cases of this condition. After examining skin biopsies, they concluded the rate of dilated vessels and blood flow surface was higher than in normal skin.

(Video) PALMER ERYTHEMA

Diabetes mellitus: About 4% of people who have diabetes experience palmar erythema. Diabetes can cause a range of dermatological issues due to microvascular complications that damage small blood vessels.

Infections: Hand-foot-and-mouth disease (a mild viral infection) Rocky Mountain spotted fever (a bacterial disease) and secondary syphilis (bacterial infections have been linked to palmar erythema.

Liver disease: Liver disease is believed to be the most common cause of disease-related palmar erythema. It occurs in 23% of patients with liver cirrhosis, a disease that can be caused by excessive alcohol intake, hemochromatosis, Wilson disease or hepatitis.

Medication side effects: Drug-induced palmar erythema is linked to amiodarone, a drug that is used to treat and prevent an irregular heartbeat. So too are gemfibrozil and cholestyramine, which are cholesterol medications; topiramate, an anti-seizure medication; and albuterol, a beta-agonist.

Skin disorders: Eczema which causes red and itchy patches of skin, and psoriasis which is characterized by raised red scaly plaques may also be related to this skin condition.

Thyroid disease: Some thyroid disorders such as thyrotoxicosis, are associated with palmar erythema; it has also been diagnosed in patients with Graves’ disease, which results from an overactive thyroid.

Childhood disorders

Children can develop palmar erythema due to the same reasons as adults including eczema, psoriasis and liver disease.

In addition, there are other health conditions that present during childhood including Raynaud’s phenomenon (which affects blood flow in the fingers and toes), rheumatological disorders and certain heavy metal poisoning.

(Video) Erythema Multiforme - Causes, Complications & Treatment

Kawasaki disease is seen in children under 5 years of age and can cause a host of symptoms including fever, swelling of the hands and feet, inflammation of the mouth and the red rash associated with palmar erythema.

How Is Palmar Erythema Diagnosed?

Diagnosis involves a care provider visually examining the hands. Once the symptoms are assessed and determined to be palmar erythema, the next step would be to investigate and identify the underlying cause (if present).

You care provider may request some or all of the following tests to measure:

  • Autoimmune antibodies
  • Complete blood count
  • Fasting glucose
  • Hepatitis B and C
  • Iron levels
  • Liver function
  • Pregnancy test
  • Thyroid-stimulating hormone

They may also request the following:

  • Biopsy
  • Chest X-ray
  • CT scan of the chest, abdomen and pelvis
  • MRI of the brain

Conditions similar to palmar erythema

Several diseases or skin conditions can be confused with palmar erythema.

  • Telangiectasias are dilated blood capillaries that cause persistent or permanent redness and are caused by smoking, alcoholism and some environmental factors
  • Erythema ab igne is characterized by a net-like appearance on the palms that is caused by chronic exposure to heat or infrared radiation
  • Hand-foot syndrome, also known as palmar-plantar erythrodysesthesia, causes redness, swelling and pain on the palms as a result of cancer treatments

Palmar Erythema Pictures

  • Palmar Erythema: What It Is, Causes, Pictures, Treatment (1)
  • Palmar Erythema: What It Is, Causes, Pictures, Treatment (2)
  • Palmar Erythema: What It Is, Causes, Pictures, Treatment (3)

Can Palmar Erythema Be Treated?

Primary palmar erythema requires no treatment. Symptoms are not harmful or uncomfortable and an underlying health condition is not responsible.

(Video) Early Liver Disease Symptoms

Secondary palmar erythema is associated with a wide range of health conditions and diseases – some serious. As such, treating the underlying disease is vital, and will result in reducing or eliminating the redness once the primary health condition is under control.

Palmar erythema management

There is no established treatment for primary palmar erythema. It does not cause discomfort and is not a cause for concern.

Secondary palmar erythema is indicative of a health issue and this issue requires medical treatment. If the disease can be successfully treated or controlled, these effects will reduce or eliminate palmar erythema.

When to See a Doctor

If you notice a reddening of your palms, see your healthcare provider. They are in the best position to determine if there is an underlying health concern.

Takeaway

Palmar erythema is a skin condition that causes reddening of the palms. It can be a sign of a health concern such as liver disease or cancer; it can also be due to a drug reaction or pregnancy. Often it is related to genetics and can be a normal state.

There is no treatment available when there are no known associated health conditions or disease. When this is the case, there is no cause for concern.

When palmar erythema is a symptom of an underlying health concern or disease, the primary

health condition must be addressed in order to reduce or eliminate this secondary symptom of redness.

(Video) Your Hands & Liver Health | What Your Hands Can Tell You About Your Liver Health

Sources

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FAQs

How do you treat palmar erythema? ›

There is no specific treatment to cure red palms caused by palmar erythema. Treatment involves finding and addressing the underlying cause of the condition. Once the underlying cause is treated, the redness in the palms may go away partially or entirely.

Why does palmar erythema occur? ›

Primary palmar erythema can be hereditary or caused by pregnancy, or it can be the result of an unknown factor. Pregnancy. Pregnancy is a common cause of palmar erythema. It's estimated that it occurs in about two-thirds of lighter-skinned pregnant women and up to one-third of darker-skinned pregnant women.

What autoimmune diseases cause palmar erythema? ›

Acquired palmar erythema is associated with various medical or physiological conditions: Pregnancy. Liver cirrhosis (liver palms) – Most common cause of secondary palmar erythema. Autoimmune disease such as systemic lupus erythematosus (SLE) or rheumatoid arthritis (reported to be a favorable prognostic sign).

Is palmar erythema associated with liver disease? ›

Frequently, palmar erythema has been documented in diseases associated with liver cirrhosis, including alcoholic liver disease, Wilson disease, hemochromatosis, hepatitis B virus infection, and hepatitis C virus infection.

What causes erythema? ›

Erythema is a type of skin rash caused by injured or inflamed blood capillaries. It usually occurs in response to a drug, disease or infection. Rash severity ranges from mild to life threatening.

How does chronic liver disease cause palmar erythema? ›

The hormone estrogen can induce vascularization3 and is known to cause palmar erythema in pregnant women and patients with cirrhosis. Because estradiol is metabolized in the liver, increased levels of estrogen are associated with hepatic decompensation in cirrhosis. Neoplasm can cause palmar erythema.

How do you keep your liver healthy? ›

How to Keep Your Liver Healthy
  1. Drink Coffee. 1/15. ...
  2. Don't Overdo Acetaminophen. 2/15. ...
  3. Practice Safe Sex. 3/15. ...
  4. Take Your Meds Right. 4/15. ...
  5. Check on Your Supplements. 5/15. ...
  6. Skip Herbal Liver Remedies. 6/15. ...
  7. Drink Only in Moderation. 7/15. ...
  8. Eat the Rainbow. 8/15.
Nov 5, 2020

How long does palmar erythema last? ›

Primary palmar erythema

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.

Can fatty liver cause red palms? ›

Symptoms of Fatty Liver Disease

Swollen belly. Enlarged blood vessels underneath your skin. Larger-than-normal breasts in men. Red palms.

Is erythema an infection? ›

(Fifth Disease; Parvovirus B19 Infection)

Erythema infectiosum is a contagious viral infection. It requires a living cell in which to multiply. A viral infection can lead to a spectrum of symptoms from... read more that causes a blotchy or raised red rash and a slapped-cheek red rash on the face along with mild illness ...

Does erythema go away? ›

The bottom line. Post-inflammatory erythema (PIE) is the residual red, pink, or purple spots left behind by acne breakouts. PIE goes away on its own, but it can be resolved more speedily when dermatological treatments are used.

Which drug is most likely to be causing erythema multiforme? ›

The medications most often associated with erythema multiforme are barbiturates, hydantoins, nonsteroidal anti-inflammatory drugs, penicillins, phenothiazines, and sulfonamides.

Can hypertension cause palmar erythema? ›

It is associated with various physiological as well as pathological changes, or may be a normal finding: Portal hypertension.

Which fruit is best for liver? ›

Fill your fruit basket with apples, grapes and citrus fruits like oranges and lemons, which are proven to be liver-friendly fruits. Consume grapes as it is, in the form of a grape juice or supplement your diet with grape seed extracts to increase antioxidant levels in your body and protect your liver from toxins.

Which is the best medicine for liver? ›

Drugs for Liver Cirrhosis
  • Dehydroemetine. Dehydroemetine is classified as an antiprotozoal agent. ...
  • Entecavir. Entecavir is an oral antiviral agent, prescribed for hepatitis B. ...
  • Lamivudine. ...
  • Metadoxine. ...
  • Methionine. ...
  • Tenofovir. ...
  • Ursodeoxycholic Acid.

Which juice is good for liver? ›

Beetroot juice helps protect the liver from oxidative damage and inflammation, all while increasing its natural detoxification enzymes.

Can liver disease be cured? ›

It's a medical emergency that requires hospitalization. Depending on the cause, acute liver failure can sometimes be reversed with treatment. In many situations, though, a liver transplant may be the only cure.

What are the 3 signs of a fatty liver? ›

Symptoms
  • Abdominal swelling (ascites)
  • Enlarged blood vessels just beneath the skin's surface.
  • Enlarged spleen.
  • Red palms.
  • Yellowing of the skin and eyes (jaundice)
Sep 22, 2021

What is the fastest way to cure a fatty liver? ›

Lifestyle and dietary changes are currently the most effective options for managing NAFLD. Losing weight, being physically active, cutting back on sugar, eating a nutrient-dense diet, and drinking coffee (if you can tolerate it) are some of the methods that may help improve symptoms associated with NAFLD.

How long does palmar erythema last? ›

Primary palmar erythema

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.

What causes red blotches on palms of hands? ›

Palmar erythema occurs when the palms develop a reddish rash that is not painful or itchy. It can occur on its own, although this is rare. Usually it occurs secondarily to a variety of conditions, such as pregnancy, cancer, liver disease, and infections. Treatment involves resolving the underlying condition.

Can liver damage reversed? ›

Liver transplants

In the most serious cases of ARLD, the liver loses its ability to function, leading to liver failure. A liver transplant is currently the only way to cure irreversible liver failure.

What is Wilson's disease caused by? ›

Mutations link of a gene called ATP7B cause Wilson disease. These gene mutations prevent the body from removing extra copper. Normally, the liver releases extra copper into bile. Bile carries the copper, along with other toxins and waste products, out of the body through the digestive tract.

How do you keep your liver healthy? ›

How to Keep Your Liver Healthy
  1. Drink Coffee. 1/15. ...
  2. Don't Overdo Acetaminophen. 2/15. ...
  3. Practice Safe Sex. 3/15. ...
  4. Take Your Meds Right. 4/15. ...
  5. Check on Your Supplements. 5/15. ...
  6. Skip Herbal Liver Remedies. 6/15. ...
  7. Drink Only in Moderation. 7/15. ...
  8. Eat the Rainbow. 8/15.
Nov 5, 2020

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