Palmar Erythema is a medical condition characterized by redness near the hands, or specifically the palms of the hand (hence palmar) and sometimes near the fingers. It is not a fatal condition but can be the symptom of a much bigger problem.
Getting checked by a doctor can give you the main cause of this skin disorder. This article will provide you with a detailed account of everything related to palmar erythema; from its causes, symptoms to its treatment as well as preventive measures.
What Exactly Is Palmar Erythema?
The condition of localized reddening of the skin of palms of the hands, mostly near the heels of the palm near the base of the thumb and the little finger is called palmar erythema. It can be over the hypothenar eminence or thenar eminence and fingers. It is a self-restrictive condition.
As the symptoms are limited to the palms and hands, it is not very serious to be worried about. This condition can sometimes also be found on the soles of the feet, in which case it is called plantar erythema.
Palmar erythema is considered to be of two types:
- Primary or physiological
- Secondary (to any disease states or other underlying condition)
These will be understood in detail as we learn about the causes of this medical condition.
What Causes Palmar Erythema?
As stated before, palmar erythema may be a condition by itself (primary) or a sign or a side effect of some other medical condition (secondary).
The most common causes for primary or unassociated palmar erythema are:
i. Heredity: Though very rare, in some cases, the causes for the occurrence of this condition can be genetic.
ii. Pregnancy: Pregnancy is the most common cause for palmar erythema. Thirty percent women are prone to experiencing this condition during their pregnancy. This is due to increased estrogen activity.
iii. Idiopathic Palmar Erythema: In this case, the exact cause of the disease is unknown, and the doctors are unable to diagnose the exact trigger that caused the condition.
Secondary palmar erythema occurs as a kind of a side effect or a sign of some other disease or disorder in the patient. The most common secondary causes include:
i. Auto-immune diseases: People with auto-immune disorders like HIV+ and rheumatoid arthritis have a possibility of developing this condition. According to studies, over 60% of people with rheumatoid arthritis are prone to developing this.
ii. Neoplastic disease: Particularly primary or metastatic brain neoplasms can be associated with the palmar condition.
iii. Polycythemia: This condition is characterized by an abnormally increased concentration of hemoglobin in blood and can be a potential cause for palmar erythema.
iv. Cancer: Brain cancer and other cancers can be triggers for palmar erythema.
v. Chronic mercury poisoning: Mercury poisoning is often linked to cases of palmar erythema.
vi. Congenital Syphilis: In some cases where the mother passes syphilis to her unborn child, the infant may develop this disease.
vii. Dermatological Conditions: Skin conditions like eczema and psoriasis can lead to a case of palmar erythema.
viii. Diabetes Mellitus: A diabetes patient is more likely to develop a condition of palmar erythema. 4% people with diabetes are prone to develop the condition.
ix. Kawasaki disease and endocrine disruptions: These medical conditions can cause a likely case of palmar erythema.
x. Coxsackievirus An infection: Also known as the hand, foot and mouth disease (HFMD), this viral infection can be a good cause for redness in palms.
xi. Smoking: Smoking is a very likely cause of a case of palmar erythema.
xii. Drug-induced: Drugs like amiodarone, gemfibrozil, cholestyramine, topiramate, and salbutamol, which are used for the treatment of various medical conditions, have often been known to be a cause of the occurrence of palmar erythema.
xiii. Liver disease: A chronic liver disease such as hepatitis, liver cirrhosis and Wilson disease have increased chances of developing this condition. In fact, studies have shown that 23% of people with liver cirrhosis develop palmar erythema.
The most common causes to cause the condition of palmar erythema in small children is as follows:
- Hereditary palmar erythema
- Kawasaki disease
- Wilson disease
- Congenital syphilis
- Hepatopulmonary hypertension
These were the primary and secondary causes that induce palmar erythema. Now we come to the actual physical changes or pathophysiological processes that are responsible for causing this disorder. So here are the factors that are the main culprits:
- Capillary dilation in the palms due to local factors or systemic mediators
- High circulating estrogen levels
- Localized inflammation
- Increased cardiac output
So basically, all the primary and secondary causes listed above are in some ways linked to these four basic underlying physical processes in the body. Palmar erythema is hence a manifestation of these processes, the balance of which varies as per different causes.
Features Of Palmar Erythema:
It is important to be able to differentiate between any other rash and the condition of palmar erythema. For this purpose, we characterize it as having the following features:
- No itchy feeling
- No pain
- Slightly warm to touch
- Symmetrical patches
So, if a patch satisfies all the above criteria, it is probably palmar erythema and is usually not a serious issue to be worried. In women, it can be quite normal due to fluctuation in estrogen levels, especially during pregnancy or due to contraception.
Symptoms Of Palmar Erythema
Palmar erythema can be characterized by a particular set of symptoms. However, the symptoms may differ from person to person and also depend upon whether it is primary or secondary and the actual cause of the disorder. Following are the signs and symptoms of palmar erythema:
- General redness of the palms of the hands, especially the thumb and base of the little finger. Commonly affected areas include thenar and hypothenar.
- Warmth in the palm region.
- Rash-like redness in the palm area. The degree of reddening varies from person to person.
- Inflammation of the skin without pain or itchiness.
- Blanching and molting whenever pressure is applied to the affected area.
- There might be itchiness in some cases involving pregnancy. Otherwise, there is no itchiness.
Diagnosis Of Palmar Erythema
As in case of any other disorder, the proper diagnosis of this condition plays a significant role in the treatment and healing process of the patient. A diagnosis of palmar erythema involves taking the patient’s entire medical history along with his family’s medical history first to determine if there is any possible genetic link to this condition.
Next would be a physical test to determine the extent of the disease and whether it is affecting just hands or the feet too. Also, any recent or past medications would be reviewed to know if any of those drugs have caused palmar erythema as a side effect.
After assessing the physical extent, the physician will make a list of other tests that need to be performed for a complete and accurate diagnosis.
The following workup is usually recommended for patients suffering from the condition of palmar erythema:
a. A specific liver function test – It determines the functionality of the liver in shedding toxins from the body.
b. Hepatitis B and C virus serology – To test for hepatitis
c. A CBC (complete blood count) including liver function – To identify any liver issues causing the problem
d. The range of motion tests – To test for rheumatoid arthritis
e. Glucose fasting test– A test for Diabetes mellitus
f. A blood urea nitrogen/ creatinine test – To test the liver and kidney function
g. Chest X-Ray – To test for any heart or lung issues that may cause this condition
h. Thyroid stimulating hormone test – To test for underlying endocrine disruptions
The results of these tests may require some further testing in some cases for further diagnosis of the condition or to confirm the diagnosis and rule out other complications.
In some cases the doctors may recommend other tests like ceruloplasmin, proalbumin, albumin, Cyclic Citrullinated Peptide Antibodies (CCPA), SSA, SSB, rheumatoid factor, MRI brain, CT chest/abdomen/pelvis or a bone marrow biopsy.
Treatments For Palmar Erythema
Palmar erythema is no serious disorder to be tensed about. It is a mere manifestation of certain internal processes of the body and is a non-specific condition. It can also affect healthy people with no recent or previous health conditions. In such cases, it heals itself on its own in a few days.
Hence it requires no treatment. But still, it is advised to visit a doctor in any case. As it is not painful and non-itchy, it doesn’t stand as an issue anyway.
Regarding the treatments for this condition, there is no specific treatment for palmar erythema. The symptoms disappear as soon as the underlying cause is eliminated. As for pregnant women, the condition no longer sustains after the delivery.
Similarly, the symptoms can be eliminated automatically be treating the causing factor of the condition.
In case of auto-immune related palmar erythema, use of corticosteroids helps in control of the symptoms. Also, if any other medication is the cause of the symptoms of palmar erythema, stopping that medication and using alternative medicine would automatically eliminate those symptoms.
In short, getting the right treatment for the cause of this condition will, in turn, be a treatment for palmar erythema too.
Since the condition of Palmer erythema is hardly ever a standalone condition and is mostly a side effect of some other medical condition, its treatments and preventive measures depend hugely on its contributing causes.
Hence, it can be prevented by preventing the primary or secondary conditions that are responsible for its symptoms to arise. Since smoking and alcohol consumption is closely linked to the symptoms of this condition, it is better to limit their consumption. It can significantly reduce the risk of developing this condition.
Careful monitoring of health is a must to look for symptoms of any liver problems, hepatitis, rheumatoid arthritis, cancer and lung problems that might be causing these symptoms.
Therefore, regular health check-ups would increase the chances of early diagnosis and better treatment.
Also, proper family planning goes a long way in ensuring that the child is not born with any genetic risk for developing palmar erythema.
Also, be careful of the medications you take as they may cause the redness as a side effect.
In most of the cases, prevention is not an option because the causes remain unknown. However, we must try as much as we can to avoid any carelessness on our side.
To summarize, palmar erythema is not a very serious condition and not even a painful one. Except for some discomfort, it doesn’t cause any grave harm as such. It is a condition that is still not fully understood by doctors and physicians.
Hence, much research is going on in this direction to better understand this condition. So basically, if you are a pregnant woman experiencing redness of palms, do not be tensed. It looks like a serious issue, but it is not.
It will disappear after the delivery. For others who experience this condition, don’t worry about it. It will probably go away on its own in a few days. In any case, just go to a doctor to be on the safe side.
This is advised because sometimes this can lead to an early diagnosis of a much more significant and serious underlying problem, as palmar erythema is considered as the first sign of some diseases.
An early diagnosis in such cases can facilitate initial treatment and better chances at healing. That said, palmar erythema, when considered independently, is harmless and gets resolved on its own in a while.
So if you ever experience something like this, do not panic, most of the times it is just a manifestation of some imbalance in the body. Just get yourself checked to be sure.