Case of Palmar Erythema during Pregnancy


Palmar erythema at 35 weeks of pregnancy

At 35 weeks’ of pregnancy, a 33-year-old woman with a history of gestational diabetes presented to the dermatology clinic with redness on both palms. She didn’t experience any pain, itching, or rashes elsewhere. After a course of topical glucocorticoids, the skin changes that first manifested during the second trimester of pregnancy did not go away. The palms and fingers of both hands were significant for patchy, blanching erythema on examination. Based on the findings, doctors diagnosed the patient with pregnancy-related palmar erythema. One of the physiologically related vascular skin alterations of pregnancy is palmar erythema. As in this instance, the erythema may be diffuse and blotchy, or it may be localized to the hypothenar or thenar eminences. Sometimes the redness is accompanied by tingling, burning, or itching.

Palmar erythema of pregnancy does not require any particular therapy, and it usually goes away within two weeks of delivery, however complete recovery could take as long as two months. However, the erythema was significantly reduced one week following the patient’s early-term spontaneous vaginal delivery, and it was completely gone two months after childbirth.

The palms of the hand may turn red due to the skin disease. Typically, the rash is neither itchy nor painful. The skin disease can develop independently or as a secondary symptom of a more serious underlying illness. Even if it could be a sign of a hidden ailment, it is not harmful on its own.

What causes palmar erythema?

Palmar erythema is caused because of dilated capillaries. The exact cause of palmar erythema is unknown and may vary from case to case. However, it is believed that there is an increase in the production of angiogenic factors, which induces the growth of more new blood vessels.

This can be caused in some cases, notably among pregnant women, by an increase in estrogen, as estrogen may trigger vascularization. Problems in the liver has also been linked with palmar erythema. The liver is where metabolises of hormones occurs, which can also cause a hormone imbalance, as a result, may cause the skin disease. Similarly, while it is believed that palmar erythema may be caused because of hormone estrogen, hormones do not always play a role in the development of palmar erythema.

Secondary causes

Secondary causes of palmar erythema may include interstitial lung disease, cancer, liver cirrhosis, rheumatoid arthritis, autoimmune disease, Raynaud’s syndrome, endocrine disorders, alcohol use disorder, atopic dermatitis and viral infections such as rheumatoid arthritis.

Redness on both palms is the most common sign of palmar erythema. The redness is not always uniformly spread. The thenar eminence (the muscle bulge by the base of the thumb), hypothenar eminence (the fleshy border of the palm beneath the pinky), the area just beneath the fingers, and the fingertips may appear more red. There are usually no other symptoms. Typically, the red region is not hot, irritated, itchy or painful.

There is no specific treatment for the condition and since it is benign, it will not be harmful to you. 

If you have palmar erythema as a result of another medical issue, you may notice changes in your palms while the underlying medical condition is treated. For example, most women who develop the condition during pregnancy will notice that their palms return to their original colour after giving birth.

However, there is no guarantee that your skin disease will go away if you address your underlying illness. You should share your concerns with your healthcare provider. For most people, though, it goes away on its own. For example, as mentioned above, if it is developed during pregnancy, it will go away postpartum.

Source: NEJM

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.


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