Dermatology/Hands

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QUESTION: Hello Dr. Fisher.  42+ Year, Male, Married.  About three months ago, I noticed what I think is a rash on the palms of my hands but I am canít really call it a rash.  The palms of my hands both turn pink/red and blotchy on a regular basis.  The reason I am not sure if itís a rash or not, is because it comes and goes during the day and it seems like it based on my activity.  It seems worse on my right hand, but I am not 100% sure on that.   Perhaps this has always been the case and I recently noticed it, but it seems more prevalent now.  Itís no where else on my body that I notice.  I wake up every morning and my hand looks perfectly normal, just a slight pink / beige tone to it.  I get up, walk around to make my morning coffee or whatever, my hands begin to turn really pink/almost red, with white blotchy spots or normal color.  It feels like blood is simply rushing to my hands when I am walking or generally active. It sort of peaks mid-day or evening, but as I wind down it begins to subside and is completely normal by morning or night when I am laying down.  I noticed if I raise my hands to chest/eye level or higher the redness / pinkish color and blotches disappear.  There is no itchiness, no dry or cracked skin or pain of any kind and the texture of my skin feels normal.  My hands  have always been callused (working out, etc), when I go to the pool and swim for a little, it's completely gone at the pool.  When I wash my hands during the day, just pressing and rubbing my hands together to wash makes my hands appear normally white/pink for a few seconds then it goes back to red.  Last Saturday morning I felt my right hand tingling, but not sure if that hand anything to do with it.  I feel perfectly fine, work out, I also run a lot,  I  coach a kids baseball team so I threw and hit quite a bit, but it doesnít feel specifically related to that.   The season is over and I havenít really touched a ball in a couple of days.  As I am walking through the airport right now, I get off my flight, look down at my hands and they seemed bright red with the blotchy white spots (picture attached), then I walk to a place to sit down and about four minutes later I look at my hand and the redness is almost completely gone (picture of the after attached).  The two pictures were taken within 3 minutes of each other.  I am not sure if I need to see a Dr, is this normal or I am just noticing something that has always been there and my hypochondria has kicked in.  The internet is brutal if you try to look stuff like this up and I donít want to ďself diagnoseĒ.  I am not looking for a diagnosis from you either just your expert opinion / educated guess as to what you think this is, or even if itís a condition at all or suddenly something in my head.   Thank you for your time.

ANSWER: The medical term for red palms is palmar erythema (PE). This can occur on its own (primary PE) or as a result of a disease (secondary PE).

Primary PE can be genetic. Red palms occur in a least 30% of pregnant women as a result of changes in the skin due to the hormonal effects of pregnancy.

Secondary PE can be caused by a wide variety of diseases. Liver disease is a common cause. Up to a quarter of people with liver cirrhosis; can manifest PE. PE has been reported in more than 60% of patients with rheumatoid arthritis. A fifth of people with hyperthyroidism (elevated thyroid levels) have PE. PE occasionally occurs in patients with diabetes mellitus. Several drugs can cause PE. The more common offenders include; amiodarone, gemfibrozil, cholestyramine, topiramate, and albuterol. Fifteen percent of patients with cancer either originating in the brain or spreading to the brain will have PE. Smoking and chronic mercury poisoning are environmental causes of PE.

Talk to your doctor about your red palms. As you can see, red palms may be a symptom of some problem in your body and, unless you have had this most of your life, you should consult your doctor.

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QUESTION: Thank you for your reply, the answer seemed a bit generic.  I'll go see my Dr.  The main question I'd like to get answered or a sense of is can you explain why it fluctuates so much?  It's not constantly or consistently red, it varies from day to day or hour to hour or minute to minute.  I can have an entire day or evening where everything is normal?  This is what makes me think it's not the options you described above.  I have done some searching since I received your answer and I really can't find examples of anything where it varies so much. Is it possible it's heat or humidity related?  Allergy?  When you say Mercury, what could possibly be a source of Mercury?  Diet?  Cinnamon?  Just guessing, that's where I'd like your expert opinion.  I can't see my Dr. for another two weeks, what if this suddenly goes away prior to that?  Thanks again for your response.

Answer
The answer as generic because there are so many causes of Palmer erythema. One has to do test determine the cause. High blood pressure is another cause of Palmer erythema. Heat and humidity have been associated with Palmer erythema. Allergies to drugs can cause this also. Mercury would have to be invested to cause this condition. If the condition resolves then this means the trigger that caused the condition is gone and you would not need to visit the doctor.

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Michael S. Fisher, <B>Ph.D., M.D.</B>

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