Palmar Erythema (What is it, Causes, Symptoms, Treatment)

Palmar erythema, also called PE, liver palms or simply red palms, is a redness of the skin that usually shows up on the heel of the palm and sometimes around the edges of the palm and fingers.

It is often not painful and not itchy, but the warmth and redness can still feel a bit unsettling. I get it — any sudden change in your hands can make you wonder what your body is trying to tell you.

The important thing to know is that palmar erythema is not a disease by itself. It is a sign, and sometimes that sign is completely harmless, while other times it can point to something else going on, such as pregnancy, liver disease, thyroid disease, autoimmune disease or a medication side effect.

This article walks through what palmar erythema looks like, why it happens, when to get checked and what treatment usually involves.

What Causes Palmar Erythema?

Palmar erythema happens when the small blood vessels near the surface of the palms become widened, or dilated. As explained in a review from the American Journal of Clinical Dermatology, this extra blood flow gives the skin its red or pink appearance.

The redness may also blanch, which means it turns lighter or white when you press on it and then returns when you let go. That little detail is one reason doctors can often recognize palmar erythema just by looking at the hands.

How red the palms look can vary a lot from person to person. Skin tone, body temperature, pregnancy hormones, medications and underlying health conditions can all make the redness more or less noticeable.

The most commonly affected areas include:

• The heel of the palm, especially near the wrist.
• The outer edges of the palm.
• The fleshy areas at the base of the thumb and little finger.
• The fingertips, in some cases.

In rarer situations, the soles of the feet may also become red, as noted by GPnotebook. This is sometimes called plantar erythema.

Primary vs. Secondary Palmar Erythema

Palmar erythema is usually grouped into two categories: primary and secondary. DermNet describes primary palmar erythema as redness that occurs without another disease causing it, while secondary palmar erythema is linked to an underlying condition, medication or exposure.

Short answer: primary is often harmless, while secondary deserves more detective work.

Primary Palmar Erythema

Primary palmar erythema can happen for a few reasons, and sometimes there is no clear reason at all. This is one of those medical situations where “we don’t know yet” is a real answer, although not always a satisfying one.

• Heredity. Some people simply have a family tendency toward red palms. In these cases, palmar erythema may appear without any illness behind it.
• Pregnancy. Palmar erythema is fairly common during pregnancy and is thought to be related to higher estrogen levels and increased blood flow. What to Expect notes that red palms and soles can occur during pregnancy, and the good news is that it usually improves after delivery.
• Idiopathic palmar erythema. “Idiopathic” is the medical way of saying there is no identifiable cause. A clinical discussion from GP Online has also described cases where no underlying disease is found.

To be clear, primary palmar erythema is not usually dangerous. But it is still worth confirming with a health care professional, especially when it is new, worsening or paired with other symptoms.

Secondary Palmar Erythema

Secondary palmar erythema is more important to investigate because it can be tied to another health issue. That does not mean you should panic, but it does mean you should not just keep staring at your hands and hoping Google will make you feel better.

Commonly reported triggers and associated conditions include:

• Liver disease. Palmar erythema has a long association with chronic liver disease and cirrhosis, which is why it is sometimes called “liver palms.” A report in The American Journal of Medicine describes palmar erythema as one of the possible skin signs seen in liver disease, and people with fatty liver disease or other liver problems should mention red palms to their clinician.
• Hepatitis B or hepatitis C. Chronic hepatitis can affect liver function and may be associated with skin changes, including palmar erythema. The Hepatitis B Foundation has also discussed palmar erythema in connection with hepatitis-related liver disease.
• Rheumatoid arthritis and other autoimmune diseases. People with rheumatoid arthritis, lupus and some other immune-related conditions may develop palmar erythema. Research has also reported the condition in connection with arthritis and lupus.
• Thyroid disease and endocrine changes. Thyroid disorders can affect circulation and skin appearance, and they are often considered during an evaluation.
• Diabetes. Diabetes and other metabolic conditions may be part of the workup, especially when symptoms such as increased thirst, frequent urination, fatigue or slow wound healing are also present.
• Skin conditions. Eczema, psoriasis and other inflammatory skin problems can also cause red, irritated hands. This is where the details matter, because those conditions usually come with scaling, cracking, itching or a more obvious rash.
• Lung disease. Some chronic lung conditions have been reported alongside palmar erythema, although this is less common.
• Certain cancers or tumors. This is not the most common cause, but palmar erythema has been described in association with some neoplasms, which is the medical term for abnormal tissue growths or tumors.
• Congenital infections. Congenital syphilis has historically been listed among possible causes in infants.
• Medication side effects. Some medications may cause red palms as a side effect, especially drugs that affect the liver, circulation or immune system. Drug safety databases such as SIDER have cataloged palmar erythema among reported adverse effects, and research has also described it with the medication topiramate.
• Alcohol use and smoking. Excess alcohol can damage the liver, and regular smoking may worsen circulation and overall health. Heavy drinking alcohol is especially important to discuss because it can be tied to liver-related palmar erythema.
• Toxin or mineral buildup. Conditions such as Wilson’s disease, which causes copper to build up in the body, may be considered when symptoms and lab results point in that direction.

That is a long list, I know. But the point is not to assume the worst; the point is to find out whether your red palms are just red palms, or whether they are a clue worth following.

Symptoms: What Palmar Erythema Looks and Feels Like

Palmar erythema has a fairly specific appearance, although it can still be confused with other hand rashes. The redness is usually symmetrical, meaning it affects both hands in a similar way.

Common signs include:

• Red or pink discoloration of the palms.
• Redness along the heel of the palm or outer edges.
• Warmth in the affected areas.
• Mild swelling, in some cases.
• Blanching when pressure is applied.
• Little to no pain.
• Little to no itching, unless pregnancy or another skin condition is involved.

Palmar erythema is not the same as a typical rash, although it can certainly look rash-like. A true rash may involve bumps, blisters, peeling, crusting, pain or intense itching, which should prompt a different kind of evaluation.

Worth noting: red hands after heat, exercise, spicy food, alcohol or emotional stress can be temporary flushing. Palmar erythema, on the other hand, tends to be more persistent.

When Should You See a Doctor?

New palmar erythema is worth mentioning to your health care provider, especially if it does not go away or you cannot connect it to pregnancy, heat or a known medication. I would be especially cautious if the redness arrived suddenly or has been getting more noticeable.

Make an appointment sooner if you also have:

• Yellowing of the skin or eyes.
• Dark urine or pale stools.
• Unexplained fatigue, nausea or loss of appetite.
• Abdominal swelling or pain, especially on the right side.
• Joint pain, swelling or morning stiffness.
• Unexplained weight loss.
• Shortness of breath or chest symptoms.
• Fever, peeling skin, blisters or painful swelling.

Those symptoms do not automatically mean something serious is happening. But they are absolutely good reasons to stop guessing and get checked.

How Palmar Erythema Is Diagnosed

Diagnosing palmar erythema often starts with something very low-tech: a careful look at your hands. Your doctor will usually check where the redness appears, whether it affects both hands, whether it blanches with pressure and whether there are signs of a separate skin condition.

From there, the medical history matters a lot. Expect questions about pregnancy, family history, alcohol intake, recent infections, known liver disease, autoimmune symptoms and all medications or supplements you take.

Depending on what your doctor finds, testing may include:

• Complete blood count. This can help screen for anemia, infection and other blood-related clues.
• Liver function tests. These typically measure enzymes and proteins that help show how the liver is working.
• Bilirubin, albumin and clotting tests. These may be added when liver disease is a concern.
• Blood urea nitrogen and creatinine. These help evaluate kidney function, and WebMD explains that BUN is one marker doctors use to look at how well the kidneys and liver are handling waste products.
• Hepatitis B and C testing. This helps rule in or rule out viral hepatitis.
• Fasting glucose or A1C. These tests look for diabetes or blood sugar problems.
• Thyroid-stimulating hormone test. This is commonly used to screen thyroid function.
• Autoimmune testing. Depending on symptoms, this may include tests for rheumatoid arthritis, lupus or other inflammatory conditions.
• Iron, copper or other mineral studies. These may be considered when conditions such as hemochromatosis or Wilson disease are possible.
• Chest X-ray or other imaging. This is not needed for everyone, but it may be ordered when lung, heart or cancer-related concerns are on the table.

As noted in StatPearls, palmar erythema is generally a clinical finding, but the workup depends on the person sitting in front of the clinician. In other words, the hands are only one part of the full story.

Treatment Options

There is no single cream, pill or home remedy that treats palmar erythema itself. Treatment is based on the cause, which is exactly why identifying the cause matters.

For pregnancy-related palmar erythema, symptoms usually fade after delivery as hormone levels shift. Not the most glamorous pregnancy symptom, but at least it is usually temporary.

For liver-related palmar erythema, treatment focuses on the liver condition. That might mean managing hepatitis, reducing or stopping alcohol intake, addressing fatty liver disease, reviewing medications or working with a liver specialist.

For autoimmune-related palmar erythema, treatment depends on the diagnosis and severity. In some cases, short courses of medications such as corticosteroids may be used, but this is something that needs clinician guidance, not a DIY experiment.

When a medication is suspected, your doctor may decide to adjust the dose, switch medications or monitor symptoms. Please do not stop a prescribed medication on your own, even if you are convinced it is the culprit.

Moisturizers may help if your hands are dry or irritated, but they usually will not make true palmar erythema disappear. Cooling the hands, avoiding harsh soaps and limiting heat exposure may bring some comfort, especially when warmth is bothersome.

Clinical Research and What We Still Do Not Know

Palmar erythema is well recognized, but it is still not fully understood. That is one reason you will see it described in research connected to several very different conditions.

Case reports and studies have looked at palmar erythema as an overlooked clinical sign, as well as its relationship with pregnancy and pregnancy-related liver function. Research has also described palmar erythema in connection with drug and alcohol use, sarcoidosis and HTLV-1 infection.

The bigger takeaway is that palmar erythema should be interpreted in context. Red palms alone may mean very little, but red palms plus abnormal liver tests, joint swelling or other symptoms can mean something quite different.

Can Palmar Erythema Be Prevented?

There is no guaranteed way to prevent primary palmar erythema, especially when it is inherited, pregnancy-related or idiopathic. You cannot exactly out-lifestyle your genetics or pregnancy hormones.

That said, you can reduce the risk of some secondary causes by taking care of the conditions most often linked with it. This is the part that is less exciting than a quick fix, but usually much more useful.

• Limit alcohol, especially if you already have liver concerns.
• Avoid smoking and ask for support if quitting feels difficult.
• Follow through on routine blood work when recommended.
• Get evaluated and treated for hepatitis B or C when appropriate.
• Manage diabetes, thyroid disease and autoimmune conditions with your clinician.
• Review medications with your doctor or pharmacist if red palms appear after starting something new.
• Use gentle soaps and moisturizers to reduce irritation, even though this will not treat the underlying vascular redness.

Careful monitoring of overall health can also catch bigger problems earlier. And honestly, that is where palmar erythema can sometimes be helpful — not because the redness itself is dangerous, but because it may push someone to get checked before a related condition has progressed.

Bottom Line

Palmar erythema is usually a sign of increased blood flow in the palms, not a disease on its own. It can be harmless, especially during pregnancy or when it runs in families, but it can also be linked to liver disease, autoimmune disease, thyroid issues, diabetes, medications or other medical conditions.

The best next step is a practical one: pay attention to whether the redness is new, persistent, symmetrical and paired with other symptoms. Then bring that information to a health care provider rather than trying to diagnose it from photos online.

For some people, the answer will be reassuring and simple. For others, palmar erythema may be the early clue that helps uncover something worth treating — and that is a clue I would not ignore.