Palmar erythema is a skin condition characterized by redness on the palms of the hands, most noticeably affecting the fleshy areas at the base of the thumb and little finger, known as the thenar and hypothenar eminences. This redness is typically symmetrical, appearing on both hands, and often feels warm to the touch. It is not painful or itchy, and when pressure is applied, the redness temporarily fades, a characteristic known as blanching. Can this redness appear and disappear, or is it a constant feature?
Understanding Palmar Erythema
Palmar erythema results from the dilation of tiny blood vessels, called capillaries, just beneath the skin’s surface in the palms. While often a sign of an underlying medical condition, it can also occur as a normal physiological variation or without any known cause. For instance, mild palm redness can be a temporary response to intense physical activity, heat, or strong emotions.
Benign situations also present with palmar erythema that is constant. Pregnancy is a common example, with 30% to 70% of pregnant individuals experiencing this condition due to increased estrogen levels and changes in blood vessels. A rare genetic form, hereditary palmar erythema (Lane’s disease), can cause permanent redness from birth or early childhood, without associated health concerns. In some instances, the cause remains unknown, referred to as idiopathic palmar erythema.
Why Palmar Erythema Can Be Intermittent
While some forms of palmar erythema are persistent, the redness can come and go in specific scenarios. This transient nature often points to temporary triggers or conditions that resolve once the underlying cause is addressed. Medications, for example, can induce palmar erythema as a side effect, which then typically fades after the drug is discontinued. Examples include some chemotherapy drugs, topiramate, antibiotics, or oral contraceptives.
Acute infections can cause intermittent palmar erythema. Conditions like Coxsackievirus A infection (hand, foot, and mouth disease) or Rocky Mountain spotted fever can cause temporary redness of the palms. Systemic inflammatory responses, such as those accompanying a fever, can cause palm redness to fluctuate. Vascular dilation is a direct, temporary reaction to the body’s response.
When Palmar Erythema is Persistent
In contrast to intermittent forms, palmar erythema can be a chronic symptom of various underlying systemic conditions. Liver disease is a cause, particularly advanced stages like cirrhosis, affecting about 23% of individuals. Other liver conditions such as Wilson’s disease or hemochromatosis also present with persistent palmar redness. The mechanism often involves hormonal imbalances, like elevated estrogen, or changes in blood flow.
Endocrine disorders, such as hyperthyroidism (thyrotoxicosis), can cause persistent palmar erythema, affecting up to 18% of those with the condition. Autoimmune diseases, including rheumatoid arthritis, show a significant association, with over 60% of affected individuals experiencing persistent redness. Cancers can also cause persistent palmar erythema as a paraneoplastic syndrome, where the redness is a remote effect of the malignancy. Other chronic causes include diabetes, polycythemia vera, and chronic mercury poisoning.
What Palmar Erythema Might Signify
While palmar erythema can be a harmless, temporary phenomenon or a benign inherited trait, its presence, particularly if new, pronounced, or persistent, can indicate underlying health issues. The degree of redness may correlate with the severity of an associated condition. If palmar erythema appears suddenly, worsens, or occurs alongside other concerning symptoms like fatigue, unexplained weight loss, jaundice, or joint pain, it warrants medical evaluation.
A healthcare professional can assess the characteristics of the palmar redness, consider a patient’s overall health history, and conduct necessary diagnostic tests to determine the cause. Early identification of the root cause allows for timely management of any underlying medical condition. Only a medical professional can accurately diagnose palmar erythema.