Carotenemia Clinical Presentation

Updated: Mar 30, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Presentation

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.

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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. [17] 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. [18]

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