EpistemisPalmar erythema
Specialty: Skin.
Why it occurs
- Chronic liver cirrhosis (peripheral vasodilation induced by hyperestrogenism secondary to failure of hepatic clearance of estrogens)
- Physiological pregnancy (direct effect of high levels of circulating estrogens on the microvasculature)
- Rheumatoid arthritis (systemic inflammation and alteration of skin microcirculation)
- Thyrotoxicosis or hyperthyroidism (hyperdynamic state with notable increase in cardiac output and peripheral perfusion)
- Chronic medications such as amiodarone, gemfibrozil or chemotherapy drugs.
Initial workup
Liver function tests (AST, ALT, GGT, alkaline phosphatase, total and fractionated bilirubin, prothrombin time, serum albumin), complete thyroid profile (TSH, free T4), rheumatoid factor, anti-cyclic citrullinated peptide (anti-CCP) antibodies, and abdominal ultrasound with portal Doppler if underlying liver disease is suspected.
red flags
Coexistence with signs of advanced hepatic decompensation such as ascites, mucocutaneous jaundice, portosystemic encephalopathy (disorientation, asterixis), hematemesis due to esophageal varices or multiple ecchymoses without apparent cause.
Standard management
- There is no specific pharmacological treatment for palmar erythema per se, since it is a reflex manifestation. Spironolactone is prescribed — aldosterone antagonist if the cause is liver cirrhosis with ascites, dose of 100 mg daily
- Propranolol — non-selective beta-blocker used for the prevention of bleeding from esophageal varices in cirrhosis with portal hypertension
- Thiamazole — antithyroid indicated in case of confirmed thyrotoxicosis
- Suspension of the suspected drug in case of erythema of drug origin.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4