eMedicine Specialties > Dermatology > Metabolic Diseases

Carotenemia

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Jack Grzybowski, MD, Staff Physician, Department of Pediatrics, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Nov 15, 2009

Introduction

Background

Carotenemia is a common finding in children, mainly due to the excessive intake of carrots, but it can also be associated with the ingestion of many other yellow and green vegetables and citrus fruits. Carotene is a lipochrome that normally adds yellow color to the skin. With elevated blood levels of carotene, the prominence of this yellowing is increased. Carotenemia may be particularly evident when the stratum corneum is thickened or when the subcutaneous fat is strongly represented. The condition of carotenemia is harmless, but it can lead to a mistaken diagnosis of jaundice.

Awareness of carotenemia may avoid confusion with jaundice and unnecessary diagnostic studies. Mothers may induce it by giving their infants large amounts of carrots in commercial infant food preparations.1 Hypothyroidism,2 diabetes mellitus,3 hepatic diseases, anorexia nervosa, and renal diseases may be associated with carotenemia unassociated with the ingestion of carotene.4 Carotenemia may also be associated with the ingestion of carotene-rich nutritional supplements.5

Red hues are a challenge for animal coloration, as multiple pigments such as carotenoids, pheomelanin, psittacofulvins, porphyrins, turacin, and hemoglobin may confer red colors.6

Also see the eMedicine Pediatrics article, Carotenemia.

Pathophysiology

Excessive intake of vitamin A precursors in foods, principally carrots, can lead to a yellow discoloration of the skin but not of the sclera and oral cavity. This condition most commonly occurs in children with liver disease, hypothyroidism, or diabetes mellitus. The absorption of dietary carotenoid requires dietary fat and is enhanced by administering with meals. The conversion of beta-carotene (provitamin A) to vitamin A is accelerated by thyroxine and hyperthyroidism. Excessive ingestion of carotenoids is nontoxic and does not cause hypervitaminosis A because the conversion of carotene to vitamin A is slow.

Frequency

International

This disorder most commonly occurs in vegetarians and young children.

Mortality/Morbidity

Carotenemia is a benign condition.

Race

Carotenemia is more easily appreciated in light-complexioned people, and it may present chiefly as yellowing of the palms and the soles in more darkly pigmented persons.

Age

Carotenemia may occur at any age, but it is most common in children.

Clinical

History

  • A history of excessive carotene intake consistent with the diagnosis of hypercarotenemia is usually present. Carotenemia can be verified by a high serum beta-carotene level, a normal or slightly elevated vitamin A level, and normal liver function test results. Accumulation of beta-carotene in the skin is delayed by up to 2 weeks compared to the serum. Because of the lipophilic nature of carotenoids, sufficient amounts can remain in tissue for several months, causing yellow skin even after serum carotene levels return to normal.
  • Metabolic carotenemia without a history of excessive carotene intake may be due to a genetic defect in the metabolism of carotenoids.
  • Amenorrhea may be associated with carotenemia. This occurs in patients who consume a pure or predominantly vegetarian diet without red meat. Dietary modifications can reduce carotene levels, which, in turn, normalize the menstrual cycle.
  • A correlation between metabolic carotenemia and biliary dyskinesia has been suggested. In patients with metabolic carotenemia, significant relationships were identified between the gall bladder contraction rate and the levels of serum carotene, vitamin A, and lipids.
  • Carotenemia may be due to the ingestion of red palm oil. Because of the lipophilic nature of carotenoids, sufficient amounts may remain in the skin to produce discoloration for up to 5 months, even if serum beta-carotene levels have returned to normal.

Physical

  • Yellow skin discoloration, especially on the palms and the soles, without affecting the sclera, is present.
    • Yellowish pigmentation of the skin (xanthoderma) may be caused by many conditions.
    • Ascertaining the presence or the absence of scleral icterus is important in determining the diagnosis.
    • Yellow sclerae are found in patients with all etiologies of elevated serum bilirubin because scleral tissues are rich in elastin, which has a special affinity for bilirubin.
  • The liver and the spleen are not enlarged.

Causes

  • Excessive intake of carotenoid-rich vegetables (mainly green and yellow) and fruits7 causes carotenemia.

More on Carotenemia

Overview: Carotenemia
Differential Diagnoses & Workup: Carotenemia
Treatment & Medication: Carotenemia
Follow-up: Carotenemia
References
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References

  1. Karthik SV, Campbell-Davidson D, Isherwood D. Carotenemia in infancy and its association with prevalent feeding practices. Pediatr Dermatol. Nov-Dec 2006;23(6):571-3. [Medline].

  2. Aktuna D, Buchinger W, Langsteger W, Meister E, Sternad H, Lorenz O, et al. [Beta-carotene, vitamin A and carrier proteins in thyroid diseases]. Acta Med Austriaca. 1993;20(1-2):17-20. [Medline].

  3. Stawiski MA, Voorhees JJ. Cutaneous signs of diabetes mellitus. Cutis. Sep 1976;18(3):415-21. [Medline].

  4. Sale TA, Stratman E. Carotenemia associated with green bean ingestion. Pediatr Dermatol. Nov-Dec 2004;21(6):657-9. [Medline].

  5. Takita Y, Ichimiya M, Hamamoto Y, Muto M. A case of carotenemia associated with ingestion of nutrient supplements. J Dermatol. Feb 2006;33(2):132-4. [Medline].

  6. Toral GM, Figuerola J, Negro JJ. Multiple ways to become red: Pigment identification in red feathers using spectrometry. Comp Biochem Physiol B Biochem Mol Biol. Mar 4 2008;[Medline].

  7. Costanza DJ. Carotenemia associated with papaya ingestion. Calif Med. Oct 1968;109(4):319-20. [Medline].

  8. Dasanu CA, Dutcher J, Alexandrescu DT. Yellow skin discoloration associated with sorafenib use for treatment of metastatic renal cell carcinoma. South Med J. Mar 2007;100(3):328-30. [Medline].

  9. Royer M, Bulai Livideanu C, Periquet B, Maybon P, Lamant L, Mazereeuw-Hautier J, et al. [Orange skin and xanthomas associated with lycopenaemia in a setting of type III dyslipoproteinemia]. Ann Dermatol Venereol. Jan 2009;136(1):42-5. [Medline].

  10. Arya V, Grzybowski J, Schwartz RA. Carotenemia. Cutis. Jun 2003;71(6):441-2, 448. [Medline].

  11. Bardella MT, Molteni N, Cesana B, Baldassarri AR, Binanchi PA. IgA antigliadin antibodies, cellobiose/mannitol sugar test, and carotenemia in the diagnosis of and screening for celiac disease. Am J Gastroenterol. Mar 1991;86(3):309-11. [Medline].

  12. Christopher R, Rangaswamy GR, Santhoshkumar N, Shetty KT. Carotenoderma in metabolic carotenemia. Indian Pediatr. Nov 1997;34(11):1032-4. [Medline].

  13. Gjerlow J. [Granulocytopenia as a sequel to carotenemia. A case with cutaneous xanthosis as a sequel to long-term excessive consumption of carrots]. Tidsskr Nor Laegeforen. Jan 1 1966;86(1):33-4 passim. [Medline].

  14. Granado-Lorencio F, Herrero-Barbudo C, Olmedilla-Alonso B, Blanco-Navarro I, Pérez-Sacristán B. Hypocarotenemia After Bariatric Surgery: A Preliminary Study. Obes Surg. Mar 28 2008;[Medline].

  15. Kemmann E, Pasquale SA, Skaf R. Amenorrhea associated with carotenemia. JAMA. Feb 18 1983;249(7):926-9. [Medline].

  16. Lascari AD. Carotenemia. A review. Clin Pediatr (Phila). Jan 1981;20(1):25-9. [Medline].

  17. Leung AK. Carotenemia. Adv Pediatr. 1987;34:223-48. [Medline].

  18. Nishimura T. A correlation between carotenemia and biliary dyskinesia. J Dermatol. May 1993;20(5):287-92. [Medline].

  19. Palleschi GM, Knoepfel BR, Lotti T. Carotenoderma: a possible pit-fall in the immunopathologic diagnosis of pemphigus vulgaris. Int J Dermatol. Jan 1992;31(1):50-1. [Medline].

  20. Prince MR, Frisoli JK. Beta-carotene accumulation in serum and skin. Am J Clin Nutr. Feb 1993;57(2):175-81. [Medline].

  21. Schwenk TL, Byrne WJ, Smith MA. Carotenemia. Am Fam Physician. Jul 1987;36(1):135-6. [Medline].

  22. Stack KM, Churchwell MA, Skinner RB Jr. Xanthoderma: case report and differential diagnosis. Cutis. Feb 1988;41(2):100-2. [Medline].

  23. Svensson A, Vahlquist A. Metabolic carotenemia and carotenoderma in a child. Acta Derm Venereol. Jan 1995;75(1):70-1. [Medline].

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Further Reading

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Keywords

excessive intake of carrots, ingestion of carotene, beta carotene, beta-carotene

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Jack Grzybowski, MD, Staff Physician, Department of Pediatrics, UMDNJ-New Jersey Medical School
Jack Grzybowski, MD is a member of the following medical societies: Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Maureen B Poh-Fitzpatrick, MD, Professor Emerita of Dermatology and Special Lecturer, Columbia University; Professor of Medicine (Dermatology), University of Tennessee
Maureen B Poh-Fitzpatrick, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and New York Academy of Medicine
Disclosure: Lundbeck, Inc. Honoraria Review panel membership

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Mary Farley, MD, Dermatologic Surgeon/Mohs Surgeon, Anne Arundel Surgery Center
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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