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Palmar Erythema

Palmar erythema can be defined as the reddening of the palmar surface of the hand, more specifically of the thenar and hypothenar eminence. It is possible that, in some cases, the erythema extends to the fingers. Some patients present a similar change on the soles of their feet. As you will have the opportunity to read below, palmar erythema can be caused by a number of medical problems. However, it can also be a normal finding, without any pathological background.


palmar erythema

The condition can appear on its own or as a symptom of an underlying medical condition. The primary form of palmar erythema is attributed to heredity but it can also appear in women who are pregnant or as an idiopathic form (of unknown cause). As you will have the opportunity to read below, there are a number of medical conditions that have palmar erythema among their symptoms, such as cirrhosis of the liver.

Characteristics of Palmar Erythema

The palmar erythema has a number of characteristics, which can be used to guide the diagnosis in the right direction. The reddening is symmetrical, appearing in both hands. At the same time, the condition does not cause itchiness and neither pain or discomfort. Because of the increased blood flow in the area, it is possible that the area of the palm affected by the erythema is slightly warm. Emotions, anxiety or fear might aggravate the reddening of the palms. The same goes in case of excessive temperatures and pressure applied to the palm.

What are the Causes of Palmar Erythema?

These are the main causes that can lead to the appearance of palmar erythema:

  • Portal hypertension – high blood pressure at the level of the portal vein system
  • Chronic liver disease – cirrhosis or chronic hepatitis
  • Pregnancy – the palmar erythema appears because of the increased blood flow to the extremities + increased level of circulating estrogen
  • Polycythemia – increased quantity of red blood cells in the blood
  • Thyrotoxicosis – occurs in patients who suffer from hyperthyroidism, due to the increased levels of thyroid hormones
  • Rheumatoid arthritis – autoimmune disorder in which the joints are affected
  • Eczema – inflammation at the level of the skin, occurring most commonly as an allergic reaction
  • Psoriasis – autoimmune disease characterized by the excessive turnover of the skin
  • Deep telangiectasia – small dilated blood vessels, affecting either the skin or the mucous membranes
  • Hand, foot and mouth disease – highly contagious infectious disease, caused by the infection with the coxsackievirus A
  • Rocky Mountain spotted fever – infectious condition caused by Rickettsia rickettsii, a bacteria spread by ticks
  • Secondary syphilis – sexually transmitted infection, occurring at several weeks after the primary infection
  • Kawasaki disease – autoimmune disease, in which the blood vessels throughout the body suffer from an inflammatory process

Other causes

  • Rare neonatal liver disease
    • Wilson disease (rare autosomal recessive inherited disorder of copper metabolism)
    • Hereditary hemochromatosis (disorder in which the body absorbs excessive quantities of iron from the diet)
  • Diabetes mellitus (metabolic disease, characterized by high levels of insulin for a prolonged period of time)
  • Myelopathy (degenerative condition with neurological deficit at the level of the spinal cord)
  • Drug-induced (amiodarone, gemfibrozil, cholestyramine – hepatic damage; Topiramate, albuterol – normal liver function)
  • Metastatic and primary brain neoplasms
  • Solid tumors (increased level of angiogenic factors and estrogens)
  • Atopic diathesis (predisposition to develop one of the following medical conditions: atopic dermatitis, bronchial asthma, allergic rhinitis or hay fever)
  • Smoking
  • Chronic mercury poisoning
  • Oral contraception
  • Sarcoidosis (multisystem inflammatory disease, in which granulomas, abnormal collections of inflammatory cells, form as nodules in multiple organs; the palmar erythema appears as an unusual manifestation of the condition)
  • Shoulder-hand syndrome/algodystrophy (reflex sympathetic dystrophy)
  • Chemotherapeutic agents
  • Antiepileptic drugs
  • Tropical paraparesis (medical condition resulting from the infection with the human T-lymphotropic virus)
  • Leukemia (cancer that occurs at the level of the bone marrow)
  • Chronic febrile disease (infectious disease).

Pictures of Palmar Erythema

palmar erythema pictures

palmar erythema pictures 2

palmar erythema pictures 3

Diagnosis

These are the most common methods used for the diagnosis of the underlying conditions:

  • Complete medical history of the patient
    • When did the symptoms appear for the first time
    • Similar problems in the past
    • Chronic illnesses
    • Family history of illnesses (inherited conditions)
    • Current and past medical treatments (including surgical interventions)
    • Unexplained weight loss in the past couple of months (suggestive of cancer)
  • Physical examination
    • Assessment of erythema at the level of the palms
    • Assessment of the soles of the feet (whether or not erythema is present there)
    • Identification of other physical signs suggestive of underlying conditions (for example, jaundice in case of hepatic disease or muscular weakness in tropical paraparesis)
    • Assessment of range of motion and muscular force (in case of rheumatoid arthritis) – determine how much functionality the patient has left (determines the severity of the condition)
  • Complete blood count
  • Liver enzymes (their levels are suggestive of the liver function; in the situation that the patient suffer from chronic liver disease, the levels of these enzymes are increased)
  • Levels of urea nitrogen and creatinine in the blood
  • Serology for hepatitis (hepatic virus B or C)
  • Ferritin levels
  • Glucose measurement (fasting – level suggestive of diabetes)
  • Thyroid stimulating hormone (identification of hyperthyroidism)
  • Erythrocyte sedimentation rate
  • Chest X-ray
  • Palmar skin biopsy – used for the confirmation for the diagnosis
  • Other investigations
    • Ceruloplasmin
    • Proalbumin
    • Albumin
    • Rheumatoid factor
    • CCPA (cyclic citrullinated peptide antibodies)
    • CT scan (chest, abdomen, pelvis)
    • MRI
    • Bone marrow biopsy.

Treatment

There is no treatment recommended for the palmar erythema. However, if the underlying condition is treated or kept under control, the palmar erythema is going to disappear as well. In the situation that the palmar erythema appears as a side-effect of medication, it is recommended that the treatment is either stopped or the medication changed with one that does not have such side-effects. Many of the autoimmune diseases which are associated with palmar erythema can be successfully kept under control with corticosteroids (prednisolone). However, the treatment cannot be administered for prolonged periods of time, due to the negative side-effects this medication can have over a person’s health.

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