PALMAR ERYTHEMA
Synonym: Liver palms
Reddening of skin on the palmar aspect of the hands, usually over the hypothenar eminence. It may also involve the thenar eminence and fingers. It can be found on the soles of the feet, when it is termed plantar erythema. It is a sign associated with many diseases but is probably most commonly seen as a normal variant. Because of the fact that it can be present in individuals without an identifiable illness or underlying cause, it is often very difficult to tell if a new claimed association for the sign is of any significance or just part of the background 'noise'. There have been no useful surveys of its prevalence in the community or the exact incidence in specific disease populations. It is probably a manifestation of many underlying pathophysiological processes, depending on the individual cause. These may include increased cardiac output, capillary dilatation in the palms due to local factors or systemic mediators, localised inflammation, an effect of high circulating oestrogen levels or a toxic dermatological reaction. It is not a very discriminative sign in terms of reaching a diagnosis, but can be useful as a marker or suggester of alternative diagnoses when conducting an initial clinical assessment.
Synonym: Liver palms
Reddening of skin on the palmar aspect of the hands, usually over the hypothenar eminence. It may also involve the thenar eminence and fingers. It can be found on the soles of the feet, when it is termed plantar erythema. It is a sign associated with many diseases but is probably most commonly seen as a normal variant. Because of the fact that it can be present in individuals without an identifiable illness or underlying cause, it is often very difficult to tell if a new claimed association for the sign is of any significance or just part of the background 'noise'. There have been no useful surveys of its prevalence in the community or the exact incidence in specific disease populations. It is probably a manifestation of many underlying pathophysiological processes, depending on the individual cause. These may include increased cardiac output, capillary dilatation in the palms due to local factors or systemic mediators, localised inflammation, an effect of high circulating oestrogen levels or a toxic dermatological reaction. It is not a very discriminative sign in terms of reaching a diagnosis, but can be useful as a marker or suggester of alternative diagnoses when conducting an initial clinical assessment.
Causes of palmar erythema :
* Established
• Idiopathic.
• Cirrhosis/chronic liver disease/excess alcohol consumption.
• Pregnancy.
• Connective tissue disorders, particularly rheumatoid arthritis, rarely sarcoidosis and systemic lupus erythematosus.
• Thyrotoxicosis.
• Polycythaemia.
• Leukaemia.
* Established
• Idiopathic.
• Cirrhosis/chronic liver disease/excess alcohol consumption.
• Pregnancy.
• Connective tissue disorders, particularly rheumatoid arthritis, rarely sarcoidosis and systemic lupus erythematosus.
• Thyrotoxicosis.
• Polycythaemia.
• Leukaemia.
• Eczema and psoriasis.
* Purported/recently suggested
• Shoulder-hand syndrome/algodystrophy (reflex sympathetic dystrophy).
• Associated with use of a variety of chemotherapeutic agents as early manifestation of palmar/plantar erythrodysesthesia.
• Neoplastic disease, particularly cerebral tumoursSome antiepileptic drugs.
• Infection with human T lymphotropic virus (HTLV-I) causing myelopathy/tropical paraparesis.
0 comments:
Post a Comment