Red Palms (Palmer Erythema): Causes, Symptoms, Treatment

Palmar erythema, sometimes called liver palms, is when both of your palms turn red. This redness usually doesn’t hurt or itch, but your hands might feel warm.

Palmar erythema sometimes has no clear cause, but it can also occur due to health conditions like liver disease, thyroid problems, or diabetes.

If your palms suddenly become red, the redness doesn’t go away, or you experience symptoms like fatigue, joint pain, or yellowing skin, talk to a healthcare provider to learn the cause.

Palmar erythema occurs when capillaries (tiny blood vessels) in the hands widen, increasing blood flow to the skin. Primary palmar erythema occurs on its own, while secondary palmar erythema is a symptom of another condition.

Primary Palmar Erythema

Primary palmar erythema occurs without an underlying disease or environmental trigger. There are three types of palmar erythema:

• Idiopathic: This type happens randomly with no clear reason. Experts don’t know exactly why it occurs. Since it doesn’t cause health problems, there is little research about this type.
• Hereditary (Lane’s disease): This runs in families and usually appears at birth or during childhood. However, it may occur later in life. It can appear in every generation or skip generations. Researchers believe many cases go unnoticed because the condition is harmless.
• Pregnancy-related: During pregnancy, about 33% of people with darker skin and 66% of people with lighter skin develop palmar erythema. This happens due to an increase in estrogen and blood flow, which causes temporary widening of the blood vessels. Pregnancy can also trigger autoimmune conditions that may lead to red palms. Palmar erythema in pregnancy is usually harmless and goes away after childbirth.

Secondary Palmar Erythema

Secondary types occur due to health conditions that cause liver problems, hormone imbalances, or inflammation (swelling and irritation), widening the small blood vessels. 

Liver Disease

Cirrhosis occurs when the liver becomes scarred from long-term damage, making it stiff and unable to function correctly. When the liver doesn’t work well, estrogen levels rise, causing blood vessels to widen and turn the palms red. Cirrhosis can develop due to hepatitis (inflammation of the liver), alcohol use, viral infections, toxins, or fatty liver disease.

Other liver diseases linked to palmar erythema include Wilson’s disease (a rare condition that causes copper buildup) and hereditary hemochromatosis (where the body absorbs too much iron).

Autoimmune Disorders 

Autoimmune disorders happen when your immune system mistakenly attacks your body, causing inflammation and organ damage. If this affects your liver, you may develop autoimmune hepatitis, which can lead to blood vessel changes and red palms.

If an autoimmune condition is causing your palmar erythema, the redness may not go away and can worsen over time. You may also notice joint pain, fatigue, or skin rashes. Some autoimmune conditions linked to red palms include:

• Autoimmune hemolytic anemia: Destroys red blood cells, leading to fatigue and pale skin
• Juvenile dermatomyositis (JDM): Causes muscle inflammation and skin rashes in children 
• Raynaud phenomenon: Narrows blood vessels in response to cold, reducing blood flow and turning the skin white or blue; when the vessels reopen, increased blood flow can cause redness
• Rheumatoid arthritis: Causes joint pain and swelling
• Sarcoidosis: Causes small lumps of inflamed tissue in different organs
• Scleroderma: Thickens and tightens the skin, which can affect blood flow
• Systemic lupus erythematosus (lupus): Affects the skin, joints, and organs
• Undifferentiated connective tissue disease (UCTD): A mild autoimmune condition that causes joint pain, fatigue, or changes in skin color, though findings don’t point to a specific disease

Skin Conditions

Several skin conditions can cause redness on your palms. These include:

• Eczema: Leads to dry, itchy, and inflamed skin, which may affect your hands
• Psoriasis: An autoimmune disease that causes red patches with silvery scales that can appear on the palms
• Contact dermatitis: Happens when your skin reacts to irritants or allergens, leading to redness and inflammation; frequent use of hand sanitizers or harsh soaps can trigger this reaction
• Erythromelalgia: A rare condition that causes burning pain, redness, and warmth in the hands or feet due to abnormal blood vessel function

Hormone Disorders

Hormonal imbalances from endocrine disorders can affect blood circulation and blood vessels, leading to palmar erythema.

Hyperthyroidism (overactive thyroid) increases thyroid hormone levels, which speeds up metabolism and blood flow, making redness more noticeable. Diabetes keeps blood sugar too high for too long, damaging blood vessels and reducing circulation.

Infections

Some viral and bacterial infections cause widespread inflammation, which can irritate and widen blood vessels, leading to red palms. Infections linked to palmar erythema include:

• Brucellosis: A bacterial infection from unpasteurized dairy
• Gestational syphilis: A syphilis infection passed from mother to baby
• Hepatitis B, C, or D: Viral infections that cause liver damage
• Human T-lymphotropic virus-1 (HTLV-1) myelopathy: A virus that affects the spinal cord
• Trichinellosis: A parasitic infection from undercooked meat
• Kawasaki disease: A rare illness—maybe from an infection or environmental trigger like cleaners—that causes swelling in the blood vessels, mostly in young children

Environmental or Lifestyle Factors

Smoking, alcohol use, and heavy metal poisoning (such as with mercury) can affect the liver and blood flow, causing palmar erythema.

Certain medications can have the same effect on the liver and blood flow, also causing red palms. These medications include:

• Antiarrhythmics: Regulate heart rhythm; Pacerone (amiodarone) is an example
• Anticonvulsants: Prevent seizures; Topamax (topiramate) is an example
• Beta-blockers: Lower heart rate; examples include Lopressor (metoprolol) and Inderal (propranolol)
• Bronchodilators: Open airways; Ventolin (albuterol) is an example
• Cholesterol-lowering drugs: Examples include Lipitor (atorvastatin), Crestor (rosuvastatin), Zocor (simvastatin), Lopid (gemfibrozil), and Prevalite (cholestyramine)

Redness usually appears on both palms and may also spread to the lower portions of your fingers and thumbs. In some cases, the redness might also appear on the back of the hands, fingertips, nail beds, or even the soles of the feet. When you press on the red areas, the color blanches (temporarily fades). 

Palmar erythema usually does not cause pain or itching, but some people feel warmth in the red areas. In rare cases, people with hereditary palmar erythema may feel discomfort or burning in cold weather. People with autoimmune diseases may find that their red palms are tender.

If your palms are red, consider seeing a healthcare provider to determine whether it’s due to a harmless hereditary condition or a sign of a more serious health issue. A medical evaluation is especially important if the symptom persists, worsens, or comes with other concerning symptoms.

Here are some examples of co-occurring symptoms that warrant a visit with a healthcare provider:

• Easy bruising or bleeding
• Fever
• Headaches or memory problems
• High blood pressure
• Joint pain
• Persistent itching
• Redness or pain in only one hand
• Swelling in the abdomen, feet, or legs
• Trouble breathing
• Jaundice (yellowing of the skin or eyes)

What They’ll Do

Your primary care provider is often the first step in evaluating red palms. They can examine your hands and talk to you about your medication history and medications. Depending on the suspected cause, they may refer you to a provider specializing in: 

• Rheumatology (autoimmune disorders)
• Endocrinology (hormone disorders)
• Hepatology (liver conditions)
• Dermatology (skin conditions) 

To determine the cause of red palms, healthcare providers may order:

• Blood tests: To check liver function, thyroid hormones, blood sugar, and autoimmune markers
• Imaging tests: Including an ultrasound or X-ray
• Urine tests: To help identify certain metabolic or liver conditions
• Skin biopsy: Examination of a skin sample under a microscope
• Dermoscopy: Involves a special magnifying tool to examine skin

Treatment depends on the cause. If an underlying condition, such as liver disease or an infection, is responsible for red palms, treating that condition may help.

Pregnancy-related palmar erythema usually disappears after childbirth without treatment. In some cases, Botox (onabotulinumtoxinA) injections can help by relaxing blood vessels and reducing sensitivity to temperature changes.

You cannot prevent some causes, like pregnancy and genetics, but there are ways to lower your risk of developing palmar erythema in certain cases. Strategies include:

• Avoid irritants, such as harsh hand sanitizers
• Limit alcohol 
• Manage chronic health conditions 
• Protect your hands from extreme temperatures
• Talk to your provider about medication side effects 
• Use gentle skincare products and moisturizers

Palmar erythema, or red palms, can happen without an apparent cause or be hereditary. It may also occur due to pregnancy, liver disease, thyroid conditions, or other health issues.

Talk to a healthcare provider if the redness is persistent or occurs alongside other symptoms. Treating the underlying cause can help improve or eliminate the redness.