Differential Diagnosis for Palmar Erythema
Single Most Likely Diagnosis
- Liver Disease: Palmar erythema is often associated with liver disease, particularly cirrhosis. The exact mechanism is unclear, but it's thought to be related to changes in circulating sex hormones and vasodilators.
Other Likely Diagnoses
- Pregnancy: Palmar erythema is a common finding in pregnancy, affecting up to 50% of pregnant women. It's attributed to increased estrogen levels leading to vasodilation.
- Thyroid Disease: Both hyperthyroidism and hypothyroidism can cause palmar erythema, though the exact mechanism is not well understood.
- Rheumatologic Diseases: Conditions like rheumatoid arthritis can cause palmar erythema due to inflammation and increased blood flow to the hands.
Do Not Miss Diagnoses
- Cancer: Certain types of cancer, such as pancreatic cancer, can cause palmar erythema. Early detection is crucial, making this a "do not miss" diagnosis.
- Chronic Hemolysis: Conditions like hereditary spherocytosis can lead to increased bilirubin levels, which may cause palmar erythema.
Rare Diagnoses
- Polycythemia Vera: A rare myeloproliferative disorder that can cause increased red blood cell mass, leading to erythema, including palmar erythema.
- Sarcoidosis: A systemic granulomatous disease that can affect multiple organs and cause skin manifestations, including palmar erythema, though this is rare.
- Vitamin B12 Deficiency: Though more commonly associated with neurological and hematological symptoms, severe vitamin B12 deficiency can cause skin changes, including palmar erythema.