Palmar erythema is a redness of the palms that appears on both hands symmetrically, most noticeable on the fleshy base of the palm near the thumb and pinky finger. It’s not a disease on its own but a physical sign that can point to an underlying condition, a normal hormonal shift, or sometimes nothing at all. The redness blanches, meaning it temporarily disappears when you press on it, then returns when you release.
What It Looks Like
The redness typically concentrates on the lower part of the palm, especially the heel of the hand and the mounds at the base of the thumb and little finger. In some people it extends upward into the fingers or even to the fingertips and nail beds. Both palms are affected equally, which helps distinguish it from a localized rash, burn, or allergic contact reaction that would usually appear on just one hand or in an asymmetric pattern.
Palmar erythema is usually painless. You might notice warmth in your palms along with the color change, but itching and discomfort are uncommon unless the redness is caused by an allergic reaction or a separate skin condition like eczema.
Why the Palms Turn Red
The redness comes from dilated blood vessels near the surface of the skin. In many cases, the trigger is elevated estrogen. Estrogen causes the tiny capillaries in the palms to widen, increasing blood flow and producing that visible flush. This is the mechanism behind palmar erythema in both liver disease and pregnancy, the two most commonly discussed causes.
In liver disease, the connection is straightforward: a healthy liver breaks down estrogen as part of normal hormone regulation. When the liver is damaged, it can no longer inactivate estrogen efficiently, so levels rise and the palms flush. In pregnancy, the body naturally produces more estrogen to support fetal development, and the palms respond the same way. Some solid tumors can also produce estrogen or other growth factors that dilate blood vessels, leading to the same appearance.
Common Causes
Pregnancy
Palmar erythema is one of several normal skin changes during pregnancy, alongside stretch marks, spider veins, and skin darkening. It occurs in at least 30% of pregnant women and is driven by the natural rise in estrogen and increased blood volume. It typically resolves on its own after delivery as hormone levels return to normal and requires no treatment.
Liver Disease
About 23% of patients with liver cirrhosis develop palmar erythema regardless of what caused the cirrhosis, whether alcohol, hepatitis, or fatty liver disease. The redness results from abnormal estrogen-to-testosterone ratios that develop as the liver loses function. In this context, palmar erythema often appears alongside other signs like spider-shaped blood vessels on the chest, yellowing of the skin, or swelling in the abdomen. If your palms are persistently red and you have risk factors for liver problems, that combination is worth investigating.
Hereditary and Idiopathic
Some people simply have red palms with no underlying disease. This can run in families, a condition sometimes called erythema palmare hereditarium. When no family pattern or medical cause is found after evaluation, doctors classify it as idiopathic, meaning it exists on its own without a known trigger. In these cases, the redness is a cosmetic finding and nothing more.
Other Medical Conditions
A range of systemic conditions can produce palmar erythema. These include rheumatoid arthritis and other autoimmune diseases, hyperthyroidism, diabetes, and chronic lung disease. In children specifically, the list also includes Kawasaki disease, connective tissue disorders, and even certain heavy metal exposures. The common thread is that each of these conditions can alter blood flow, hormone levels, or inflammatory signaling in ways that dilate the small blood vessels in the palms.
Medications
Certain drugs can trigger palmar erythema through two different paths. Some cause it by damaging the liver, which then fails to clear estrogen normally. Amiodarone (a heart rhythm medication), gemfibrozil (a cholesterol drug), and cholestyramine fall into this category. Others cause palm redness even with normal liver function. Albuterol, a common asthma inhaler, and topiramate, used for seizures and migraines, are the most well-documented examples. If you notice new palm redness after starting a medication, it’s worth mentioning to your prescriber.
How It’s Diagnosed
Palmar erythema is identified visually. The key features are symmetry (both palms), blanchability (fades with pressure), and the characteristic distribution on the lower palm. The more important diagnostic step is figuring out why it’s there.
Your doctor will likely start by asking about your medical history, medications, alcohol use, and whether you’re pregnant or could be. Blood tests to assess liver function and hormone levels are a typical next step if the cause isn’t obvious. Depending on what those results show, additional testing might follow. For someone who is otherwise healthy, with no abnormal lab results and no other symptoms, the diagnosis often lands on idiopathic or hereditary palmar erythema.
Treatment and What to Expect
Palmar erythema itself doesn’t get treated directly. There’s no cream or procedure that targets the redness. Instead, management focuses entirely on the underlying cause. If liver disease is responsible, treating or managing the liver condition is the path forward, and the redness may improve as liver function stabilizes. If a medication is the culprit, switching to an alternative can resolve it. If pregnancy is the cause, the redness fades after delivery without any intervention.
For hereditary or idiopathic cases, there’s no treatment needed because there’s no disease driving the redness. The palms stay red, but it’s harmless. Some people find the appearance bothersome, but the condition doesn’t progress, cause pain, or lead to complications on its own. The redness is simply a visible marker of increased blood flow in the palms, and when it exists in isolation, it carries no health risk.