Palmar Erythema

Erythema of the thenar/hypothenar portion of the hand with a pale central palm, seen in liver disease (likely from imbalance of estrogens to androgens).

Patient 1:

This is a middle-aged woman with cirrhosis.

Patient 2:

This is a middle-aged man with cirrhosis.

Patient 3:

This is a young man with cirrhosis.

Patient 4:

This is a middle-aged man with cirrhosis. Note the presence of Dupuytren’s contracture, which is associated with liver disease.

This patient also has spider angiomas as well as a bounding peripheral pulse from the high output state of cirrhosis.

Patient 5:

This is a middle-aged woman with cirrhosis. Note the presence of clubbing, which should trigger a search for the presence of a right-to-left shunt, such as hepatopulmonary syndrome.