The skin is yellow but the eyes are not (as opposed to jaundice).

CAROTENEMIA

In carotenemia, the skin (but not the sclera) takes on a yellowish hue from elevated levels of ß-Carotene.

• This chromophore accumulates in the stratum corneum when circulating levels are high. It is most common where the stratum corneum is thickest, e.g., the palms and soles.
  
• Generalized carotenemia is rare.
  
• Carotenemia may be associated with the diet, hyperlipidemia, or the metabolism.
  

Dietary Carotenemia

A diffuse yellowish discoloration of the palms and soles may occur in a patient who eats large quantities of ß-carotene-containing foods, e.g., carrots, sweet potatoes, squash, green beans, papayas, and pumpkins. In contrast to jaundice, the eyes are not icteric. Rarely, it may be seen in the palate.

Hyperlipidemia-Associated Carotenemia

A diffuse yellowish discoloration of the palms and soles in a patient with type IIA hyperlipidemia in which beta-lipoprotein is elevated (e.g., hypothyroidism, nephrotic syndrome, or diabetes mellitus). This is because beta-lipoprotein is a major carrier of beta-carotene.

Metabolic Carotenemia

Metabolic carotenemia is thought to occur secondary to a deficiency in the enzyme 15-15 dioxygenase which converts beta carotene to vitamin A, with the resultant elevated beta carotene. Serum vitamin A levels may be normal or low. Typical associations include anorexia nervosa, liver disease, renal disease, hypothyroidism, and diabetes mellitus.

Treatment

For dietary carotenemia, a diet low in retinol is rapidly curative. Usually, carotenemia need not be treated. It is doubtful that carotenemia is deleterious as it usually goes untreated.

RegionalDerm

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