What are the manifestations of palmar erythema?

Palmar erythema is one of the most common clinical manifestations in patients with liver cirrhosis. Typically, it appears at the base of the thumb and little finger on the palms. So, what are the characteristic features of palmar erythema?

Features of Palmar Erythema

Skin hyperemia, redness, or red macules and patches appear on the thenar eminence (base of the thumb), hypothenar eminence (base of the little finger), and the corresponding areas of the little finger. Pressure applied to these areas results in blanching of the skin—hence the term “cinnabar palm.” Palmar erythema occurs in patients with chronic hepatitis and liver cirrhosis, primarily due to impaired hepatic inactivation of estrogen resulting from liver dysfunction, leading to elevated circulating estrogen levels and subsequent clinical manifestations.

In addition to hepatic manifestations, patients with liver cirrhosis may also develop spider angiomas. Clinically, palmar erythema is most frequently observed in patients with chronic hepatitis or liver cirrhosis, although it may occasionally occur in otherwise healthy individuals. Once palmar erythema is identified, clinicians should assess for underlying chronic hepatitis or liver cirrhosis, as recurrent or persistent chronic liver disease can progress to cirrhosis—characterized clinically by hepatic dysfunction and portal hypertension. Physical examination may reveal palmar erythema, spider angiomas, and a sallow complexion; laboratory tests often show abnormal liver function. In advanced stages, complications such as esophageal and gastric varices, upper gastrointestinal bleeding, hepatic encephalopathy, and ascites may develop.

Abnormal estrogen inactivation may also cause menstrual disturbances in women, testicular atrophy, or gynecomastia in men. Wishing you good health and happiness!