Author: George Shand, final year medical student, University of Auckland. Chief Editor: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, September 2015.
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).
Drug-induced palmar erythema: drugs include topiramate and salbutamol if the liver is functioning normally, or amiodarone, cholestyramine and gemfibrozil if there is liver impairment
How is the underlying cause of palmar erythema determined?
The following work-up is recommended for all patients presenting with palmar erythema:
Complete history and physical examination
Complete blood count
Liver function and blood urea nitrogen/creatinine
Hepatitis B and C virus serology
Ferritin
Fasting glucose
Thyroid stimulating hormone
Chest x-ray.
In addition to these tests, a clinician may consider ordering ceruloplasmin, proalbumin, albumin, rheumatoid factor, Cyclic Citrullinated PeptideAntibodies (CCPA), ANA, SSA, SSB, MRI brain, CT chest/abdomen/pelvis or a bone marrow biopsy.
What is the 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.
