Palmar Erythema (Liver Palms): Causes, Symptoms, Treatment & More

Introduction

Persistent redness and warmth of the palms can be concerning and may indicate palmar erythema. Although it is often benign, palmar erythema may also be associated with several underlying physiological or pathological conditions¹. 

Understanding the causes, clinical features, diagnosis, treatment, and prevention of palmar erythema can facilitate early recognition of associated disorders and guide appropriate management. 

What is Palmar Erythema?

Palmar erythema is a condition in which the palms appear red and, on applying pressure, turn pale. It may involve the fingertips, nail beds, back of the hand and, rarely, even the soles of the foot¹. The medical phrase, Palmar erythema means red palms². It mostly affects the padded part of the palms at the base of the thumb and little finger. It often involves various underlying conditions, both physiological & pathological such as liver diseases, pregnancy, rheumatoid arthritis, diabetes, and brain tumours. Palmar erythema may also occur in association with chronic alcohol use and certain medications¹.

Causes of Palmar Erythema

Palmar erythema may occur in several physiological and pathological conditions, including: 

• Pregnancy: Palmar erythema is commonly manifested during pregnancy⁴.
• Genetics: Hereditary form of palmar erythema could run in the family without any underlying condition^2,5. 
• Liver diseases: Palmar erythema is commonly known as “liver palms”. Specific liver diseases that exhibit palmar erythema include Wilson’s disease (a genetic disorder in which body fails to remove excess copper leading to its accumulation and toxic effects in the body), liver cirrhosis, haemochromatosis, autoimmune liver diseases and other chronic liver disorders¹.
• Hormonal abnormalities: Hormonal disorders such as diabetes mellitus and thyrotoxicosis have been associated with palmar erythema^6,7.
• Autoimmune diseases: Conditions like rheumatoid arthritis are strongly associated with palmar erythema⁴.
• Medications: Use of certain medicines like gemfibrozil, salbutamol, topiramate and amiodarone are known to cause palmar erythema⁴.
• Others:  Rare associations include metastatic malignancies, HIV infection and chronic pulmonary diseases such as chronic obstructive pulmonary disease (COPD)^6,8,9.

Symptoms of Palmar Erythema

Palmar erythema is characterized by the following features: 

• Redness of palms, usually involving both the palms¹⁰.  
• Palms appear pale while applying pressure and revert on releasing¹.
• No associated itching, pain or discomfort in the involved region^9,10.
• The palms may feel warm on palpation⁶.
• Often involves the padded parts of the palm and the fingers¹.

Other associated symptoms depending upon the underlying cause such as autoimmune condition, liver disease, pregnancy etc, may also be noted along with the above-mentioned symptoms. 

Risk Factors of Palmar Erythema

Some people are more likely to develop palmar erythema than others. People who are at a higher risk of developing palmar erythema include the following: 

• Pregnant women due to the change in skin’s structural and functional integrity⁴.
• Individuals at risk of chronic liver disease, including those with viral hepatitis, autoimmune liver disease or chronic alcohol use⁴.
• Hormonal imbalances as in diabetes and hyperthyroidism^1,6. 
• Medications, certain medicines (amiodarone, gemfibrozil, topiramate, etc.) are known to increase the risk of palmar erythema⁴.
• Genetics, as palmar erythema may be present since birth in those showing familial forms of palmar erythema⁵. 

How is Palmar Erythema Diagnosed?

Palmar erythema is primarily a clinical diagnosis. Once identified, evaluation should focus on determining whether an underlying systemic disorder is present. Following the clinical examination, the primary cause of palmar erythema will be evaluated by the following:  

• Physical examination and medical history: The doctor will inquire about your symptoms, past medical history, current medications, alcohol consumption, smoking habits, pregnancy (if relevant), and any current medical issues. To determine the reason for redness, they will also inspect your hands and seek for any other signs or symptoms that are relevant⁴.
• Laboratory testing: Investigations may include complete blood count, liver function tests, blood glucose, thyroid function tests, ferritin, kidney function tests, and viral hepatitis serology where clinically indicated⁶. 
• Abdominal ultrasound: To check for any liver-related conditions. 
• Chest Xray: To look for any lung-related underlying disease⁶. 

Treatment of Palmar Erythema

The specific palmar erythema, rather the treatment plan depends on the underlying cause: 

• No specific treatment is required for hereditary or pregnancy-associated palmar erythema, as these are generally benign physiological conditions⁴.
• If a medicine is responsible for causing palmar erythema, a doctor may advise stopping it or changing to another medication. In many cases, the condition is reversible & the redness gradually fades after the medicine is stopped, provided there are no other underlying conditions causing the problem. However, it is unsafe to discontinue prescribed medicines without consulting the right specialist⁴.
• Management is directed towards treating the underlying disorder, including liver disease, thyroid disorders, diabetes, autoimmune diseases, or infections⁴.
• Limiting or avoiding excessive alcohol consumption and quitting smoking are important lifestyle measures that can improve palmar erythema. These changes may help manage the underlying cause of palmar erythema and may allow the redness of the palms to gradually improve⁴.

Can Palmar Erythema Be Reversed?

Palmar erythema often improves or resolves once the underlying cause is effectively treated. However, it may persist in chronic irreversible conditions such as liver cirrhosis⁴.

Also, the hereditary form of palmar erythema often persists throughout life and does not require any treatment unless if presents along with any associated disease or symptoms^2,4.

How to Prevent Palmar Erythema?

Prevention of Palmar Erythema involves⁴:

• Managing associated health conditions, such as liver diseases, thyroid, or diabetes. 
• Taking medications as prescribed by the doctor, discussing their side effects and alternatives. 
• Abstinence from alcohol and smoking. 

Also Read: Liver Fibrosis: What Is It, Causes, Symptoms & Treatment

When to Consult a doctor?

A doctor should be consulted for palmar erythema in the following conditions⁴:

• If the redness persists or worsens: If the redness of the palms does not improve over time, becomes more noticeable, spreads or causes discomfort, consult the doctor. Persistent or worsening palmar erythema may indicate an underlying medical condition that requires evaluation. 
• If you have associated medical conditions: Patients with conditions such as liver disease, diabetes, thyroid disorders, or autoimmune diseases should seek expert medical advice if they develop palmar erythema, as it may be related to the progression or management of these disease conditions. 
• If palmar erythema develops after starting a new medication: Consult your healthcare provider if you notice redness of the palms after beginning a new medicine. Some medicines can cause palmar erythema as a side effect. Your doctor can determine whether the medication should be adjusted or replaced. Do not stop taking prescribed medications without medical advice. 
• If you are unsure of the cause: If you cannot identify why your palms have become red or if the redness is accompanied by other symptoms, seek medical evaluation. 

Conclusion

Palmar erythema is a condition in which redness of the palms occurs. Although palmar erythema is often benign, it may also serve as an important clinical sign of an underlying systemic disorder, particularly chronic liver disease. Persistent or unexplained palmar erythema warrants medical evaluation so that any associated condition can be identified and managed appropriately. 

Frequently Asked Questions (FAQs)

References

 1. Bhandari A, Mahajan R. Skin Changes in Cirrhosis. J Clin Exp Hepatol. 2022;12(4):1215-1224. doi:10.1016/j.jceh.2021.12.013 https://pubmed.ncbi.nlm.nih.gov/35814509/

2. Langenauer J. Erythema Palmare Hereditarium (‘Red Palms’, ‘Lane’s Disease’). Case Rep Dermatol. 2014;6(3):245-247. doi:10.1159/000368822 https://pmc.ncbi.nlm.nih.gov/articles/PMC4255997/

3. Liu Y, Zhao Y, Gao X, et al. Recognizing skin conditions in patients with cirrhosis: a narrative review. Ann Med. 54(1):3017-3029. doi:10.1080/07853890.2022.2138961 https://pubmed.ncbi.nlm.nih.gov/36308406/

4. Serrao R, Zirwas M, English JC. Palmar erythema. Am J Clin Dermatol. 2007;8(6):347-356. doi:10.2165/00128071-200708060-00004 https://pubmed.ncbi.nlm.nih.gov/18039017/

5. Gurioli C, Patrizi A, Lambertini M, Neri I. Lane’s Disease (Erythema Palmare Hereditarium): A Report of Five Cases and a Review of the Literature. Pediatr Dermatol. 2017;34(5):590-594. doi:10.1111/pde.13211  https://pubmed.ncbi.nlm.nih.gov/28804916/

6. Palmar erythema. DermNet®. October 26, 2023. Accessed July 14, 2026. https://dermnetnz.org/topics/palmar-erythema 

7. Lu J, Liu C, Zhou X, et al. Palmar erythema and palmar papules as predictors for dermatomyositis-related acute/subacute interstitial lung disease: a retrospective study. Rheumatology. 2021;61(1):413-421. doi:10.1093/rheumatology/keab177 https://pubmed.ncbi.nlm.nih.gov/33629112/

8. Noble JP, Boisnic S, Branchet-Gumila MC, Poisson M. Palmar erythema: cutaneous marker of neoplasms. Dermatology. 2002;204(3):209-213. doi:10.1159/000057883  https://europepmc.org/article/med/12037449

9. Palmar erythema and pruritus. Accessed July 14, 2026. https://www.aaaai.org/allergist-resources/ask-the-expert/answers/2023/palmar 

10. Sow Y, Wachuku C, Barrera T, et al. Palmar and plantar erythema: An initial presentation of undifferentiated connective tissue disease. JAAD Case Rep. 2023;35:94-97. doi:10.1016/j.jdcr.2023.03.007  https://pmc.ncbi.nlm.nih.gov/articles/PMC10147949/

11. Pesut DP, Samardzic AM, Bulajic MV, Cvok-Debeljak TT. Palmar telangiectasia is associated with the intensity of smoking. J Bras Pneumol. 2019;45(2):e20180273. Published 2019 Apr 18. doi:10.1590/1806-3713/e20180273 https://pmc.ncbi.nlm.nih.gov/articles/PMC6733739/

12. Edwards E, Yosipovitch G. Skin Manifestations of Diabetes Mellitus. [Updated 2025 Mar 21]. In: Feingold KR, Adler RA, Ahmed SF, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK481900/# 

13. Kakroo SN, Banday S, Kakroo B, Beg MA. Cutaneous Manifestations of Respiratory Diseases. International Journal of Pharmaceutical and Clinical Research 2024; 16(9); 905-913. https://impactfactor.org/PDF/IJPCR/16/IJPCR,Vol16,Issue9,Article148.pdf   

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