Palmar erythema

Author: George Shand, final year medical student, University of Auckland. Chief Editor: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, September 2015.

What is palmar erythema?

Palmar erythema is redness involving the heel of the palm, and occasionally the fingers.

What are the characteristics of palmar erythema?

Palmar erythema is characteristically:

The degree of redness varies with emotional states, elevation of the hand, temperature and pressure on the palm.

What are the causes of palmar erythema?

The redness of palmar erythema is due to increased dilatation of surface capillaries in the hand. The degree of redness is often related to the severity of any underlying disease (if present). In many cases this can be related to the amount of circulating oestrogen.

Palmar erythema may be completely normal for an individual (primary), or be a sign of underlying disease (secondary).

Primary palmar erythema

Primary palmar erythema is classified as:

Secondary palmar erythema

Causes of secondary palmar erythema include:

In children, the most common causes of palmar erythema are:

Investigations for palmar erythema

The following work-up is recommended for all patients presenting with palmar erythema:

In addition to these tests, a clinician may consider ordering ceruloplasmin, proalbumin, albumin, rheumatoid factor, Cyclic Citrullinated Peptide Antibodies (CCPA), ANA, SSA, SSB, MRI brain, CT chest/abdomen/pelvis or a bone marrow biopsy.

Treatment of palmar erythema

No treatment is indicated for primary palmar erythema.

If the cause of the palmar erythema is thought to be secondary to a drug, then it may be advisable to stop it. Treatment of an underlying cause of the palmar erythema may or may not lead to improvement of the redness.

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