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What Is Palmar Erythema?

Medically Reviewed by Dan Brennan, MD on April 19, 2021

Palmar erythema is a skin condition that makes the palms of your hands turn red. It can be hereditary but can also be the result of a variety of health conditions. It’s also relatively common during pregnancy. 

Palmar erythema is also known as liver palms, red palms, or Lane’s disease.

Symptoms of Palmar Erythema

Here are some ways to know if the redness on your palms is palmar erythema:

  • It’s symmetrical — that is, the redness appears on both palms.
  • The redness is blanchable, meaning if you press on it, it goes away.
  • Your palms feel slightly warm.
  • It’s not painful and not itchy.

The redness usually involves the lower part of your palm but may extend to your fingers. In some cases, it may extend over the fingertips to the nail beds. 

If there is redness on the soles of your feet, that’s called plantar erythema.

What Causes the Redness?

Your palms have turned red because of dilated capillaries, which are the smallest blood vessels in your body. How red your palms get seems to vary with how severe the underlying disease is. Some researchers believe this has to do with increased hormone levels. 

Primary Palmar Erythema

Primary palmar erythema can be hereditary or caused by pregnancy, or it can be the result of an unknown factor. 

Pregnancy. Pregnancy is a common cause of palmar erythema. It’s estimated that it occurs in about two-thirds of lighter-skinned pregnant women and up to one-third of darker-skinned pregnant women. This may happen because of changes to your blood vessels related to an increase in estrogen production during pregnancy.

Many of the changes to your blood vessels in pregnancy are temporary and disappear soon after you give birth. 

Hereditary. Palmar erythema can be inherited, but it is a very rare condition. The redness of the palms can appear at birth or later in life and remain from then on. This may happen to at least two members of the family, but some individual cases have also been reported. 

There are no signs of inflammation, allergic reaction, or other health conditions that have been linked to palmar erythema. Only a few cases of hereditary palmar erythema have been discussed in medical literature since it was first described by John E. Lane in 1929.

Unknown origin. In some cases, palmar erythema may be idiopathic. This means that there’s no known cause and you have no other associated health conditions. 

Secondary Palmar Erythema

Secondary palmar erythema can be the result of an underlying medical condition, medication, or environmental causes. There is a large variety of possible underlying conditions that can cause it.

Liver disease. Palmar erythema is associated with several types of liver diseases. About 23% of those with liver cirrhosis have palmar erythema.

Cirrhosis happens when your liver is severely scarred and your healthy liver tissue is being replaced with scar tissue as it tries to repair itself.

Other liver diseases related to palmar erythema include rare liver diseases like Wilson Disease, an inherited disorder in which excessive amounts of copper build up in your body, and hereditary hemochromatosis, in which your body absorbs too much iron from the food you eat.

Babies and young children with liver disease are less likely to have palmar erythema than teenagers and adults. 

Autoimmune diseases.Rheumatoid arthritis is a common autoimmune and inflammatory disease that causes painful swelling in the joints and other parts of the body.

In a study of 152 people with rheumatoid arthritis, 61% were found to have palmar erythema. Another study compared patients with rheumatoid arthritis with those who had other internal diseases. Palmar erythema was significantly higher in those with rheumatoid arthritis.

Other conditions that have been associated with palmar erythema include:

Diabetes. People with diabetes tend to get skin infections, and their wounds also heal slower. An estimated 4.1% of people with Type 1 and Type 2 diabetes mellitus have palmar erythema. 

Thyroid disease. Palmar erythema affects up to 18% of those with thyrotoxicosis, which is when you have too much thyroid hormones in your blood.

Brain tumors. In a study of 107 people with brain tumours, 25% were found to have palmar erythema. The intensity of the redness depended on the type of tumor and its growth.

HIV. There has been one reported case of palmar erythema linked to HIV.

Medications. Some medications may cause palmar erythema. For example, if you take topiramate for treatment of paranoid schizophrenia. In a rare case, a pregnant woman given albuterol to prevent premature labor developed palmar erythema.

Other medications that may be linked to palmar erythema include amiodarone, gemfibrozil, and cholestyramine.

Environmental causes. Smoking, alcoholism, and mercury poisoning are some environmental causes of palmar erythema.

There are a few other possible conditions that researchers say may be associated with palmar erythema. These include:

Skin conditions. A recent case of palmar erythema in a three-year-old boy with no other problems had doctors puzzled until they learned that he had been using hand sanitizer every 20 to 30 minutes throughout the day. They determined that it was an unusual presentation of contact dermatitis.

COVID-19. Skin rashes have appeared in some people with COVID-19. In one case of a woman who tested positive for Covid-19, palmar erythema was the only symptom. She didn’t have other typical COVID-19 symptoms, nor did she have other health conditions related to palmar erythema.

How is Palmar Erythema Diagnosed?

Your doctor will be able to diagnose palmar erythema by inspecting your palms, but they’ll also review your medical history and perform a physical exam.

As there are many possible underlying disorders that can result in the redness of your palms, your doctor may order one or more diagnostic tests. These include tests that measure:

Other tests may include:

How Is Palmar Erythema Treated?

There’s no standard treatment for palmar erythema. If you have an underlying condition causing the palmar erythema, your doctor will work to treat it. If the cause is related to a medication, it’s advisable to stop it or change to a different class of drug.

WebMD Medical Reference

Sources

SOURCES:

Adolescent Medical Clinics: “Wilson's disease and hemochromatosis.”

American Family Physician: “Common Skin Conditions During Pregnancy.”

American Journal of Clinical Dermatology: “Palmar Erythema.”

Case Reports in Dermatology: “Erythema Palmare Hereditarium (‘Red Palms’, ‘Lane's Disease’).”

Cureus: “Palmar Erythema as the Sole Manifestation of COVID-19.” 

Cutis: “Palmar Telangiectases as a Manifestation of Graves Disease.”

Dermatology: “Palmar erythema: cutaneous marker of neoplasms.”

European Journal of Dermatology: “Palmar erythema: inaugural manifestation of HIV infection."

Journal of the American Medical Association: “A NOTE ON PALMAR ERYTHEMA (SO-CALLED LIVER PALMS).”

Journal of Tropical Pediatrics: “Fluctuating Palmar Erythema in a Toddler during COVID-19 Pandemic: Do You Know the Offender?.”

Mayo Clinic: “Cirrhosis.”

Pediatric Dermatology: “Lane's Disease (Erythema Palmare Hereditarium): A Report of Five Cases and a Review of the Literature.”

QJM: An International Journal of Medicine: “Palmar and plantar erythema, pulmonary fibrosis and the anti-synthetase syndrome.”

Rheumatology: Current Research: “Dermatologic Manifestations of Rheumatoid Arthritis.”

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