Palmar Erythema

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

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
  • 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]

Primary palmar erythema

  • Heredity.
  • Pregnancy (due to alterations in skin function and vasculature).[1, 2, 3]
  • Idiopathic.

Secondary palmar erythema

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.

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  1. Serrao R, Zirwas M, English JC; Palmar erythema. Am J Clin Dermatol. 2007 8(6):347-56.
  2. Henry F, Quatresooz P, Valverde-Lopez JC, et al; Blood vessel changes during pregnancy: a review. Am J Clin Dermatol. 2006 7(1):65-9.
  3. Walker I, Chappell LC, Williamson C; Abnormal liver function tests in pregnancy. BMJ. 2013 Oct 25 347:f6055. doi: 10.1136/bmj.f6055.
  4. Liu SW, Lien MH, Fenske NA; The effects of alcohol and drug abuse on the skin. Clin Dermatol. 2010 Jul-Aug 28(4):391-9. doi: 10.1016/j.clindermatol.2010.03.024.
  5. Rabbani MA, Shah SM, Ahmed A; Cutaneous manifestations of systemic lupus erythematosus in Pakistani patients. J Pak Med Assoc. 2003 Nov 53(11):539-41.
  6. Hyperthyroidism; NICE CKS, June 2013 (UK access only)
  7. Makkar RP, Mukhopadhyay S, Monga A, et al; Palmar erythema and hoarseness: an unusual clinical presentation of sarcoidosis. Med J Aust. 2003 Jan 20 178(2):75-6.
  8. 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 15 36(4):507-13. Epub 2003 Jan 30.
  9. Noble JP, Boisnic S, Branchet-Gumila MC, et al; Palmar erythema: cutaneous marker of neoplasms. Dermatology. 2002 204(3):209-13.
  10. Preda VA, Frederiksen P, Kossard S; Indurated reticulate palmar erythema as a sign of paraneoplastic palmar fasciitis Australas J Dermatol. 2009 Aug 50(3):198-201.
  11. Scheinfeld N, Spahn C; Palmar erythema due to topiramate. J Drugs Dermatol. 2004 May-Jun 3(3):321-2.
Dr Michelle Wright
Peer Reviewer:
Dr Helen Huins
Document ID:
2567 (v22)
Last Checked:
12 March 2014
Next Review:
11 March 2019

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.