Pathology: palmar erythema

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.

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11 Responses to Pathology: palmar erythema

  1. bmargerummedergygroup says:

    Greetings! I would like request permission to reproduce your image that you have used in this post. Can you please contact me at bmargerum (at) medergygroup (dot) com ? Thanks so much!

  2. Hi there,

    Could I please request permission to reproduce the palmar erythema image used in this post.

    Thanks you.

    CJZ/Genepool Productions

  3. Lewis Potter says:

    Hi. I’d like to use this image in an upcoming clinical skills video. Do you have the rights to this image and if so, could you provide permission to use this to demonstrate the sign?

    Kind regards

    Lewis Potter

  4. Terrific picture! Would you be happy for us to reproduce it in an upcoming handbook Fast Facts: Liver Disorders by Tom Mahl and John O’Grady (see wwww.fastfacts.com regarding the series). Senior Editor, Health Press Limited.

  5. Eric Strong says:

    Sorry to have another person bother you with this request, but would love to have permission to reproduce this image, with attribution, for a non-commerical, educaitonal YouTube video on the physical findings of liver disease. Thanks for considering! – Eric Strong

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