Tuesday, May 17, 2022

What It Is, Causes, Pictures, Treatment

  • 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. 

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.  

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.

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.

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 

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.  

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.

Sources

  • Ezhilarasan D. Critical role of estrogen in the progression of chronic liver diseases. Hepatobiliary Pancreat Dis Int. 2020;19(5):429-434. doi:10.1016/j.hbpd.2020.03.011
  • Gurioli C et al. I. Lane’s Disease (Erythema Palmare Hereditarium): A Report of Five Cases and a Review of the Literature. Pediatr Dermatol. 2017;34(5):590-594. doi:10.1111/pde.13211
  • Serrao R et al., Zirwas M, English JC. Palmar erythema. Am J Clin Dermatol. 2007;8(6):347-356. doi:10.2165/00128071-200708060-00004
  • Donald E. Thomas. Jr. The Lupus Encyclopedia. John Hopkins University Press. 2014; Baltimore.
  • Noble JP et al. Palmar erythema: cutaneous marker of neoplasms. Dermatology. 2002;204(3):209-213. doi:10.1159/000057883
  • Mahmood T et al. Cutaneous manifestations of diabetes mellitus. J Pak Assoc Derm 2005; 15: 227–32. https://www.researchgate.net/publication/287639429_Cutaneous_manifestations_of_diabetes_mellitus
  • Labib A, Rosen J, Yosipovitch G. Skin Manifestations of Diabetes Mellitus. [Updated 2022 Apr 21]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK481900/
  • Dombrowski J et al. Secondary Syphilis. Diagnostic Pathology: Nonneoplastic Dermatopathology (2nd ed), 2017. https://www.sciencedirect.com/topics/medicine-and-dentistry/secondary-syphilis
  • Wieland C. Clinical examination: Skin. Clin Liver Dis (Hoboken). 2016;7(6):119-125. Published 2016 Jun 28. https://doi.org/10.1002/cld.551
  • Scheinfeld N, Spahn C. Palmar erythema due to topiramate. J Drugs Dermatol. 2004;3(3):321-322. https://pubmed.ncbi.nlm.nih.gov/15176170/
  • Levi A et al. Palmar Telangiectasias: A Cutaneous Sign for Smoking. Dermatology. 2017;233(5):390-395. doi:10.1159/000481855
  • Nabatian A, Suchter MF, Milgraum S. Palmar telangiectases as a manifestation of Graves disease. Cutis. 2012;89(2):84-88. https://pubmed.ncbi.nlm.nih.gov/22474732/
  • Panda PK, Sharawat IK. Fluctuating Palmar Erythema in a Toddler during COVID-19 Pandemic: Do You Know the Offender?. J Trop Pediatr. 2021;67(1):fmab011. doi:10.1093/tropej/fmab011
  • Agarwal S et al. Kawasaki disease: etiopathogenesis and novel treatment strategies. Expert Rev Clin Immunol. 2017;13(3):247-258. doi:10.1080/1744666X.2017.1232165
  • Maekawa M. Palmar erythema as a sign of cancer. Cleve Clin J Med. 2017;84(9):666-667. doi:10.3949/ccjm.84a.16114
  • White RE. Estrogen and vascular function. Vascul Pharmacol. 2002;38(2):73-80. doi:10.1016/s0306-3623(02)00129-5
  • Panambur B, Kakkilaya SB. Palmar Erythema as the Sole Manifestation of COVID-19. Cureus. 2020;12(11):e11291. doi:10.7759/cureus.11291
  • Levi A et al. Palmar Telangiectasias: A Cutaneous Sign for Smoking. Dermatology. 2017;233(5):390-395. doi:10.1159/000481855
  • Kettelhut EA, Traylor J, Roach JP. Erythema Ab Igne. [Updated 2021 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538250/
  • Nikolaou V et al. Incidence and implications of chemotherapy related hand-foot syndrome. Expert Opin Drug Saf. 2016;15(12):1625-1633. doi:10.1080/14740338.2016.1238067

» Show all

Latest Articles