Differential Diagnosis for Palmar Erythema in a 30-Year-Old Female
Single Most Likely Diagnosis
- Pregnancy: Palmar erythema is a common finding in pregnancy, affecting up to 60% of pregnant women, particularly during the first trimester. The exact cause is unknown, but it's thought to be related to hormonal changes and increased blood volume.
Other Likely Diagnoses
- Liver Disease: Conditions such as cirrhosis and liver cancer can cause palmar erythema due to changes in circulating sex hormones and other substances that affect blood vessels.
- Thyroid Disease: Hyperthyroidism can lead to increased blood flow and warmth, resulting in palmar erythema.
- Rheumatologic Diseases: Certain autoimmune diseases like rheumatoid arthritis and lupus can cause palmar erythema due to inflammation and increased blood flow.
Do Not Miss Diagnoses
- Hepatocellular Carcinoma: Although rare, hepatocellular carcinoma can cause palmar erythema, and missing this diagnosis could be fatal.
- Polycythemia Vera: A myeloproliferative disorder that can cause increased red blood cell mass, leading to increased blood viscosity and palmar erythema. Missing this diagnosis could lead to thrombotic complications.
- Chronic Liver Disease with Portal Hypertension: Palmar erythema can be a sign of advanced liver disease, and missing this diagnosis could lead to delayed treatment and poor outcomes.
Rare Diagnoses
- POEMS Syndrome: A rare paraneoplastic syndrome associated with a plasma cell disorder, characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes, including palmar erythema.
- Vincent's Angina: A rare condition characterized by painful ulcers and erythema of the oral mucosa, which can also affect the palms.
- Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet, which can be primary or secondary to other conditions such as myeloproliferative disorders.