Palmar Erythema

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 be found on the soles of the feet, when it is termed plantar erythema.
• It is a sign associated with many diseases but is probably most commonly seen as a normal variant.
• It can be present in individuals without an identifiable illness or underlying cause. This makes it difficult to confirm true associations between conditions and the finding of palmar erythema.
• There have been no useful surveys of its prevalence in the community or the exact incidence in specific disease populations.
• It is probably a manifestation of many underlying pathophysiological processes, the balance of which will vary between different individuals and causes. These processes include:
  • Increased cardiac output
  • Capillary dilatation in the palms due to local factors or systemic mediators
  • Localised inflammation
  • High circulating oestrogen levels
  • A toxic dermatological reaction
• It is not a very discriminative sign in terms of reaching a diagnosis, but can be useful as a marker. It may also suggest an alternative diagnoses when conducting an initial clinical assessment.

• Established:
  • Idiopathic
  • Cirrhosis
  • Chronic liver disease
  • Excess alcohol consumption
  • Pregnancy¹
  • Connective tissue disorders:
    • Particularly rheumatoid arthritis
    • Rarely sarcoidosis^2,3
    • Systemic lupus erythematosus^4,5
  • Thyrotoxicosis
  • Polycythaemia
  • Leukaemia
  • Eczema and psoriasis
• Purported or recently suggested:
  • Shoulder-hand syndrome/algodystrophy (reflex sympathetic dystrophy)
  • Associated with use of a variety of chemotherapeutic agents as early manifestation of palmar-plantar erythrodysesthesia^6,7
  • Neoplastic disease, particularly cerebral tumours⁸
  • Some antiepileptic drugs⁹
  • Infection with human T lymphotropic virus (HTLV-I) causing myelopathy/tropical paraparesis¹⁰