Palmar Erythema

Palmar erythema is characterized by a warm, reddish discoloration of the palms, particularly noticeable in the hypothenar and thenar regions. This condition can be indicative of various underlying health issues.

Palmar erythema, regardless of its initial cause, results from increased perfusion of the palms. Central to many mechanisms that lead to palmar erythema are elevated estrogen levels, increased estrogen-to-testosterone ratios, or raised circulating free estrogens.

Estrogen is known to have a proliferative effect on endometrial capillary density, and it is believed that this effect may similarly influence capillary density in the palms.

Other contributing factors may include:

• Disordered hepatic metabolism of bradykinin and other vasoactive substances.
• Abnormal cutaneous vasoconstrictor and vasodilator reflexes.

Causes of Palmar Erythema

Palmar erythema can arise from several factors, including:

1. Familial Factors:
   • In some cases, palmar erythema may have a hereditary component.
2. Liver Conditions:
   • Cirrhosis of the liver is a common cause, leading to changes in blood flow and skin appearance.
3. Rheumatological Disorders:
   • Conditions such as rheumatoid arthritis can also manifest with palmar erythema.
4. Hematological Disorders:
   • Chronic leukaemia may present with this symptom due to alterations in blood circulation.
5. Endocrine Disorders:
   • Thyrotoxicosis, or excessive thyroid hormone levels, can result in palmar erythema.
6. Vascular Anomalies:
   • An extensive collection of arteriovenous anastomoses can lead to increased blood flow to the palms.

1. Nutritional Deficiencies:
   • A painful variant of palmar erythema has been associated with dry beriberi, a condition resulting from thiamine deficiency.

Examination of Palmar Erythema

A thorough examination is essential for diagnosing palmar erythema and understanding its underlying causes:

• The clinician inspects the palms for the characteristic reddish discoloration, noting the extent and specific areas affected, particularly the hypothenar and thenar eminences.