Palmar erythema, often referred to as red palms, is a dermatological sign characterized by the reddening of the skin on the palms. This coloration results from the dilation of the small blood vessels, or capillaries, located just beneath the skin’s surface. The condition typically involves both hands and may feel slightly warmer to the touch. Understanding the cause of this increased blood flow is necessary, as the symptom can range from a harmless, temporary reaction to a sign of an underlying systemic health issue.
Acute and Environmental Causes
Red palms can often be traced to non-pathological, transient factors that increase blood flow to the extremities. Engaging in intense physical exertion or manual labor increases core body temperature and blood circulation, which naturally causes superficial capillaries to widen. This temporary vasodilation helps the body dissipate excess heat, often manifesting as flushed palms that quickly return to their normal color once the body cools.
Exposure to extreme heat or cold can also trigger this temporary flushing as the body attempts to regulate its temperature. Intense emotional states, such as stress or anxiety, can induce a systemic adrenaline response that causes temporary flushing in the skin. Certain topical irritants or chemicals, like those found in harsh soaps or cleaning products, can cause mild contact dermatitis, resulting in localized, temporary redness and irritation on the palms.
In some cases, the redness is simply a hereditary trait, known as primary palmar erythema, which is present from birth or early childhood. This inherited form is considered benign and does not require medical treatment. These causes are not indicative of a chronic systemic disease.
Palmar Erythema and Liver Function
When palmar erythema becomes chronic and persistent, it frequently points toward an underlying health concern, most notably chronic liver disease. The association between red palms and liver conditions such as cirrhosis is significant, with approximately 23% of individuals exhibiting this sign. This manifestation is sometimes referred to as “liver palms” due to this strong clinical link.
The mechanism centers on the liver’s impaired metabolic functions, which leads to a hormonal imbalance. A damaged liver cannot effectively break down sex hormones, resulting in elevated levels of estrogen in the bloodstream. This state of hyperestrogenemia is thought to be the primary driver of the vascular changes observed in the palms.
The excess estrogen activates nitric oxide synthase, which increases the production of nitric oxide. Nitric oxide is a potent vasodilator, and its increased concentration causes the small arteries and capillaries in the palms to expand significantly. This chronic vasodilation leads to a deep, persistent redness that is typically symmetrical on both hands. The redness is often most concentrated on the thenar and hypothenar eminences, the fleshy areas at the base of the thumb and little finger.
Hormonal and Autoimmune Conditions
Chronic palmar erythema can be a manifestation of other systemic conditions, including hormonal shifts and autoimmune disorders. Hormonal changes are a common cause, particularly during pregnancy, where the condition is observed in up to 70% of women. The dramatic increase in circulating estrogen levels and the overall increase in blood volume promote generalized vasodilation, resulting in the characteristic redness. This form is temporary and generally resolves shortly after childbirth.
Another endocrine cause is hyperthyroidism, involving an overactive thyroid gland. Hyperthyroidism accelerates the body’s metabolism, leading to increased peripheral blood flow and elevated body temperature. The resulting widespread vasodilation can manifest as palmar erythema, affecting about 18% of individuals with excess thyroid hormone.
Autoimmune and connective tissue diseases represent a different category of systemic causes driven by inflammatory processes. Rheumatoid arthritis (RA), a chronic inflammatory disorder, is a frequent association. The inflammation and vascular changes characteristic of RA contribute to the dilation of palmar capillaries. Other autoimmune conditions, such as Systemic Lupus Erythematosus or Psoriasis, can also cause palmar erythema through similar inflammatory pathways. Chronic dermatological conditions like severe eczema (atopic dermatitis) can also cause persistent inflammation localized to the hands.
When to Consult a Healthcare Professional
While temporary redness is often harmless, persistent or progressive palmar erythema warrants a medical evaluation to rule out underlying systemic disease. A visit to a healthcare professional is advisable if the redness has been present for weeks or months and does not resolve after eliminating environmental triggers.
Seek medical advice if the red palms are accompanied by other systemic symptoms. These warning signs include chronic fatigue, unexplained weight loss, easy bruising or bleeding, abdominal swelling, or jaundice (a yellowing of the skin or eyes). Joint pain, shortness of breath, or a persistent fever are also concerning co-occurring symptoms.
Redness that only appears on one hand, known as unilateral palmar erythema, is another specific sign that requires prompt investigation. A medical professional can conduct a physical examination and order blood tests, such as liver function panels, to determine the cause. Addressing the underlying condition is the only way to resolve the secondary symptom of palmar erythema.