History

A history of excessive carotene intake consistent with the diagnosis of hypercarotenemia is usually present.

Metabolic carotenemia without a history of excessive carotene intake may be due to a genetic defect in the metabolism of carotenoids.

As previously mentioned, 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.

Patients may present with symptoms—such as pruritus, fatigue, abdominal pain, and weight loss—specific to one of the rare causes of carotenemia.^[17]

Pica, common in people with iron deficiency, may produce a compulsion to eat excessive amounts of carrots, which may possibly lead to carotenemia.^[18]

Physical Examination

Carotenemia is characterized by a yellow pigmentation of the skin that is more pronounced under artificial light.

Because carotene is excreted by sebaceous glands and is present in sweat, the yellow pigmentation is particularly noticeable in areas where sweating is marked.

Yellow pigmentation often appears first on the tip of the nose, palms, soles, and nasolabial folds, extending gradually over the entire body.^[19]However, the yellow pigmentation is most prominently displayed on the palms, soles, and nasolabial folds. The pigmentary change results from deposition of carotene in the fat-soluble stratum corneum.

The sclerae are always spared, which readily distinguishes carotenemia from jaundice; however, carotenemia occasionally may present with coloration of the palate. Note that the conjunctivae and oral mucosa are areas lacking stratum corneum.

Children who present with rare causes of carotenemia that are not related to diet may have physical signs specific to that disease process. Trichrome vitiligo with an orange coloration may be due to carotenemia.^[20]

Differential Diagnoses

Hsiao C, Clukay CJ. Orangeness-Peeling Back the Myths Behind Carotenemia. JAMA Dermatol. 2017 Sep 1. 153 (9):873. [QxMD MEDLINE Link].
Julka S, Jamdagni N, Verma S, Goyal R. Yellow palms and soles: A rare skin manifestation in diabetes mellitus. Indian J Endocrinol Metab. 2013 Oct. 17:S299-300. [QxMD MEDLINE Link]. [Full Text].
Comerford KB, Ayoob KT, Murray RD, Atkinson SA. The Role of Avocados in Maternal Diets during the Periconceptional Period, Pregnancy, and Lactation. Nutrients. 2016 May 21. 8 (5):[QxMD MEDLINE Link].
Gangakhedkar A, Somerville R, Jelleyman T. Carotenemia and hepatomegaly in an atopic child on an exclusion diet for a food allergy. Australas J Dermatol. 2017 Feb. 58 (1):42-44. [QxMD MEDLINE Link].
Karthik SV, Campbell-Davidson D, Isherwood D. Carotenemia in infancy and its association with prevalent feeding practices. Pediatr Dermatol. 2006 Nov-Dec. 23(6):571-3. [QxMD MEDLINE Link].
Takita Y, Ichimiya M, Hamamoto Y, Muto M. A case of carotenemia associated with ingestion of nutrient supplements. J Dermatol. 2006 Feb. 33(2):132-4. [QxMD MEDLINE Link].
Nunez-Cordoba JM, Martínez-Gonzalez MA. Antioxidant Vitamins and Cardiovascular Disease. Curr Top Med Chem. 2011 Apr 21. [QxMD MEDLINE Link].
Darvin ME, Fluhr JW, Meinke MC, Zastrow L, Sterry W, Lademann J. Topical beta-carotene protects against infra-red-light-induced free radicals. Exp Dermatol. 2011 Feb. 20(2):125-9. [QxMD MEDLINE Link].
Vaishnava S, Hooper LV. Eat Your Carrots! T Cells Are RARing to Go. Immunity. 2011 Mar 25. 34(3):290-2. [QxMD MEDLINE Link].
Kaimal S, Thappa DM. Diet in dermatology: revisited. Indian J Dermatol Venereol Leprol. 2010 Mar-Apr. 76(2):103-15. [QxMD MEDLINE Link].
Jung S, Wu K, Giovannucci E, Spiegelman D, Willett WC, Smith-Warner SA. Carotenoid intake and risk of colorectal adenomas in a cohort of male health professionals. Cancer Causes Control. 2013 Feb 1. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Stawiski MA, Voorhees JJ. Cutaneous signs of diabetes mellitus. Cutis. 1976 Sep. 18(3):415-21. [QxMD MEDLINE Link].
Sale TA, Stratman E. Carotenemia associated with green bean ingestion. Pediatr Dermatol. 2004 Nov-Dec. 21(6):657-9. [QxMD MEDLINE Link].
Hulková H, Svojanovský J, Sevela K, Krusová D, Hanuš J, Vezda P, et al. Systemic AL amyloidosis with unusual cutaneous presentation unmasked by carotenoderma. Amyloid. 2014 Mar. 21(1):57-61. [QxMD MEDLINE Link].
Sansone RA, Sansone LA. Carrot man: A case of excessive beta-carotene ingestion. Int J Eat Disord. 2012 Mar 19. [QxMD MEDLINE Link].
Gupta S, Bourke MJ, Burgess NG. Pain and Pigmentation: A Puzzling Presentation. Gastroenterology. 2021 Mar. 160 (4):1034-1036. [QxMD MEDLINE Link].
Nakagami F, Nozato Y, Yamamoto K, Rakugi H. Carotenemia induced by iron deficiency. BMJ Case Rep. 2021 Jan 28. 14 (1):[QxMD MEDLINE Link].
Kayhan-Tetik B, Çaylan N. Betacarotenemia with isolated nose involvement in a child: a case report. Arch Argent Pediatr. 2019 Oct 1. 117 (5):e502-e504. [QxMD MEDLINE Link].
Singh S, Bhari N, Rai M, Gupta S. Orangechrome Due to Carotenemia Presenting as Trichrome Vitiligo. J Cutan Med Surg. 2018 Jul/Aug. 22 (4):422. [QxMD MEDLINE Link].
Dasanu CA, Dutcher J, Alexandrescu DT. Yellow skin discoloration associated with sorafenib use for treatment of metastatic renal cell carcinoma. South Med J. 2007 Mar. 100(3):328-30. [QxMD MEDLINE Link].
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. 2009 Jan. 136(1):42-5. [QxMD MEDLINE Link].
Nguyen LM, Scherr RE, Linnell JD, Ermakov IV, Gellermann W, Jahns L, et al. Evaluating the relationship between plasma and skin carotenoids and reported dietary intake in elementary school children to assess fruit and vegetable intake. Arch Biochem Biophys. 2015 Apr 15. 572:73-80. [QxMD MEDLINE Link].
Ermakov IV, Gellermann W. Optical detection methods for carotenoids in human skin. Arch Biochem Biophys. 2015 Apr 15. 572:101-11. [QxMD MEDLINE Link].
Kiuchi S, Ihara H, Koyasu M, Tani A, Hashizume N. A Case of β-Carotenemia Misdiagnosed as Jaundice by the Bilirubin Oxidase Method. J Nutr Sci Vitaminol (Tokyo). 2019. 65 (5):451-454. [QxMD MEDLINE Link].

Media Gallery

Carotenoderma visible on nasolabial folds of young child.

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jack Grzybowski, MD Staff Physician, Department of Pediatrics, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Jack Grzybowski, MD is a member of the following medical societies: Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Jatinder Bhatia, MBBS Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia

Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, Society for Pediatric Research, and Southern Society for Pediatric Research