Red Hands Meaning

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What Is Palmar Erythema?

Palmar erythema is a skin condition in which the palms of the hands develop a red rash. The rash is usually not itchy or painful. Palmar erythema may occur on its own, or it may occur secondarily to a more serious underlying disease. It is not harmful by itself, although it may be a warning sign of an underlying condition.

In this article, learn more about palmar erythema and its symptoms, causes, diagnosis, and treatment.

Illustration by Zoe Hansen for Verywell Health

Causes

Physiologically, palmar erythema is the result of dilated capillaries, which are very small blood vessels.

The exact reason this happens is not well-known, and may differ from case to case. However, it is believed that there is an increased production of angiogenic factors, which is what causes more new blood vessels to grow.

In some cases, particularly among pregnant people, this can be caused by an increase in estrogen , as estrogen can cause vascularization .

Problems in the liver, where hormones are metabolized, may also lead to a hormone imbalance and subsequently palmar erythema.

Primary Cause

It is rare, but some people develop palmar erythema without any identifiable underlying medical condition. This is called erythema palmare hereditarium and sometimes referred to as Lane’s disease.

To date there is relatively little research published on Lane’s disease. It is believed to be genetic, but the exact pattern of inheritance has not yet been discovered.

Secondary Cause

It is more common for palmar erythema to occur secondarily to an underlying medical condition. Conditions that have been associated with palmar erythema include:

Interstitial lung disease (group of diseases causing scarring of the lungs)
Cancer
Liver cirrhosis (late-stage scarring of the liver caused by liver disease)
Rheumatoid arthritis and other autoimmune disorders
Raynaud’s syndrome (blood disorder affecting the fingers and toes)
Endocrine disorders (medical condition causing a hormone imbalance)
Alcohol use disorder
Pregnancy
Atopic dermatitis ( eczema )
Viral infections, like COVID-19

Symptoms

The main symptom of palmar erythema is redness on both palms. The redness is usually not evenly distributed. It may appear more red on the thenar eminence (the muscular bulge by the base of the thumb), hypothenar eminence (the fleshy edge of the palm beneath the pinky), the area just beneath the fingers, and the fingertips.

In most cases, there are no other symptoms. The red area is typically not painful, itchy, irritated, or hot.

When to Talk to Your Healthcare Provider

If you notice the color of your palms changes, you should discuss this with your healthcare provider, even if it is not painful or itchy. Palmar erythema can be a sign of more serious underlying conditions, and early diagnosis can be key to better outcomes.

Diagnosis

Your healthcare provider can look at your palms and suspect palmar erythema. However, they will want to put you through some additional tests to rule out any other explanations and identify any possible underlying conditions.

Differential diagnosis of palmar erythema should be performed. This is the process in which a diagnosis is confirmed by ruling out other possible explanations.

In the case of palmar erythema, there are other skin conditions that can present similarly and should be ruled out first. These include:

Allergic reactions
Drug reactions
Hand foot syndrome
Palmoplantar pustulosis
Dermatomyositis
Contact dermatitis
Cellulitis

If after this evaluation your healthcare provider still suspects palmar erythema, then they may run some tests to identify underlying conditions like an infection, autoimmune disease, liver disease, or cancer.

Treatment

There is no treatment specifically for palmar erythema. On its own, palmar erythema is benign, meaning it is not harmful to you.

However, if you are experiencing palmar erythema as the result of an underlying condition, then you may notice changes in your palms as the underlying medical condition is treated. For instance, most people who develop palmar erythema during pregnancy will find their palms return to their normal shade postpartum.

However, there is no guarantee that palmar erythema will resolve with treatment for your underlying condition. You should discuss any concerns about this with your healthcare team.

Summary

Palmar erythema occurs when the palms develop a reddish rash that is not painful or itchy. It can occur on its own, although this is rare. Usually it occurs secondarily to a variety of conditions, such as pregnancy, cancer, liver disease, and infections. Treatment involves resolving the underlying condition.

A Word From Verywell

Even if your red palms aren’t bothering you, it’s still worth bringing up to your healthcare provider. It might be that you have hereditary palmar erythema and there is nothing to worry about. Or, this might be a warning sign of a more serious condition. Be sure to talk about your concerns with your provider, including ruling out other skin conditions or ways to treat any underlying cause.

Frequently Asked Questions

What conditions cause palmar erythema?

Palmar erythema may occur on its own, or it may be secondary to other conditions such as interstitial lung disease, cancers, liver disease, infections, endocrine disorders, autoimmune disorders, pregnancy, or alcohol use disorder.

Is palmar erythema curable?

For some people, palmar erythema may go away as their underlying condition resolves. For example, palmar erythema that developed during pregnancy typically goes away postpartum.

What hormone causes palmar erythema?

Palmar erythema is not always caused by hormones, but it is believed that the hormone estrogen plays a role in palmar erythema among people who are pregnant or who have cirrhosis.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Langenauer J. Erythema palmare hereditarium (‘red palms,’ ‘Lane’s disease’). Case Rep Dermatol. 2014;6(3):245-247. doi:10.1159/000368822
Maekawa M. Palmar erythema as a sign of cancer. CCJM. 2017;84(9):666-667. doi:10.3949/ccjm.84a.16114
Serrao R, Zirwas M, English JC. Palmar erythema. American Journal of Clinical Dermatology. 2007;8(6):347-356. doi:10.2165/00128071-200708060-00004
Chiu YH, Lu CC, Liu FC, Chen HC. Palmar and plantar erythema, pulmonary fibrosis and the anti-synthetase syndrome. QJM. 2018;111(5):329-330. doi:10.1093/qjmed/hcy035
Panda PK, Sharawat IK. Fluctuating palmar erythema in a toddler during covid-19 pandemic: do you know the offender?. Journal of Tropical Pediatrics. 2021;67(1):fmab011. doi:10.1093/tropej/fmab011
Panambur B, Kakkilaya SB. Palmar erythema as the sole manifestation of covid-19. Cureus. 2020;12(11). doi:10.7759/cureus.11291

By Sarah Bence, OTR/L
Bence is an occupational therapist with a range of work experience in mental healthcare settings. She is living with celiac disease and endometriosis.

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Raynaud’s Phenomenon

Raynaud’s phenomenon is a problem that causes decreased blood flow to the fingers. In some cases, it also causes less blood flow to the ears, toes, nipples, knees, or nose. This happens because of spasms of blood vessels in those areas. The spasms happen in response to cold, stress, or emotional upset.

Raynaud’s can occur on its own. This type is known as its primary form. Or the condition may happen along with other diseases. This type is known as its secondary form. The diseases most often linked with Raynaud’s are autoimmune or connective tissue diseases, such as:

Lupus
Scleroderma
CREST syndrome (a form of scleroderma)
Buerger disease
Sjögren syndrome
Rheumatoid arthritis
Occlusive vascular disease, such as atherosclerosis
Polymyositis
Blood disorders
Thyroid disorders
Pulmonary hypertension

What causes Raynaud’s phenomenon?

Healthcare providers don’t know the exact cause of Raynaud’s. It’s possible that some blood disorders may cause Raynaud’s by increasing the blood thickness. This may happen from extra platelets or red blood cells. Or special receptors in the blood that control the narrowing of the blood vessels may be more sensitive.

Who is at risk for Raynaud’s phenomenon?

Certain factors can increase your risk for Raynaud’s. They include:

A connective tissue or autoimmune disease
Chemical exposure
Cigarette smoking
Injury or trauma
Repetitive actions, such as typing or using tools that vibrate, such as a jackhammer
Side effects from certain medicines
Carpal tunnel syndrome
Being assigned female at birth
Living in a cold climate

What are the symptoms of Raynaud’s phenomenon?

Symptoms can occur a bit differently in each person. Common symptoms include:

Fingers that turn pale or white then blue when exposed to cold, or during stress or emotional upset. They turn red when the hands are warmed and blood flow returns.
Hands that may become swollen and painful when warmed
In severe cases, sores on the finger pads
In rare cases, gangrene in the fingers that causes infection or needs amputation

How is Raynaud’s phenomenon diagnosed?

Your healthcare provider will ask about your health history and do a physical exam. Your provider may also do a cold challenge test. It is done to see the color changes in the hands and fingers. During the test, your hands are exposed to cold. Your healthcare provider may also look at the tiny blood vessels in your fingernails with a microscope. Adults who start to have Raynaud’s phenomenon after age 35 may be tested for an underlying disease. You may have blood tests to see if your condition is primary or secondary.

How is Raynaud’s phenomenon treated?

Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is. There is no known cure for Raynaud’s phenomenon. But symptoms can be managed with correct treatment. Treatment and preventive measures may include:

Limiting exposure to cold
Keeping warm with gloves, socks, scarf, and a hat
Stopping smoking
Wearing finger guards over fingers with sores
Preventing trauma or vibrations to the hand, such as with vibrating tools
Taking blood pressure medicines during the winter months to help reduce blood vessel constriction

Talk with your healthcare providers about the risks, benefits, and possible side effects of all medicines.

What are possible complications of Raynaud’s phenomenon?

In severe cases, you may have sores on finger pads. These sores may progress to gangrene. In rare cases, gangrene may lead to finger amputation.

Living with Raynaud’s phenomenon

For most people living with Raynaud’s, it is more of an inconvenience than a serious problem. Attacks may last from a few minutes to more than an hour. Staying away from triggers, mainly cold, can reduce the spasms that lead to symptoms. If there is an underlying cause, such as scleroderma or lupus, it may be harder to manage attacks. If you have secondary Raynaud’s, work with your healthcare provider to manage your underlying condition. This may help decrease attacks of Raynaud’s.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, let your healthcare provider know.

Key points about Raynaud’s phenomenon

Raynaud’s phenomenon is a disorder that causes decreased blood flow to the fingers. In some cases, it also causes less blood flow to the ears, toes, nipples, knees, or nose.
Spasms of blood vessels happen in response to cold, stress, or emotional upset.
Secondary causes of Raynaud’s include other conditions, such as lupus and scleroderma.
Symptoms of Raynaud’s include fingers that turn pale or white then blue when exposed to cold, or during stress or emotional upset. They then turn red when the hands are warmed and blood flow returns.
Managing Raynaud’s means not being cold, dressing warmly, and stopping smoking.

Find a Doctor

Sjogren’s Syndrome
Lupus Nephritis
Lupus

Acute Leukemia
Blood Disorders
Bleeding Disorders
Systemic Lupus Erythematosus (SLE)
Arthritis of the Fingers
Arthritis of the Hand
Arthritis of the Shoulder
Arthritis
Autoimmune Lung Disease
Rheumatoid Arthritis
Hip Arthritis

Find a Treatment Center

Rheumatology
Beacham Center for Geriatric Medicine

Infusion Center
Pediatric Rheumatology (Johns Hopkins All Children’s Hospital)
Pediatric Rheumatology (Johns Hopkins Children’s Center)
Hematology
Johns Hopkins All Children’s Hospital Cancer and Blood Disorders Institute

Find Additional Treatment Centers at:

Howard County Medical Center
Sibley Memorial Hospital
Suburban Hospital