Introduction:
Carotenemia is a condition in which there is a discoloration of the skin due to excess levels of carotene in the body. Carotene is a pigment that is present in different fruits and vegetables. Excess amounts of carotene can lead to discoloration of the skin, which is typically yellow and sometimes slightly orange in color. It is a relatively harmless condition that subsides on necessary dietary changes. Though the condition can occur in any age group and skin color type, it is found to occur more commonly in young children and vegetarians, and people with a lighter complexion, as the yellow hue is more clearly visible.
What Is Carotene?
Carotene is a pigment found in most yellow, orange, and red-colored fruits and vegetables. It is an important nutrient that is a part of a healthy diet and does not cause any symptoms when consumed moderately. The common form of carotene in the human diet is beta-carotene, which gets converted into vitamin A in the body. Vitamin A is beneficial for eyes, skin, and also in fetal development.
Some of the fruits and vegetables which are rich in beta-carotene include:
Carrots.
Spinach.
Parsley.
Butternut squash.
Coriander.
Sweet potato.
Pumpkin.
Basil.
Chicory.
Chives.
Apricots.
Mango.
Green beans.
Plum.
Green peas.
Okra.
What Happens When There Is Excess Carotene in the Body?
Consumption of carotene-rich foods in excess raises the levels of carotene in the body, which causes a yellowish discoloration of the skin. The excess carotene, however, gets converted very slowly into vitamin A which does not cause hypervitaminosis A (Vitamin A toxicity in the body). As carotene is non-toxic to the body, even high levels do not cause any complications.
The following terms that are used interchangeably with carotenemia include:
Carotenosis: A condition where there are high carotene levels in the blood and skin discoloration together referred to as carotenosis.
Hypercarotenemia: A condition with excess carotene levels in the blood is called hypercarotenemia.
Carotenoderma: Carotenoderma is when excess amounts of carotene occur in the skin.
Xanthoderma: Yellow discoloration of the skin that can occur due to any cause is called xanthoderma.
Are Carotenemia and Jaundice Related?
Carotenemia and jaundice are two different conditions that are misinterpreted due to the common yellowish discoloration of the skin. Carotenemia is a harmless condition that occurs due to excess carotene levels in the body, whereas jaundice is a manifestation of a medical condition, mostly liver or gall bladder dysfunction. The important distinguishing factor between carotenemia and jaundice is that there is a yellow discoloration of the sclera (whites) of the eye and the inner lining of the mouth in jaundice, which is absent in carotenemia. Carotenemia subsides upon reducing dietary intake of carotene, whereas jaundice requires immediate medical treatment.
What Are the Causes of Carotenemia?
Carotenemia is classified into two types based on the causes, which include:
Primary carotenemia.
Secondary carotenemia.
Primary Carotenemia:
Primary carotenemia occurs due to excess consumption of foods rich in carotene, especially carrots. Therefore, the skin discoloration that occurs due to excess carotene is called primary carotenemia.
Secondary Carotenemia:
Certain diseases that decrease the metabolism of carotene and delay its conversion into vitamin A lead to accumulation of the excess carotene in the skin, causing symptoms. Secondary carotenemia, therefore, occurs due to diseases that affect carotene metabolism rather than intake of excess carotene itself.
Conditions that are associated with secondary carotenemia include:
Diabetes mellitus is a condition in which the body’s ability to respond to the hormone insulin reduces, which causes high blood sugar levels.
Hypothyroidism is a condition causing decreased production of thyroid hormones that affect metabolism.
Anorexia nervosa is an eating disorder where the person yearns for a thin body consciously.
What Are the Symptoms of Carotenemia?
The only symptom that occurs in carotenemia is the yellowish discoloration of the skin. The pigmentation is sometimes yellowish-orange in color but never red. This yellowish discoloration of the skin is called xanthoderma, which is more predominantly visible in the palms of the hand and soles of the feet, which are lighter in color when compared to the other body parts. No other visible symptoms are present. Therefore carotenemia can be ruled out based on the symptoms that are not present.
Symptoms except for yellow discoloration that is not present in carotenemia include:
Yellowish discoloration of the whites (sclera) of the eye and lining of the mouth.
Itching, tenderness, or burning sensation of the skin.
Skin rashes.
Dryness and peeling of the skin.
Nausea and vomiting.
Diarrhea.
Enlargement of liver and spleen.
Greenish discoloration of the hair and skin (seen in cases with contact with copper).
Discoloration of the sweat and urine is sometimes noted; however, it is temporary and reverses on stopping foods containing carotene.
How Is Carotenemia Diagnosed?
Diagnosis of carotenemia is based on the classic feature of yellowish discoloration of the skin, especially of the palms and soles. Doctors may also rule out jaundice by checking for any discoloration of the sclera (whites) of the eye and the inner lining of the mouth. Medical history and diet habits are noted, which help identify foods with excess carotene being consumed by the affected person. The following tests are recommended by the health care professionals to confirm the diagnosis of carotenemia, which include:
Blood Tests: The normal beta-carotene blood levels are 50 to 300 mcg/dL (micrograms per deciliter) or 0.93 to 5.59 micromol/L (micromole/liter). In carotenemia, the levels can be three to four times the normal ranges.
Liver Function Tests: Liver function tests help rule out any liver dysfunction which causes discoloration.
Skin Biopsy: A small sample of the skin tissue is removed and sent to the laboratory to analyze any skin conditions causing discoloration.
How Is Carotenemia Treated?
There is no specific medication or treatment for carotenemia. Reducing the intake of carotene-rich foods helps resolve the condition. However, carotene-containing foods must not be avoided for a long period of time, as they provide many essential nutrients required for normal body functioning.
In the case of primary carotenemia, decreasing the intake of carotene-containing foods will suffice. However, in cases of secondary carotenemia, the underlying cause has to be identified and treated appropriately.
Conclusion:
Carotenemia is a harmless condition that causes yellowish discoloration of the skin due to excess intake of foods containing carotene. It occurs more commonly in children as they consume fruits and vegetables in good amounts for normal growth and development. Carotenemia is a reversible condition without any complications. It does not require any treatment or medicines and subsides by simply reducing the intake of dietary carotene.
