Liver Palms (Palmar Erythema)

      A 48-year-old white woman presented with worsening fatigue, diffuse arthralgias, joint swelling, malaise, and icterus. In view of ongoing joint pains sparing the distal interphalangeal joints, early morning stiffness, strong family history of rheumatoid arthritis, positive rheumatoid factor, and a positive anti-cyclic citrullinated peptide antibody, she was recently diagnosed with rheumatoid arthritis. She had noticed a change in the color of her palms for about a year (Figure). She had no visible plantar erythema. There was no palpable hepatosplenomegaly, caput medusae, or ascites, with complete absence of other cutaneous signs of liver disease. Her liver function tests revealed hyperbilirubinemia, with a total bilirubin of 4.1 mg/dL, and elevated serum transaminases, with an alanine transaminase of 500 units/L and aspartate transaminase of 799 units/L. Her autoantibody profile revealed a positive antinuclear antibody with a titer of (1:640), with a positive anti-smooth muscle antibody titer (1:320), raising the concern for autoimmune hepatitis. She underwent a liver biopsy, which revealed moderately active hepatitis, predominantly acute, with features suggestive of transition to chronicity with bridging necrosis and early fibrosis.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Niederau C.
        • Lange S.
        • Fruhauf M.
        • Thiel A.
        Cutaneous signs of liver disease: value for prognosis of severe fibrosis and cirrhosis.
        Liver Int. 2008; 28 (Epub 2008 Feb 26): 659-666
        • Perera G.A.
        A note on palmar erythema (so-called liver palms).
        JAMA. 1942; 119: 1417-1418
        • Bean W.
        Acquired palmar erythema and cutaneous vascular ‘spiders’.
        Am Heart J. 1943; 25: 463-477
        • Walsh E.N.
        • Becker S.W.
        Erythema palmare and naevus-araneus-like telangiectases.
        Arch Derm Syphilol. 1941; 44: 616-630
        • Maruyama Y.
        • Adachi Y.
        • Aoki N.
        • et al.
        Mechanism of feminization in male patients with non-alcoholic liver cirrhosis: role of sex hormone-binding globulin.
        Gastroenterol Jpn. 1991; 26: 435-439
        • Fitzpatrick T.
        • Arndt K.
        • Clark W.
        • et al.
        Dermatology in General Medicine.
        McGraw-Hill, New York1971
        • Crawford D.
        • Powell L.
        • Halliday J.
        Factor's influencing disease expression in hemochromatosis.
        Ann Rev Nutr. 1996; 16: 139-160
        • Massarrat S.
        • Fallahazad V.
        • Kamalian N.
        Clinical, biochemical and imaging-verified regression of hepatitis B-induced cirrhosis.
        Liver Int. 2004; 24: 105-109
        • Cribier B.
        • Samain F.
        • Vetter D.
        • et al.
        Systematic cutaneous examination in hepatitis C virus infected patients.
        Acta Derm Venereol. 1998; 78: 355-357
        • Clayton P.T.
        Diagnosis of inherited disorders of liver metabolism.
        J Inherit Metab Dis. 2003; 26: 135-146
        • Bean W.B.
        A note on the development of cutaneous arterial ‘spiders’ and palmar erythema in persons with liver disease and their development following the administration of estrogens.
        Am J Med Sci. 1942; 204: 251-252
        • Chopra I.J.
        • Abraham G.E.
        • Chopra U.
        • et al.
        Alterations in circulating estradiol-17 in male patients with Graves' disease.
        N Engl J Med. 1972; 286: 124-129
        • Bland J.H.
        • O'Brien R.
        • Bouchard R.E.
        Palmar erythema and spider angiomata in rheumatoid arthritis.
        Ann Intern Med. 1958; 48: 1026-1031
        • Noble J.P.
        • Boisnic S.
        • Branchet-Gumila M.C.
        • Poisson M.
        Palmar erythema: cutaneous marker of neoplasms.
        Dermatology. 2002; 204: 209-213
        • Serrao R.
        • Zirwas M.
        • English J.C.
        Palmar erythema.
        Am J Clin Dermatol. 2007; 8: 347-356