Ask patients if they are taking medications that may result in liver damage. The entire lesion usually is 0.5-1 cm in diameter. Pressure on the lesion causes it to disappear. Blanching is replaced by rapid refill from the central arteriole when pressure is released. Occasionally, pulsation of the central papule is noted.
Lesions occur most commonly on the face, below the eyes, and over the cheekbones.
Other common sites include the hands, forearms, and ears. Pregnant women and individuals with liver disease may demonstrate palmar erythema. Patients with significant internal disease may exhibit numerous prominent lesions over the trunk and face. Examine patients with extensive lesions for palmar erythema, pallid or white nails with distal hyperemic bands, splenomegaly, ascites, jaundice, and asterixis. A common characteristic is an elevated blood estrogen level.