What Is Palmar Erythema?

Palmar erythema is a skin condition in which the palms of the hands develop a red rash. The rash is usually not itchy or painful. Palmar erythema may occur on its own, or it may occur secondarily to a more serious underlying disease. It is not harmful by itself, although it may be a warning sign of an underlying condition.

In this article, learn more about palmar erythema and its symptoms, causes, diagnosis, and treatment.

Causes

Physiologically, palmar erythema is the result of dilated capillaries, which are very small blood vessels.

The exact reason this happens is not well-known, and may differ from case to case. However, it is believed that there is an increased production of angiogenic factors, which is what causes more new blood vessels to grow.

In some cases, particularly among pregnant people, this can be caused by an increase in estrogen, as estrogen can cause vascularization.

Problems in the liver, where hormones are metabolized, may also lead to a hormone imbalance and subsequently palmar erythema.

Primary Cause

It is rare, but some people develop palmar erythema without any identifiable underlying medical condition. This is called erythema palmare hereditarium and sometimes referred to as Lane's disease.

To date there is relatively little research published on Lane's disease. It is believed to be genetic, but the exact pattern of inheritance has not yet been discovered.

Secondary Cause

It is more common for palmar erythema to occur secondarily to an underlying medical condition. Conditions that have been associated with palmar erythema include:

• Interstitial lung disease (group of diseases causing scarring of the lungs)
• Cancer
• Liver cirrhosis (late-stage scarring of the liver caused by liver disease)
• Rheumatoid arthritis and other autoimmune disorders
• Raynaud's syndrome (blood disorder affecting the fingers and toes)
• Endocrine disorders (medical condition causing a hormone imbalance)
• Alcohol use disorder
• Pregnancy
• Atopic dermatitis (eczema)
• Viral infections, like COVID-19
  

Symptoms 

The main symptom of palmar erythema is redness on both palms. The redness is usually not evenly distributed. It may appear more red on the thenar eminence (the muscular bulge by the base of the thumb), hypothenar eminence (the fleshy edge of the palm beneath the pinky), the area just beneath the fingers, and the fingertips.

In most cases, there are no other symptoms. The red area is typically not painful, itchy, irritated, or hot.

Diagnosis

Your healthcare provider can look at your palms and suspect palmar erythema. However, they will want to put you through some additional tests to rule out any other explanations and identify any possible underlying conditions.

Differential diagnosis of palmar erythema should be performed. This is the process in which a diagnosis is confirmed by ruling out other possible explanations.

In the case of palmar erythema, there are other skin conditions that can present similarly and should be ruled out first. These include:

• Allergic reactions
• Drug reactions
• Erythema
• Hand foot syndrome
• Palmoplantar pustulosis
• Dermatomyositis
• Contact dermatitis
• Cellulitis

If after this evaluation your healthcare provider still suspects palmar erythema, then they may run some tests to identify underlying conditions like an infection, autoimmune disease, liver disease, or cancer.

Treatment

There is no treatment specifically for palmar erythema. On its own, palmar erythema is benign, meaning it is not harmful to you.

However, if you are experiencing palmar erythema as the result of an underlying condition, then you may notice changes in your palms as the underlying medical condition is treated. For instance, most people who develop palmar erythema during pregnancy will find their palms return to their normal shade postpartum.

However, there is no guarantee that palmar erythema will resolve with treatment for your underlying condition. You should discuss any concerns about this with your healthcare team.

Summary

Palmar erythema occurs when the palms develop a reddish rash that is not painful or itchy. It can occur on its own, although this is rare. Usually it occurs secondarily to a variety of conditions, such as pregnancy, cancer, liver disease, and infections. Treatment involves resolving the underlying condition.

A Word From Verywell

Even if your red palms aren't bothering you, it's still worth bringing up to your healthcare provider. It might be that you have hereditary palmar erythema and there is nothing to worry about. Or, this might be a warning sign of a more serious condition. Be sure to talk about your concerns with your provider, including ruling out other skin conditions or ways to treat any underlying cause.