How to treat red flaky spots on your head

Cause and pathogenesis

As mentioned earlier, “liver signs” (including erythema) that appear on human skin are a consequence of developed hepatocellular failure. That is, the liver becomes unable to fully perform its basic functions. In particular, the process of utilization of “spent” hormones is disrupted, among which estrogens occupy a special place.

The resulting hyperestrogenemia has a systemic effect on the body, especially on the vascular wall, causing dilatation of capillaries, promoting the opening of arteriovenous shunts (the area where the arterial and venous beds connect). This, in turn, leads to blood flow to the periphery. Hence the redness (erythema) of the palms and the formation of telangiectasia (or, more simply, spider veins).

But it is worth saying that estrogen levels can be elevated under other circumstances, especially when it comes to women. Thus, pregnancy, various tumor processes in the ovaries, menopause, hormonal dysfunctions in females can be accompanied by hyperestrogenemia (and, as a result, erythema). Therefore, this symptom is diagnostically significant only in combination with other signs of damage to a particular organ.

Thus, palmar erythema can accompany the following physiological conditions and diseases:

1. Pregnancy.
2. Polycystic ovary syndrome.
3. Hormonally active ovarian tumors.
4. Menstrual irregularities.
5. Cirrhosis of the liver.
6. Obesity.
7. Chronic renal failure.
8. Aromatase overactivity syndrome.
9. Hereditary pathologies (Lane's disease).

Complications

While mucosal lesions heal completely, skin rashes can lead to scarring. In addition, strictures of the urethra, esophagus, vagina and anus are common. Urinary retention, phimosis, and hematocolpos have been reported as a result of strictures. Ocular complications occur in 20% of patients and can lead to uveitis, conjunctivitis, corneal scarring, panophthalmitis, and permanent blindness. If the nasolacrimal duct is narrowed, epiphora may occur. Many patients develop dry eye syndrome and corneal scarring.

Symptoms

Palmar erythema most often appears on the palms. First of all, the eminences of the thumb and little finger are affected. The skin in these areas is quite transparent, and the vessels underneath practically do not close even normally, so the erythema here is the brightest. Less commonly, similar phenomena may appear on the soles of the feet.

Erythema may appear as a solid red spot or as many scarlet spots on the palms. At the same time, the skin is warm and does not itch. When pressure is applied, the redness disappears, but appears again after the pressure stops.

With liver damage, palmar erythema appears along with:

• telangiectasia;
• red raspberry, lacquered tongue;
• bright red shiny lips;
• hemorrhagic syndrome (bleeding gums, nosebleeds, bruises on the skin, etc.);
• gynecomastia (in men);
• amenorrhea (in women);
• impotence.

The combination of at least several symptoms with erythema is an alarming sign. If you find them in yourself, you should consult a specialist.

What does the pathology look like?

Distinctive signs of the syndrome can be seen in the photo. The reddened areas are usually symmetrical. Redness looks like small spots or dots and is localized on the palms and soles. When pressed, they temporarily disappear, but pain may appear. At the site of redness, vessels diverging in different directions, shaped like “stars,” sometimes appear. In some cases, the skin may itch.

Associated symptoms associated with liver disease:

• Itching of the skin, characteristic of cholestatic syndrome. The sensation can be periodic or constant, localized both on the palms and soles, and on other parts of the body.
• The patient's skin turns yellow. This symptom is explained by an increase in the level of bilirubin in the blood. The appearance of jaundice in a patient is usually associated with the presence of viral or cholestatic hepatitis in a chronic form.
• Hemorrhages (purpuras) on the skin and mucous membranes, also called hemorrhagic syndrome. A distinctive feature of purpura is that it does not disappear with pressure. May be small or large (resembling a bruise).
• In the presence of chronic liver pathologies, the tongue swells and turns red. If the patient suffers from liver failure, then the surface of the tongue, lips and mucous membranes becomes dark red, and sometimes even acquires a purple tint .
• Due to liver disease, an allergic form of dermatitis occurs. Distinctive features are bright red spots on the skin.
• Asthenovegetative syndrome is a general deterioration in the patient’s well-being. The temperature rises, weakness appears, appetite worsens, poor sleep. The patient sweats heavily, becomes nervous and irritable.

Palmar erythema in children

In most cases, erythema in children indicates the development of hepatitis. Basically, this disease begins gradually. Signs of the emerging disease may initially be systemic or hepatic. But with the further development of this disease, both groups will begin to appear.

Systemic symptoms include the following:

• skin rash;
• fever;
• arthralgia.

Liver symptoms include the following:

• pain under the ribs, which tends to increase;
• palmar erythema is manifested by the appearance of spider veins;
• enlarged liver and spleen;
• increased body temperature;
• headache;
• severe fatigue.

As a rule, liver signs are usually the first to appear in a child. Therefore, if at least one of the above symptoms appears, parents should seek help from a specialist as quickly as possible. Do not forget that in children, hepatitis can quickly take on a chronic form, with exacerbations occurring a couple of times a year.

Which doctor treats palmar erythema?

In order for palmar erythema to go away, first of all, it is necessary to cure the underlying disease.
Accordingly, the patient should be treated by a doctor who specializes in the pathology that caused this symptom. But in any case, the first person the patient will encounter on this issue will be the general practitioner. If a hepatobiliary disease is detected, he will either continue treating the patient on his own (since this is within his competence), or will refer the patient to a more specialized specialist - a gastroenterologist or even a hepatologist.

If a gynecological spectrum problem is identified, the patient will be treated by a gynecologist and endocrinologist.

Epidemiology

Erythema multiforme is reported worldwide without any ethnicity. The disease occurs at any age, most often in young people. The average age is 20 to 30 years, and 20% of cases occur in children. ME is more common in men, with a sex ratio of 1 to 5. Prevalence is unknown but appears to be well below 1%. Because the classification is not always clear, cases of Stevens-Johnson syndrome have often been included in ME studies.

Patients with HIV, those taking corticosteroids, those who are immunocompromised, those who have undergone bone marrow transplantation, and those with lupus are predisposed to developing erythema multiforme.

Diagnostics

The diagnostic search consists of identifying pathologies in the patient that accompany palmar erythema. After a thorough history and physical examination, the doctor determines additional research methods to clarify the preliminary diagnosis.

First of all, it is necessary to exclude liver pathology. To do this:

1. Complete blood count (evaluate the level of red blood cells, platelets, leukocytes and lymphocytes, hemoglobin, exclude hypersplenism syndrome).
2. Biochemical blood test (they study the activity of transaminases - specific enzymes that are found mainly in hepatocytes, which means that when they are destroyed, they increase their activity; evaluate the level of protein - protein synthetic function of the liver; the level of bilirubin and its fractions, cholesterol, alkaline phosphatase, GGTP, etc.) .
3. General analysis of urine and feces (color, level of urobilin and stercobilin).
4. Ultrasound of the abdominal organs.
5. CT or MRI (if indicated).

Treatment

To get rid of palmar erythema, it is necessary to eliminate the cause of its occurrence. That is, treat the disease that caused it.

The most common disease is cirrhosis of the liver. Its therapy depends on the etiological agent that led to the formation of connective tissue restructuring of the organ. Therefore, treatment for erythema may include:

1. Antiviral drugs (analogs of nucleotides or nucleosides - Lamivudine, Telbivudine, Tenofavir, etc.).
2. Interferon preparations are also used as a means to combat viruses (they are contraindicated in persons with Class B and C cirrhosis according to the Child-Pugh classification).
3. Patients with alcoholic cirrhosis of the liver are prescribed amino acid preparations - Ademetionine in the form of a two-stage course.
4. For primary biliary cirrhosis, ursodeoxycholic acid (Ursosan) is used.

A special place in the treatment of palmar erythema is occupied by drugs from the group of hepatoprotectors (some of them were mentioned above). Their task is to restore as much as possible the lost functions of the liver (synthetic, immunological, detoxification, etc.). This is achieved by activating its enzyme systems. This group of drugs includes:

• phospholipid hepatoprotectors (Essentiale, Phosphogliv);
• flavonoids (Legalon, Silibor).
• amino acids (Hepa-Merz, Ademethionine).
• herbal preparations (Artichoke extract, Bilignin, Liv-52).

To achieve a positive effect from treatment and the disappearance of erythema, it is necessary to choose the right therapy and combination of medications. You cannot do this on your own; a mandatory consultation with a specialist is necessary to make an accurate diagnosis and prescribe adequate treatment.

Kinds

Pathology amazes with the variety of types - there are 28 of them:

• Persistent towering. Another name is persistent erythema. A rare disease with an unspecified etiology. Oblong ridges of rich red color are formed.
• Dychromic. One of the varieties of red lichen. The spots are ash-blue. No treatment has been developed.
• Stevens-Johnson. A variety of multiform. Characterized by general intoxication.
• Viral. It begins as an acute viral disease, but is distinguished by a small rash resembling diathesis. It appears in the initial stage on the cheeks, then on the internal organs. Children of primary preschool age are most often affected. The danger lies in damage to the functions of hematopoiesis, joints and bone marrow.
• Infectious. It is caused by parvovirus, and the main risk group is preschool children. The rash covers the cheeks, then the entire body. It is often asymptomatic.
• Symptomatic. They cause emotions - anger, shame, excitement.
• Chamera. The etiology of the disease is infectious. The rash has the appearance of a butterfly, the rash merges into large spots. It is not difficult to tolerate and is accompanied by symptoms of mild intoxication.
• Polymorphic. One of the types of erythema multiforme. The rash occurs in the form of spots, hemorrhagic effusions, nodules and blisters filled with liquid.
• Physiological. Appears when there is a difference in temperature or under the influence of natural irritants. It is observed in infants in the postpartum period. It goes away on its own.
• Centrifugal erythema of Biette. Refers to a type of lupus erythematosus.
• Centrifugal erythema of Daria. Rash in the form of rings with unknown etiology.
• Ring-shaped. Occurs with weak immunity, cancer, fungal and bacterial infections. The body is covered with huge spots in the form of rings.
• Toxic form of newborns. It is of allergic origin. Treated with antihistamines.
• Exudative multiform - has a toxic-allergic nature. Sore throat, headache, muscles. The rash grows up to 3 centimeters, the spots merge into large “continents” and have a bluish tint. They appear symmetrically on the body and frame the lips on the face. Pain and itching are felt.
• Radial. Appears as a reaction to an x-ray examination.
• Scarlatiniform. The causative agents are streptococci and staphylococci. The prognosis is favorable.
• Nodular - the course of the disease can be acute or chronic. The rash looks like nodules that are painful to the touch. The diameter of the papules varies from ½ to 5 centimeters. There are practically no rashes on the face.
• Solar. Appears during prolonged exposure to the open sun, sometimes it is of an allergic nature. Hyperthermia is accompanied by swelling and deterioration of well-being.
• Miliana. Appears as a result of an allergy to the anti-syphilis drug salvarsan.
• Cold. Occurs as a reaction to cold. There is no specific therapy.
• Twisty Gammel. Resembles a cut of a tree, found in cancer.
• Bordered. Autoimmune response to the administration of medicinal serums. Manifested by urticaria.
• Afzelius-Lipschütz. Borreliosis or Lyme disease. The causative agent of the disease is a tick. Antibacterial and symptomatic therapy is carried out.
• Telangiectatic Bloom. The second name is infrared. Occurs with prolonged exposure to infrared radiation - a fireplace, heating pad.
• Palmarnaya. Popularly called “liver palms”. Hyperemia is noted over the entire area of ​​the palms. Cause abnormal liver and blood diseases, rheumatoid arthritis.
• Vascular erythema.
• Nodose. Synonym for knotty. Creeping.

Depending on the factors of occurrence, infectious and non-infectious hyperthermia are distinguished.

Infectious diseases include:

• exanthema;
• Lyme disease;
• multiform;
• undifferentiated;
• migratory;
• nodal

Non-infectious forms cause autoimmune reactions of the body to external stimuli.

Non-infectious forms:

• x-ray (radiation);
• persistent;
• infrared.

Prevention

To prevent the appearance of erythema on the palms, it is necessary to prevent the diseases that accompany it. For this you should:

1. Avoid casual sex (risk of viral hepatitis).
2. Do manicures/pedicures only by persons who heat treat instruments (contact with blood can also pose a risk of contracting hepatitis C and B).
3. Eliminate bad habits (drinking large doses of alcohol, especially its surrogates).
4. Undergo routine medical examinations and tests.
5. Promptly contact specialists if any pathologies of the hepatobiliary system arise.

If you notice erythema on your palms, you shouldn’t panic. Especially if this symptom is isolated. The best solution would be to contact a doctor who will conduct a set of necessary studies to accurately determine the cause of erythema and prescribe adequate therapy.

Author: Valentina Anit, specialist, especially for Dermatologiya.pro