Palmar Erythema - An Insight

Introduction

Palmar erythema is known by other names like red palms, liver palms, or Lane’s disease. It can be caused due to hereditary reasons and also as a result of various health conditions. It is a common phenomenon during pregnancy. Affected persons may feel warmth in their hands but are not swollen, itchy, or painful. The condition itself is not harmful but can indicate an underlying serious health issue.

What Are the Factors That Affect the Degree of Redness in the Palms?

The factors that affect the degree of redness are:

• Temperature.

• Emotional state.

• Holding the arms up.

• Pressure applied to the hands.

What Are the Causes of Palmar Erythema?

The causes are as follows:

Primary Palmar Erythema:

1. Congenital Causes: Inherited forms of palmar erythema are very rare with only a few cases being reported in the medical literature. In primary palmar erythema, the redness is congenital (present at birth) and can remain throughout the life of the individual. The redness is due to the dilated blood vessels underneath the skin.

2. Pregnancy: Palmar erythema can occur in about two-thirds of pregnant women who are light-skinned and in about one-third of pregnant women who are dark-skinned. This is due to changes in the blood vessels associated with an increase in the level of estrogen hormone during pregnancy. A majority of the changes to the blood vessels during pregnancy are transitional and disappear after delivery.

3. Idiopathic: Palmar erythema can also occur due to unknown reasons and with no underlying health conditions.

Secondary Palmar Erythema: Palmar erythema can occur as a manifestation of many health conditions. It can be the initial sign of an underlying medical issue. These issues include:

1. Liver Diseases: About 23 percent of people with liver cirrhosis (long-standing liver damage that results in scarring of liver tissue and liver failure) experience palmar erythema. Other liver diseases that cause palmar erythema include hemochromatosis (presence of excessive iron in the body), and Wilson’s disease (presence of excessive copper in the body).

2. Diabetes: About 4.1 percent of diabetic people experience palmar erythema.

3. Autoimmune Diseases: Palmar erythema is common in 60 percent of people with rheumatoid arthritis (a chronic, inflammatory disorder that affects many joints such as the joints in the hands and feet).

4. Thyroid Disease: About 18 percent of people with excess thyroid hormone have palmar erythema.

5. HIV: A case of palmar erythema linked with HIV was first reported in 2017.

6. Skin Conditions: Atopic dermatitis (itchy inflammation of the skin), psoriasis (a condition resulting in the accumulation of skin cells and formation of scales, itchy, and dry patches), and eczema (a condition in which patches of the skin turn itchy, inflamed, crack, and rough) can cause palmar erythema.

7. Bacterial or Viral Infections: These include coxsackie virus (hand, foot, and mouth disease), Rocky Mountain spotted fever, and syphilis. Chronic obstructive pulmonary disease (lung disease), and brain tumors that are malignant and metastasize (spread to other body parts) could also cause palmar erythema. Palmar erythema can appear even in COVID-19 cases.

8. Environmental Causes: In case the liver function is normal, intake of medications like Topiramate, and Albuterol can cause palmar erythema. In those with impaired liver function, consumption of drugs like Amiodarone, Gemfibrozil, and Cholestyramine can cause palmar erythema to appear. Other environmental causes could be excessive alcohol consumption, smoking, and mercury poisoning.

What Are the Conditions Associated With Palmar Erythema in Children?

The associated conditions are as follows:

• Congenital syphilis (transmission of infection from a mother affected with syphilis to her baby during pregnancy).

• Wilson disease (presence of excessive copper in the body).

• Poisoning.

• Hepatopulmonary hypertension (a condition in which the blood vessels in the lungs expand and increase in number making it difficult for the red blood cells to absorb oxygen properly).

• Kawasaki disease (inflammation in the walls of certain blood vessels in the body).

What Are the Characteristic Features of Palmar Erythema?

The following are the characteristic features:

• Appears symmetrical in both hands.

• Not painful.

• Non-itchy.

• Non-irritating.

• Does not swell.

• Slightly warm.

• The redness may spread to the fingers but not anywhere else on the body. There are no additional symptoms observed.

How Can Palmar Erythema Be Diagnosed?

Palmar erythema can be diagnosed by simply observing the palms but further diagnosis is required to determine if an underlying health condition is causing the redness. A physician will take a complete medical history followed by a physical examination and can suggest one or more of the following diagnostic tests to be taken:

• Liver function.

• Blood sugar level.

• Complete blood cell count.

• Thyroid function.

• Hepatitis B, and Hepatitis C serology.

• Creatinine levels.

• Blood urea nitrogen.

• Iron levels.

• Copper levels.

• Rheumatoid factor levels.

• Computed tomography (CT) scan of the chest, abdomen, and pelvis, magnetic resonance imaging (MRI) of the brain, bone marrow biopsies, and tests for other antibodies may be suggested if required.

Palmar erythema due to unknown causes (idiopathic) will be concluded if all other probabilities have been ruled out.

Can Palmar Erythema Be Treated?

There are no treatments available to treat palmar erythema. Since an underlying medical condition causes palmar erythema in secondary palmar erythema, resolving the underlying condition could treat the redness in the palms. If palmar erythema is related to an autoimmune condition, following a short course of corticosteroid drugs as prescribed by the physician could clear the condition. If the causative factor of palmar erythema is due to drugs, one must consult a physician and take alternative drugs.

What Is the Prognosis of Palmar Erythema?

The prognosis is as follows:

• Primary palmar erythema: Symptoms can persist in hereditary cases of palmar erythema.

• Secondary palmar erythema: Treating the underlying conditions could cause the symptoms of palmar erythema to fade with time.

• In pregnancy: The redness in the palms disappears after delivery.

Conclusion

Palmar erythema is a condition in which there is redness in the palms. The causes could be congenital, secondary to other health conditions, can occur in pregnancy, or can be a result of an unknown cause. Whatever the reason may be, one must consult a physician immediately to identify any underlying health condition which needs to be treated at the earliest before any complications emerge.