Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Palmar Erythema – A condition in which the palms of the hands become red is called Palmar Erythema. The redness usually occurs on the lower part of the palm. It would sometimes extend upwards to the fingers and also through them. Along with this, there is also raised warmth in the palm or palms. Pregnancy and liver cirrhosis, among many causes, are the most important ones for palmar erythema. When such redness occurs in the soles of the feet, it is called plantar erythema. The redness which resembles a rash would turn pale when pressed. The degree of redness in palmar erythema / plantar erythema is determined by the body temperature, physical activity and emotional state of individuals.
Related Reading – ‘Palmar Erythema – causes, symptoms, prevention and treatment’
In this article we will try to understand ‘Palmar Erythema’ from an Ayurveda perspective.
Palmar Erythema: Ayurveda Understanding
1. Pitta connection
Pitta increase will cause redness in a part or different parts of the body. This is because, as said earlier, rakta is a resident of pitta and both are closely interrelated. Raaga – reddish discoloration, which can be localized or generalized, is a feature / symptom of pitta vriddhi – pathological increase of pitta and also pitta prakopa – aggravation of pitta.
Ranjaka Pitta is a subtype of pitta, which imparts color to rasa and converts it into rakta. When there is excessive production of ranjaka pitta, its impact on rakta too will be heavy. This might cause palmar erythema and this may be a part of generalized reddish discoloration of the whole body.
Pitta and Rakta Involvement in the pathogenesis of Palmar Erythema
a. Pitta involvement –
Raga, the redness – Palmar erythema is marked by redness of the palms of the hands. Raga or rakta tvak i.e. Redness is ‘pitta color’. When there is aggravation of pitta in the body it reflects on the exterior in the form of redness of one or more of the skin, eyes and urine. Palmar erythema is the ‘redness of the skin of the palm’ itself. This also explains that there is abnormal increase of pitta in the body. Same is the case with plantar erythema.
Ushnata, the temperature – In Palmar Erythema, there is also warmth in the palms. Warmth or raise in temperature of the body / skin is also caused by increased pitta. ‘Ushma’ – maintenance of temperature of the body within normal limits is the function of ‘pitta in a state of balance’. But when pitta increases beyond normal limits, the temperature in and outside the body will increase reflecting its (pitta) increase.
Krodha, the anger – Emotional state is one of the factors which determine the degree of redness in a disease, palmar erythema in this case. Krodha or anger, according to Ayurveda, is said to increase pitta. This is because anger is fiery in nature and so is pitta. We can note that when one gets angry, his or her skin of the face turns red in color.
b. Rakta connection –
‘Rakta twak Netra mutratah’ i.e. redness or reddish discoloration of skin, eyes and urine has been mentioned among the symptoms of rakta vriddhi i.e. abnormal increase of blood tissue in the body. Redness of skin includes redness of skin of palm, as in palmar erythema.
c. Ashraya Ashrayi Bhava or Rakta and Pitta
In this context we also need to understand the interrelationship between rakta and pitta. Rakta, the blood is the residence / abode of pitta – the resident. Both are hot and liquid in nature. They tend to contaminate each other. Increase of pitta would affect rakta and increase of rakta would impact pitta. When one or both of these increases, there will be burnouts in the body and body parts. Redness of the body parts is a part and parcel of this kind of pathogenesis, along with increased warmth or heat. When the pathogenesis is limited only to the hands / palms, it causes redness therein, i.e. palmar erythema. The same when occurs in the foot, it causes plantar erythema.
2. Vatarakta & its subtypes
This is a disease caused by combined aggravation of vata and rakta. It is a systemic disorder with painful symptoms, mainly in the joints. The disease is either superficial, confined to skin and muscles or dive into deeper tissues making the clinical picture of the disease difficult and complicated. This disease is often correlated to gout and other peripheral vascular diseases.
‘Tamra varnatva’ i.e. appearance of coppery red color has been mentioned among the symptoms of vatarakta caused due to predominant aggravation of rakta – blood. Though a specific region of manifestation of this color has not been mentioned, it shall happen anywhere, including the palms. When it happens in the palms, it resembles ‘palmar erythema’.
Vatarakta is of two types. Uttana Vatarakta is limited to skin and muscles while Gambhira Vatarakta includes the involvement of deeper tissues including bones and joints. Among these, the word ‘rakta’ mentioned in uttana vatarakta points towards the appearance of redness. When ‘raktata’ occurs in the palmar region, it resembles palmar erythema. The other symptoms of vatarakta should be taken into consideration along with palmar erythema to consider it as vatarakta induced erythema of the palm.
When vatarakta line of treatment is administered to those suffering from gouty arthritis or other peripheral vascular disorders or just palmar or plantar erythema, the symptom is found to be relieved.
3. Raktavrita Vata
This is a condition in which the passages, movements and actions of vata are blocked by Rakta – blood. Among the symptoms of this condition, Raaga is mentioned – which means redness. It may be associated with pain and swelling in this condition. The manifestation is similar to Vatarakta.
4. Rakta Vriddhi
Pathological increase of rakta or aggravation of rakta can cause palmar erythema. ‘Rakta Twak’ has been mentioned amongst the symptoms of vatarakta which means ‘redness of the skin’. Increased rakta also causes conditions like vatarakta and kushta, which can present with palmar erythema as one of the symptoms.
5. Raktavaha Sroto Dushti & Rakta Pradoshaja Rogas
Among the symptoms of contamination of or vitiation of raktavaha srotas – channels transporting blood, ‘asru mandalam’ has been mentioned which actually means reddish skin eruptions or patches. But the deeper meaning of this word may also include ‘palmar erythema’. ‘Vatarakta’ and ‘Asru Mandalam’ are also diseases caused due to contamination of blood.
6. Kushta
Since the redness appears like a rash, the skin diseases which when prominent on the hands can appear like palmar erythema. They include Udumbara (pitta predominant), Mandala (kapha predominant) and Rishyajihva (Vata-Pitta predominant) Kushta.
Other points of interest
Modern research studies suggest that palmar erythema is a marker of neoplasms and also that indurated reticulate palmar erythema as a sign of paraneoplastic palmar fasciitis and polyarthritis syndrome.
Vatarakta is a systemic disease which presents as polyarthritis apart from having systemic symptoms. Ragata i.e. redness representing palmar erythema as present in vatarakta and its subtypes has already been discussed early in this article. Arbuda, which is a word which represents tumors and neoplasms, has been counted among the symptoms of vatarakta which determines the bad prognosis of the disease. So, even according to Ayurveda, these dots connect.
Ayurveda Treatment of Palmar Erythema
Nidana Parivarjana
The etiological factors responsible for pitta and kapha aggravation and causation of vatarakta, kushta and raktavaha sroto dushti and raktapradoshaja rogas should be avoided.
Treatment of primary diseases
Kushta, Vatarakta etc. diseases which have been considered to cause palmar erythema (as explained above) shall be promptly treated.
The treatment, medicines, diet and lifestyle changes enumerated under the below mentioned conditions in the form of treatment principles shall be adopted –
– Vatarakta Chikitsa
– Raktapradoshaja Roga Chikitsa
– Raktavaha Sroto Dushti Chikitsa
– Pitta Vriddhi Chikitsa
– Rakta Vriddhi Chikitsa
– Raktavrita Vata Chikitsa
– Kushta Chikitsa
Panchakarma Therapies
Virechana – therapeutic purgation is the main therapy which will be beneficial in cases of palmar erythema. Vasti will be highly beneficial if palmar erythema is a symptom of vatarakta. These will help in treating the main disease as well as palmar erythema, mainly the deep-seated ones and are also helpful in the superficial ones.
Raktamokshana – bloodletting shall be considered in severe cases of vatarakta causing palmar erythema.
Dhara – showering of liquid medicines prepared with vatarakta alleviating herbs and Lepa – application of pastes of the same herbs will be helpful in vatarakta located superficially (uttana). Example – milk processed with Dashamula or Guduchi or Dashamula and Laksha will be helpful.
Beneficial formulations
– Tiktaka Kashayam
– Guluchyadi Kashayam
– Mahatiktaka Kashayam
– Patolakaturohinyadi Kashayam
– Patoladi Kashayam
– Tiktaka Ghrtam
– Mahatiktaka Ghrtam
– Kalyanaka Ghrtam
– Trivrit Leha
– Guduchi Sattva
