Palmar erythema

Nonspecific signs on physical exam include jaundice, tea-colored urine, bruising, hepatomegaly, splenomegaly, spider angiomata, caput medusae, palmar erythema, gynecomastia, and testicular atrophy. 

In rare instances, extrahepatic symptoms may develop arthritis, postcervical lymphadenopathy, palmar erythema, cryoglobulinemia, and vasculitis. 

Pruritus, jaundice, palmar erythema, spider angiomata, hyperpigmentation Gynecomastia, reduced libido Ascites, edema, pleural effusion, and respiratory difficulties Malaise, anorexia, and weight loss Encephalopathy Laboratory tests Hypoalbuminemia Elevated prothrombin time Thrombocytopenia Elevated alkaline phosphatase... 

Cirrhosis is often asymptomatic until complications of liver disease are present. Mrs MW may present with itching, jaundice, dark urine, pale fatty stools, abdominal pain, nausea, fatigue, bleeding - such as nose bleeds, hepatic encephalopathy, hepatomegaly, ascites, distended abdominal veins, spider angiomata, palmar erythema and asterixis. She may also present with the signs and symptoms of alcohol withdrawal, which include irritability, anxiety, tachycardia, tremor, sweating, confusion and hallucinations. 

Differential diagnosis Palmar erythema is also found in pregnancy, in hyperthyroidism, collagen diseases, endocarditis, long-standing feverish conditions, tuberculosis, diabetes mellitus, malignant tumours, chronic polyarthritis and in cases of malnutrition — as well as in healthy people. 

Aetiopathogenesis As with spider naevi, the capillary dilatation causing palmar erythema is attributed to an increased oestrogen content of the blood, a rise in bile acids or endotoxins and an activation of vasodilating substances with more numerous arteriovenous shunts and a hypercirculatory syndrome. Portal hypertension is seen as an important codeterminant. The blossoming of spider naevi and palmar erythema is also observed in the phenomenon of haemodynamic-related resistance to diuretics. 

Incomplete spider naevi can develop within a palmar erythema they have no central artery. The combination of these two liver skin stigmata is frequently found in decompensated liver cirrhosis and in highly active chronic hepatitis. 

Whereas Dupuytren s contracture is only found in about 2% of the population, it is detectable in about 30% of all cirrhosis patients, mainly bilaterally. Men are affected in 90% of cases and thus far more often than women. The disease generally commences unilaterally. Men are frequently affected in their younger years, whereas in women, the disease commences later and takes a more rapid course. There is a greater tendency towards recurrence of the disease after surgery than after radiological treatment. In cirrhosis patients, contracture occurs predominantly in combination with palmar erythema. There also seems to be a correlation between contracture and spider naevi. (2, 4, 12, 23)... 

Palmar erythema was observed in 12 of 209 patients who were treated with ritodrine for more than 7 days (SEDA-12, 123). 

Ichthyosis Lichen planus Lupus erythematosus Melanoma Palmar erythema... 

Extremities, hands/nails - Aldrich-Mees lines [11] Extremities, hands/palms - red (palmar erythema) Extremities - abnormal sensations (dysesthesias) [1, 2] Extremities - tremors [10]... 

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