Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

Palmar Erythema is a condition in which the palms of the hands become red. It usually occurs in both palms. Redness of the palms is typically seen on the lower part of the palm (the heel). It may sometimes extend upwards to and through the fingers. The palms may also feel slightly warm. There are many causes leading to this condition, pregnancy and liver cirrhosis being the most important ones. A similar condition can occur in the feet wherein there is redness of the soles of the feet. This condition is called Plantar Erythema.

The redness of palmar erythema may resemble a rash. When pressed, the skin would turn pale.

The body temperature, physical activity and emotional state of individuals are the factors that determine the degree of redness in the disease.

Other Names

–        Liver Palms

Is Palmar Erythema a primary or a secondary condition?

Palmar Erythema can be both, primary and secondary. Though it can sometimes be a primary condition without any underlying cause, it is usually secondary i.e. caused by another medical condition. Though Palmar Erythema is not a harmful condition, the underlying conditions which cause it may be harmful especially if left untreated.

Causes and Risk Factors

Palmar Erythema is marked by the redness of the palms. This redness is caused by dilated capillaries in the hand. These in turn draw more blood to the surface (palm).

Some link hormonal changes to this condition.

Many causes and underlying risk factors contribute towards manifestation of Palmar Erythema. They vary depending on the type of erythema.

Types of Palmar Erythema

1. Primary Palmar Erythema

It is a condition or physical symptom which is not caused by any other condition. It occurs independently, all by itself. A few risk factors are also involved in the development of this condition.

Pregnancy – It is a very common cause of Primary Palmar Erythema. Rise of estrogen levels subsequent to hormonal changes during pregnancy in a pregnant woman’s body is thought to be contributory. Putting it in other words, there are likely (higher) chances that palmar erythema develops due to higher estrogen levels in pregnant women. On the other hand this redness of palmar erythema will likely disappear after pregnancy since the estrogen rise during pregnancy is temporary i.e. estrogen levels will fall down to normal levels following delivery of the child and hence the redness will vanish.

Genetics – Genetics may also contribute to primary palmar erythema in rare cases. Therefore those having family members with palmar erythema are more likely to get this condition.

Idiopathic – Sometimes palmar erythema occurs without any evident cause and is called idiopathic. In this case no underlying trigger can be traced by the physicians.

2. Secondary Palmar Erythema

When palmar erythema occurs as a symptom of some other disease it is called secondary palmar erythema. It may often be the first obvious symptom of a medical condition. As a secondary symptom it is linked to many different medical conditions.

Common conditions with which palmar erythema or redness of the palms are associated are –

Liver diseases – Many liver conditions may cause palmar erythema. They include liver cirrhosis, hemochromatosis and Wilson’s disease. This is the reason it is called Liver Palms.

Other conditions which might present redness of the palms as symptom include –

–        Hepatitis C
–        Rheumatoid Arthritis, HIV and other autoimmune conditions
–        Diabetes mellitus etc. endocrine conditions
–        Eczema, Atopic dermatitis
–        Infections (bacterial or viral)
–        Thyrotoxicosis
–        Chronic obstructive lung disease
–        Metastatic brain cancer
–        Smoking

The most common conditions to which palmar erythema in children may be linked are – Wilson disease, congenital syphilis, Kawasaki disease, hepato-pulmonary hypertension and poisoning. Genetic predisposition is also contributory in some cases.

Symptoms of Palmar Erythema

Redness – Redness of the palms of the hands is the main characteristic symptom of palmar erythema. Redness appears on both hands. There is usually no pain or itching.

Warmth – Hands may be felt to be slightly warmer by some patients but typically there is absence of irritation or swelling.

Spread – The redness and warmth of palmar erythema may spread to the fingers but will not spread to any other part of the body, and hence the name.

Other symptoms – of palmar erythema may occur in the body depending on the underlying condition. On the other hand palmar erythema itself typically does not cause any additional symptoms.

Diagnosis

Inspection – Doctors will diagnose palmar erythema just by inspecting the palms. Redness of the palms clinches the diagnosis. Anyways the doctor might advise certain other tests to rule out other underlying causes (secondary) if any. MRI or CT scans may be required to diagnose the underlying conditions causing palmar erythema in some cases.

Your doctor may take thorough history and also may enquire about the family history (if your close blood relatives too have similar symptoms).

One or more of the below mentioned tests may be helpful in confirming the diagnosis (and ruling out certain conditions) –

–        Liver function tests
–        Thyroid functions
–        Total blood cell count
–        Fasting glucose levels
–        Blood urea nitrogen
–        Creatinine levels
–        Iron levels
–        Copper levels
–        Tests to know the presence of Hepatitis B or C
–        Levels of various antibodies

Imaging tests – Your doctor may also advise imaging tests such as CT or MRI depending on the suspected underlying causes of palmar erythema. Bone marrow biopsy may also be ordered in some cases.

Palmar Erythema will be considered to be idiopathic if no evident underlying cause has been found after having tested for all other possibilities.

Treatment

There is no specific treatment to cure the redness of palms caused by palmar erythema. Diagnosing the underlying conditions and effectively treating them is the mainstay of treating palmar erythema. The redness of the palms will go away once the underlying causative condition is effectively treated.

In case redness is caused due to side effects of some medication, doctors may recommend discontinuing such medicines and recommend alternative medications.

Outlook of Palmar Erythema

Any person with unexplained redness occurring in the palms should immediately contact the doctor so that it is properly diagnosed and promptly treated. This will avoid any complications arising out of this condition.

It is crucial to diagnose the underlying cause of palmar erythema. Treating the underlying cause will often reduce the symptoms. When palmar erythema is primary i.e. has no evident underlying cause, the symptoms in spite of being persistent are harmless. One should check in with his doctor periodically if palmar erythema is a long-term condition or is recurring.

Study – One study observes that palmar erythema is a cutaneous marker of neoplasms. The results suggest that acral erythema is associated with malignant tumors and that the intensity of erythema and vascular changes of brain tumors are related. This is probably due to angiogenic factors.

Study – Yet another study suggests indurated reticulate palmar erythema as a sign of paraneoplastic palmar fasciitis and polyarthritis syndrome.

Ayurveda Understanding of Palmar Erythema

Redness of palmar erythema may occur due to abnormal / pathological increase of pitta, rakta or both either at systemic level or locally. Raaga – redness and Ushnata – increase in warmth or heat – are attributed to pitta or rakta.

Ranjaka Pitta imbalances also may contribute to palmar erythema.

Redness of the skin has been mentioned amongst the symptoms of Rakta Vriddhi – abnormal increase of blood.

Palmar Erythema is seen as a symptom in Vatarakta, which is caused by combined aggravation of vata and rakta and is often correlated with gouty arthritis and peripheral vascular diseases.

Likewise, Raaga or Rakta varnata is also found in some types of Kushta.

Raaga is also a feature of Raktavrita Vata – functions and movements of vata being obstructed by blood, Raktavaha sroto dushti – contamination of channels of transportation of blood tissue and is also a Rakta Pradoshaja Vikara – disease caused due to contamination of blood.

Though ‘palm’ has not been specifically mentioned in these descriptions, raaga and rakta varnata being generally mentioned, we need to customize its explanation to palmar erythema if found as a feature of the above-mentioned conditions along with other signs and symptoms of those disorders and also if palmar erythema is a striking feature even when generalized reddish discoloration of the body is evident.

Treatment of Palmar Erythema mainly lays in

–        addressing the underlying cause,
–        attending the primary disorder in the backdrop which is causing it,
–        to avoid the dosha aggravating or disease-causing etiological factors,
–        administration of Panchakarma therapies – including virechana, vasti and raktamokshana as and when needed and
–        proper planning of dietetic and lifestyle changes

Related Reading – ‘Palmar Erythema – Ayurveda Understanding’