palmar erythema

 Q: The palmar erythema in cirrhosis is more prominent on? (select one) 

A) thenar eminence 

B) hypothenar eminence

Answer: B

The objective of this question is to enhance the importance of astute physical exams at the bedside. The presence of palmar erythema helps to confirm the diagnosis. Cirrhosis is one of the diseases which presents a wide range of physical findings. Few dermatological signs in cirrhosis are popularly known as 'stigmata of cirrhosis', and include spider angioma, palmar erythema, and abdominal wall collaterals. The palmar erythema is usually blotchy and patchy. It is more prominent on the hypothenar eminence. This palmar erythema spares the center of the palm. These findings are relatively easily identifiable on fair skin patients. 

Palmar erythema can be present in other diseases besides cirrhosis including Wilson's disease, neoplasms, and diabetes. Pregnant patients may also develop it transiently. 

#physical-exam

#hepatology

References:

 1. Serrao R, Zirwas M, English JC. Palmar erythema. Am J Clin Dermatol. 2007;8(6):347-56. doi: 10.2165/00128071-200708060-00004. PMID: 18039017.

2. Kakehashi R, Watanabe S, Ikoma J, Suzuki S. [Clinical symptoms of patients with liver cirrhosis]. Nihon Rinsho. 1994 Jan;52(1):40-4. Japanese. PMID: 8114308.