Red palms, medically known as Palmar Erythema (PE), are caused by the dilation of tiny blood vessels (capillaries) beneath the skin’s surface. This increased blood flow results in symmetrical redness, usually concentrated on the heel of the palm near the thumb and little finger. While often harmless, PE can also signal an underlying health condition that requires medical attention. The redness is typically painless and non-itchy, though the affected areas may feel slightly warmer.
Physiological and Temporary Explanations
Many instances of red palms are transient, resulting from normal bodily functions that increase blood circulation. The degree of redness fluctuates with changes in body temperature, physical activity, and emotional state. When the body needs to cool itself down, blood vessels near the skin surface, including those in the palms, naturally dilate to release heat. This mechanism allows the body to dissipate excess warmth.
Vigorous physical activity or exposure to hot environments causes this temporary increase in blood flow. Strong emotional responses, such as anxiety or stress, can also trigger temporary reddening. These physiological instances resolve quickly once the trigger is removed.
Contact with common irritants can also cause temporary redness that mimics PE. Using harsh soaps or certain cleaning products can lead to contact dermatitis, resulting in localized inflammation and reddening. This redness is usually accompanied by irritation and subsides after avoiding the irritant.
Primary Palmar Erythema
Primary Palmar Erythema is diagnosed when redness is present without any identifiable medical cause or external trigger. This form is often either hereditary, known as Lane’s disease, or idiopathic, meaning its origin is unknown. It is a benign finding that does not indicate any other health concern.
In hereditary cases, the redness may be present from birth or appear during childhood. Primary PE is characterized by symmetrical redness on both palms that blanches, or temporarily fades, when pressed. This condition is considered harmless and requires no treatment.
Pregnancy is also considered a form of Primary Palmar Erythema. The significant hormonal changes, particularly the surge in circulating estrogen, cause the capillaries to dilate. This temporary redness occurs in an estimated 30% to 70% of pregnant individuals and resolves spontaneously after delivery.
Systemic Conditions Causing Red Palms
When Palmar Erythema is a symptom of another illness, it is categorized as Secondary Palmar Erythema. The redness in these cases results from altered vascular control mechanisms or elevated levels of certain hormones and vasoactive substances. This type of red palms can be an early indication of a systemic issue.
Liver Disease
Chronic liver conditions, most notably cirrhosis, are the most well-known systemic cause of red palms. Palmar Erythema is present in approximately 23% of individuals with liver cirrhosis, where healthy liver tissue is replaced by scar tissue. The diseased liver cannot efficiently metabolize and clear hormones and vasoactive substances from the blood.
One consequence is an increase in circulating estrogen levels, as the liver is responsible for breaking down this hormone. This hormonal imbalance promotes the dilation of the small blood vessels in the palms, leading to the characteristic redness. Altered metabolism of other vasodilatory substances, like nitric oxide, may also contribute to this vascular change.
Endocrine and Metabolic Conditions
Hormonal imbalances from endocrine disorders can also lead to Palmar Erythema. Individuals with hyperthyroidism may develop red palms because the excess thyroid hormone speeds up metabolism and increases overall blood flow. Up to 18% of people with excessive thyroid hormone in the bloodstream (thyrotoxicosis) show this sign.
Diabetes Mellitus is another metabolic condition associated with this symptom, affecting about 4% of patients. High blood sugar levels over time can damage the small blood vessels throughout the body, including those in the palms, contributing to the vascular changes that cause redness.
Autoimmune and Connective Tissue Disorders
Certain autoimmune diseases, where the body’s immune system mistakenly attacks its own healthy tissues, have been linked to secondary Palmar Erythema. Rheumatoid Arthritis (RA) is one such condition, with red palms occurring in more than 60% of affected individuals. The underlying mechanism is not fully understood but may involve generalized inflammation and altered vascular function.
Other connective tissue disorders, such as Systemic Lupus Erythematosus (Lupus) and Scleroderma, have also been associated with this symptom. The redness may be related to the underlying inflammatory process that affects blood vessels. Certain cancers, including brain tumors, have also been reported to cause PE due to the release of growth factors that promote new blood vessel formation.
Medications
A variety of medications have been implicated in causing drug-induced Palmar Erythema as a side effect. Certain drug classes, including antiarrhythmics (like amiodarone), cholesterol-lowering agents, and some chemotherapy drugs, can induce the redness. In some instances, the drug may affect liver function, leading to hormonal imbalances.
When to Consult a Healthcare Provider
While many cases of red palms are harmless, medical consultation is warranted if the redness is persistent, worsening, or appears alongside other concerning symptoms. Seek professional advice if the Palmar Erythema does not resolve after eliminating temporary causes, such as heat or emotional stress, or if it is a new development.
It is particularly important to see a healthcare provider if the redness is accompanied by signs of systemic illness. These warning signs include:
- Jaundice (yellowing of the skin or eyes)
- Unexplained fatigue
- Easy bruising
- Swelling in the abdomen or legs
- The appearance of spider veins on the chest or arms
These symptoms can collectively suggest liver dysfunction.
A healthcare provider will begin the investigation by taking a detailed patient history, including questions about lifestyle and medication use. Depending on the initial findings, diagnostic tests may be ordered to determine the underlying cause. Common tests include liver function panels, complete blood counts, and thyroid-stimulating hormone levels.
These blood tests help to rule out or confirm systemic diseases such as chronic liver failure or hyperthyroidism. Identifying the cause of Secondary Palmar Erythema is the first step, as treating the underlying condition often leads to the resolution or improvement of the redness.