The hyperdynamic circulatory state of portal hypertension is associated with a dilated, vascular periphery. This is driven by an excess of systemic nitric oxide. Ectatic blood vessels commonly form, and are often noted atop the chest, neck and face. These are referred to as ‘spider telangectasias’ because they fill centrifugally (like legs of a spider) after the center is blanched.
When these telangectasias occur in the palms, it frequently manifests as a diffuse erythema and the individual vessels are not clearly demarcated. This is because the skin on the thenar and hypothenar prominences is thicker and the ectatic vessels are deeper within the dermis.
Palmar erythema can also be seen in pregnancy, polycythemia, thyrotoxicosis, rheumatoid arthritis, excema, psoriasis and even normal individuals. The clinician should have a high suspicion for cirrhosis when palmar erythema is identified in a patient with longstanding liver disease.