What Drugs Can Cause Palmar Erythema? A Pharmacological Review

October 12, 2025 •

3 min read

An estimated 4.1% of people with diabetes and 23% of those with liver cirrhosis experience palmar erythema. While often linked to underlying conditions, a key question for clinicians is: what drugs can cause palmar erythema? Several medications are known culprits.

Quick Summary

A detailed overview of medications that can induce palmar erythema. This summary covers specific drug classes, the mechanisms involved, and how the condition is identified and managed when it is drug-related.

Key Points

Primary vs. Secondary: Palmar erythema can be a normal finding (primary) or caused by an underlying disease or medication (secondary).
Two Main Drug Mechanisms: Drugs can cause palmar erythema either by inducing liver damage (e.g., amiodarone) or through direct effects with normal liver function (e.g., topiramate).
Chemotherapy is a Major Cause: Many cancer drugs, like capecitabine and sorafenib, cause a related condition called hand-foot syndrome or palmar-plantar erythrodysesthesia (PPE).
Key Implicated Drugs: Common culprits include topiramate, albuterol, amiodarone, gemfibrozil, and cholestyramine.
Diagnosis is Key: Identifying drug-induced palmar erythema requires a careful medication history to rule out other causes like liver disease or pregnancy.
Management is Discontinuation: The primary treatment is to stop the causative medication under a doctor's supervision, with symptoms often resolving in weeks.
Not Always Itchy or Painful: In many cases, especially those not related to chemotherapy, palmar erythema is a cosmetic issue with no pain or itching.

Understanding Palmar Erythema

Palmar erythema, also known as 'liver palms,' is characterized by a symmetrical reddening of the palms, often more pronounced on the thenar and hypothenar eminences. This redness typically blanches under pressure and is usually not accompanied by pain or itching. While strongly associated with conditions like liver disease and pregnancy, palmar erythema can also be a side effect of certain medications.

Mechanisms of Drug-Induced Palmar Erythema

The precise cause of palmar erythema is not fully understood, but it is thought to involve localized vasodilation. Elevated estrogen levels are considered a contributing factor due to their vasodilatory effects, which is why it's seen in pregnancy and liver disease where estrogen metabolism is altered. Drug-induced cases can occur via two primary mechanisms:

Associated with Liver Damage: Some drugs cause palmar erythema by impairing liver function, leading to altered hormone metabolism.
Independent of Liver Function: Other medications can induce palmar erythema without affecting the liver, possibly through direct vascular effects or the release of vasoactive substances. Some cancer therapies may increase factors like VEGF, promoting blood vessel growth and dilation.

Specific Drugs and Drug Classes Implicated

Various medications have been linked to palmar erythema, with the association potentially depending on the patient's liver health.

Drugs Causing Palmar Erythema with Normal Liver Function

These drugs are thought to cause palmar erythema through direct mechanisms. Examples include the anticonvulsant Topiramate and the bronchodilator Albuterol.

Drugs Causing Palmar Erythema Associated with Liver Impairment

In these cases, palmar erythema is often a symptom of drug-induced liver injury. Further details on specific implicated drugs can be found on {Link: Dr. Oracle website https://www.droracle.ai/articles/114708/palmar-erythema}.

Chemotherapy and Targeted Cancer Therapies

This category frequently causes a related condition known as palmar-plantar erythrodysesthesia (PPE) or hand-foot syndrome (HFS), which involves erythema, swelling, and pain. More information on specific cytotoxic agents and targeted therapies linked to PPE is available on {Link: Dr. Oracle website https://www.droracle.ai/articles/114708/palmar-erythema}.

Comparison of Drug Classes Associated with Palmar Erythema


Drug Class	Example Drugs	Associated Liver Status	Probable Mechanism
Anticonvulsants	Topiramate	Normal Liver Function	Direct vascular effect or unknown
Bronchodilators	Albuterol (Salbutamol)	Normal Liver Function	Direct vascular effect or unknown
Antiarrhythmics	Amiodarone	Impaired Liver Function	Drug-induced hepatic damage
Lipid-Lowering Agents	Gemfibrozil, Cholestyramine	Impaired Liver Function	Drug-induced hepatic damage
Cytotoxic Chemo	Capecitabine, Doxorubicin	N/A (Direct Toxicity)	Direct cellular toxicity to keratinocytes
Targeted Cancer Tx	Sorafenib, Vemurafenib	N/A (Direct Toxicity)	Inhibition of kinase pathways (e.g., VEGFR, BRAF)

Diagnosis and Management

Diagnosing drug-induced palmar erythema involves reviewing the patient's medical and medication history to determine if symptoms appeared after starting a new drug and to exclude other potential causes like liver disease. Treatment typically involves discontinuing the suspect medication under medical guidance, which often leads to symptom resolution in 2 to 4 weeks. For essential medications, dose adjustments or supportive therapies may be considered.

Conclusion

Palmar erythema is a clinical sign that can be caused by various factors, including certain medications. Some drugs, like topiramate and albuterol, may cause it without liver issues, while others such as amiodarone are linked to drug-induced liver damage. Cancer treatments, including both cytotoxic and targeted therapies, are also known to cause palmar-plantar reactions. Proper identification of the causative medication, guided by a healthcare provider, is key to managing drug-induced palmar erythema, often through discontinuation or modification of the drug.

For more detailed information on skin conditions, an authoritative resource is {Link: DermNet NZ https://dermnetnz.org/topics/palmar-erythema}.

Frequently Asked Questions

Palmar erythema, or 'liver palms,' is a condition that causes a red discoloration on the palms of the hands, most prominently on the fleshy parts below the thumb and little finger. The redness typically blanches (fades) with pressure.

Yes, certain cardiovascular drugs have been linked to palmar erythema. For example, amiodarone, an antiarrhythmic, can cause it, often in association with drug-induced liver damage.

The condition itself is not typically dangerous, but it can be a sign of an underlying issue, such as drug-induced liver damage. If caused by a drug, it's important to consult a doctor to evaluate the medication's overall safety and side effect profile.

The main treatment is to discontinue the medication causing the reaction, which should only be done after consulting with your doctor. Symptoms usually improve within a few weeks of stopping the drug.

Topiramate (an anticonvulsant) and albuterol (an asthma medication) have been reported to cause palmar erythema in patients without any signs of liver problems.

Yes, many chemotherapy agents are well known to cause a condition called palmar-plantar erythrodysesthesia (PPE) or hand-foot syndrome, which includes redness, swelling, and sometimes pain on the palms and soles. Examples include capecitabine and doxorubicin.

Yes, in cases of drug-induced palmar erythema, the condition typically resolves within two to four weeks after discontinuing the causative drug.