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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.
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
- Around 30% of pregnant women develop palmar erythema.
- 23% of those with liver cirrhosis develop palmar erythema.
- Palmar erythema may be found in up to 60% of people with rheumatoid arthritis.
Primary palmar erythema
Secondary palmar erythema
- Liver cirrhosis and its many causes including alcohol abuse.(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.
- Diabetes mellitus.
- Gestational syphilis.
- Human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy.[1, 8]
- Neoplastic disease (as a paraneoplastic disorder), particularly primary or metastatic brain neoplasms.[1, 9]However, also associated with ovarian carcinoma.
- Drug-induced (amiodarone, gemfibrozil, cholestyramine, topiramate and salbutamol have all been implicated).[1, 11]
- Chronic mercury poisoning.
These will depend on the underlying condition(s) suggested by the overall clinical picture. Idiopathic palmar erythema should be a diagnosis of exclusion.
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
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.
Rabbani MA, Shah SM, Ahmed A; Cutaneous manifestations of systemic lupus erythematosus in Pakistani patients. J Pak Med Assoc. 2003 Nov53(11):539-41.
Hyperthyroidism; NICE CKS, June 2013 (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.
Lenzi ME, Cuzzi-Maya T, Oliveira AL, et al; Dermatological findings of human T lymphotropic virus type 1 (HTLV-I)-associated myelopathy/tropical spastic paraparesis. Clin Infect Dis. 2003 Feb 1536(4):507-13. Epub 2003 Jan 30.
Noble JP, Boisnic S, Branchet-Gumila MC, et al; Palmar erythema: cutaneous marker of neoplasms. Dermatology. 2002204(3):209-13.
Preda VA, Frederiksen P, Kossard S; Indurated reticulate palmar erythema as a sign of paraneoplastic palmar fasciitis Australas J Dermatol. 2009 Aug50(3):198-201.
Scheinfeld N, Spahn C; Palmar erythema due to topiramate. J Drugs Dermatol. 2004 May-Jun3(3):321-2.
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