Background

Carotenemia is the term used in medicine to describe yellow-orange skin pigment brought on by high quantities of carotene in the blood, and it was first used in 1919 by Meyers and Hess. Carotene-rich vegetables and fruits that are consumed in excess are frequently to blame. Carotenemia has historically been noted in a few old medical published reports as a rather old illness.

Due to famine and food scarcity, this illness was also observed during World Wars 1 and 2, when most people followed a plant-based lifestyle. Carotenoids are organic substances that can be found in many types of foods and plants. The primary carotenoid present in plants, beta-carotene, is more frequently to blame for this ailment. Primary care professionals frequently meet carotenosis for the first time.

Despite being benign, this disease is frequently mistaken for jaundice, which prompts pointless tests. Although carotenemia is a benign illness, it might result in a false-positive jaundice diagnosis. Orangeness could have important metaphorical meanings as well. Von Noorden first identified carotinemia as xanthosis diabetica in 1904 and noted that it was more pronounced on the soles and palms and within the nasolabial folds.

Epidemiology

Carotenemia is a common presenting complaint to family doctors and pediatrics, despite the lack of prevalence data. In a Sri Lankan research, 615 kids who consumed a diet high in carotenes had a 2 percent frequency of carotenemia.

Although it can manifest at any age, it usually does so in young children. The average age at appearance, according to Glasgow research, ranged from seven months to eleven years and was thirteen months. Other age groups may also experience it, though.

Another study found that children with mental problems had a substantially greater prevalence of carotenemia (around 22%). The scientists speculated that it might be because they were fed in different ways and with different diets than healthy kids.

Anatomy

Pathophysiology

Organic hydrocarbons called carotenoids are primarily sourced from plants. The primary carotenoid present in plants is beta-carotene. Alpha-carotene, lutein, lycopene, and beta-cryptoxanthin are further carotenoids. Two important enzymes, beta-carotene-15-15′-dioxygenase and 15-15′-carotenoid dioxygenase are involved in the conversion of beta-carotene into vitamin A. In humans, beta-carotene is the primary precursor to vitamin A.

The portal circulation receives the majority of its absorption in the proximal small intestine. 10 percent of the carotene that is consumed is absorbed without being converted and is transported to the liver through the portal vein. Fortunately, excessive intake of carotene does not result in hypervitaminosis A because the body only converts a small amount of carotene to vitamin A each day.

If blood levels of carotene are too high, it deposits in the corneum and contributes to the yellowing of the skin while sparing the mucous membranes. Only ten percent of people with diabetes mellitus have yellow skin; however, many people with diabetes mellitus have elevated blood-carotene concentrations.

Carotenemia may be brought on by hyperlipidemia, a restricted diet, or a poor liver’s ability to convert carotene to vitamin A. Carotene is not properly converted into vitamin A in hypothyroidism, and hypercholesterolemia also plays a part in the pathophysiological mechanism that underlies carotenemia. The rate of catabolism of vitamin A is mediated by the thyroid hormone, which is an antagonist to it.

Hypothyroidism results in lower vitamin A consumption and a slower conversion of carotene to vitamin A. Carotenemia and anorexia nervosa are related conditions. A reversible impairment in the conversion of beta-carotene to vitamin A is connected with hypercholesterolemia in patients with anorexia nervosa. Additionally, it might be caused by a typical consumption of carotene in the context of a decreased need.

Etiology

The majority of the body’s carotenoids come from food consumption. Carotenemia could result from excessive consumption (more than 30 mg per day) over an extended period of time. Certain fruits and vegetables contain a lot of carotenes. Apricots, oranges, cantaloupe, peaches, papaya, prunes, and mango are some examples of fruits. Carrots, broccoli, parsley, spinach, sweet potatoes, asparagus, squash, mustard, pumpkins, lettuce, kale, and green beans are examples of vegetables.

Butter, palm oil, eggs, and milk are additional foods that contain a lot of beta-carotene. Although nutrition is frequently to blame, cases of carotenemia have also been described in genetic illnesses where there is a lack of the enzyme beta-carotene-15-15′-dioxygenase, which prevents the conversion of carotene to vitamin A. Carotenemia caused by diet is more common in young children and infants.

Additionally, mothers may unintentionally cause carotenemia by giving their infants excessive amounts of carrots in prepared foods. Additionally, compared to non-vegetarians, vegetarians are more likely to acquire carotenemia. This illness may also result from taking nutritional supplements high in carotene. Carotenemia can also be caused by conditions such as hepatic problems, hypothyroidism, anorexia nervosa, renal illnesses, and diabetes mellitus.

Genetics

Prognostic Factors

A low-carotene diet causes the yellow skin tone to gradually go away. Due to the lipophilic nature of carotenoids, yellow skin may continue for several months even after carotene levels return to normal. The condition of carotenemia is benign.

Clinical History

Age Group: 

• Carotenemia can occur in individuals of any age, from infants to the elderly. 
• It is more commonly observed in infants who are introduced to solid foods high in carotenoids, and in young children who consume a diet rich in orange and yellow vegetables. 

Physical Examination

Skin Coloration: 

• The most prominent feature of carotenemia is a yellow-orange discoloration of the skin. This discoloration is usually most noticeable on the palms of the hands, soles of the feet, and on areas with thicker skin, such as the knees and elbows. 
• The coloration may vary in intensity, ranging from a mild yellowish tint to a deeper orange hue. 
• The color change is typically uniform and does not cause any skin lesions or discomfort. 

Scleral Examination: 

• In some cases, a faint yellowish tint may be observed in the sclera (white part) of the eyes, although this is less common compared to the skin discoloration. 

Medical History: 

• Healthcare providers will also inquire about the individual’s dietary habits, focusing on the consumption of carotenoid-rich foods such as carrots, sweet potatoes, pumpkin, and squash. 
• They may ask about any recent changes in diet or eating patterns that could contribute to the development of carotenemia. 

Age group

Associated comorbidity

Carotenemia is typically not associated with specific comorbidities, but certain factors may contribute to its development: 

• Dietary habits: Excessive consumption of carotenoid-rich foods, such as carrots, sweet potatoes, and squash. 
• Vegetarian diets: Individuals following a vegetarian or vegan diet, especially if it includes a high intake of carotenoid-rich plant foods. 
• Impaired metabolism: Certain medical conditions affecting the metabolism of carotenoids may contribute to carotenemia. 

Associated activity

Acuity of presentation

• Carotenemia generally has a gradual onset and is a benign condition. 
• The skin discoloration may become noticeable after several weeks of increased consumption of carotenoid-rich foods. 
• The yellow-orange pigmentation tends to develop slowly and is often more pronounced on the palms, soles, and nasal area. 

Differential Diagnoses

Jaundice: 

• Elevated blood levels of bilirubin cause jaundice, which is represented by a yellowish coloring of the skin and eyes. 
• Causes of jaundice include liver diseases (such as hepatitis or cirrhosis), hemolytic disorders, and bile duct obstruction. 

Hypothyroidism: 

• Skin changes, including an orange or yellow tint, might be related to hypothyroidism, a condition when the thyroid gland produces insufficient thyroid hormone. 
• This discoloration is distinct from carotenemia and may be associated with other symptoms such as fatigue, weight gain, and cold intolerance. 

Porphyria Cutanea Tarda (PCT): 

• PCT is a rare skin disorder associated with an abnormal accumulation of porphyrins, leading to photosensitivity and skin fragility. 
• Skin may exhibit a yellowish or brownish tint, resembling carotenemia, but the underlying causes are different. 

Liver Disease: 

• Certain liver diseases, aside from causing jaundice, can lead to changes in skin coloration due to impaired liver function. 

Renal Failure: 

• Kidney dysfunction can result in skin changes, and individuals with renal failure may present with a yellowish tint similar to carotenemia. 

Lipid Storage Disorders: 

• Disorders affecting lipid metabolism, such as Niemann-Pick disease or Wolman disease, can cause skin discoloration. 
• These conditions are rare but may present with yellowish or orange skin pigmentation. 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Dietary Modification: 

• Reduce intake of carotenoid-rich foods: Encourage individuals to limit the consumption of foods high in carotenoids, such as carrots, sweet potatoes, pumpkin, and other orange or yellow fruits and vegetables. 
• Increase variety: Diversify the diet to include a broader range of foods that are not rich in carotenoids to help balance the nutrient intake. 

Monitoring and Education: 

• Regular follow-up: Monitor the individual’s progress and adjust dietary recommendations accordingly. 
• Patient education: Provide information about the condition, its causes, and the importance of dietary modifications. 

Addressing Underlying Conditions: 

• Identify and treat any underlying health conditions: In some cases, carotenemia may be associated with certain medical conditions affecting the metabolism of carotenoids. Treating these underlying conditions can help resolve carotenemia. 

Symptomatic Relief: 

• Skin care: Although carotenemia itself is not harmful, some individuals may be concerned about the cosmetic aspect of skin discoloration. Using mild soaps and moisturizers can help improve the appearance of the skin. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

use-of-a-non-pharmacological-approach-for-treating-carotenemia

Dietary Modification: 

• Encourage individuals to reduce their consumption of carotenoid-rich foods, especially those with high levels of beta-carotene. This includes carrots, sweet potatoes, pumpkins, butternut squash. 

• Emphasize a more balanced and varied diet, incorporating a range of foods with lower carotenoid content to help normalize skin pigmentation. 

Increased Water Intake: 

• Staying well-hydrated can help flush out excess carotenoids through urine and may contribute to a faster resolution of carotenemia. 
• Adequate hydration supports overall health and can assist in maintaining proper fluid balance. 

Educational Counseling: 

• Provide education and counseling to individuals about the link between diet and carotenemia. 
• Help individuals understand the importance of a diverse and balanced diet for overall health. 

Monitoring and Follow-Up: 

• Schedule regular follow-up appointments to monitor the progression of carotenemia and adjust dietary recommendations as needed. 
• Periodic check-ins allow healthcare professionals to assess the effectiveness of dietary modifications and address any concerns. 

Emphasize Nutritional Variety: 

• To guarantee a balanced nutritional intake, promote the consumption of a variety of vegetables, fruits, and other dietary categories. 
• Promote a diet rich in antioxidants, vitamins, and minerals from various sources. 

Skin Care: 

• While carotenemia itself is benign, the yellow-orange discoloration may be a cosmetic concern for some individuals. 
• Recommend mild soaps and moisturizers to improve the appearance of the skin, although these measures do not address the underlying cause. 

Avoidance of Carotenoid Supplements: 

• If applicable, advise against the use of high-dose beta-carotene supplements, as these can contribute to elevated blood levels of carotenoids. 

Role of Supplement Adjustment in the treatment of Carotenemia

Carotenemia is primarily managed through non-pharmacological approaches, such as dietary modifications and lifestyle changes, rather than pharmaceutical interventions.

If carotenemia is secondary to an underlying medical condition such as hypothyroidism or liver disease, pharmaceutical agents may be prescribed to address the underlying cause.

In rare instances where carotenemia is exacerbated by high-dose beta-carotene supplements, discontinuation or dose adjustment of these supplements may be recommended. 

use-of-intervention-with-a-procedure-in-treating-carotenemia

Chemical Peels: 

• It involves the application of a chemical solution to the skin, which causes exfoliation and peeling. 
• Superficial chemical peels may be considered to improve the texture and color of the skin. However, their efficacy in treating carotenemia specifically is not well-established. 

Laser Therapy: 

• Laser therapy can target pigmentation in the skin and may be considered to reduce the intensity of skin discoloration associated with carotenemia. 
• This approach is more commonly used for conditions like hyperpigmentation and may have limited evidence for carotenemia. 

Microdermabrasion: 

• Microdermabrasion is a procedure that involves the mechanical exfoliation of the skin’s outer layer. 
• While it may help improve skin texture, its effectiveness in treating carotenemia is not well-documented. 

use-of-phases-in-managing-carotenemia

Assessment and Diagnosis: 

• The initial phase involves assessing the individual’s medical history, dietary habits, and clinical presentation to confirm the diagnosis of carotenemia. 
• Medical professionals may do a physical checkup to assess pigmentation on the skin and rule out further possible reasons for skin discoloration. 

• Laboratory tests, if indicated, may be performed to confirm elevated levels of carotenoids in the blood. 

Education and Counseling: 

• Once diagnosed, healthcare providers educate the individual about carotenemia, its benign nature, and the link between dietary habits and skin pigmentation. 
• Counseling sessions may focus on dietary modifications to reduce the intake of carotenoid-rich foods and promote a more balanced diet. 

Dietary Modification: 

• The primary phase of management involves implementing dietary changes to reduce the consumption of carotenoid-rich foods. 
• Individuals are encouraged to diversify their diet and incorporate a variety of vegetables,fruits, and other food groups to balance their nutrient intake. 
• Healthcare providers may offer guidance on meal planning and healthy eating habits to support long-term dietary modifications. 

Monitoring and Follow-Up: 

• Appointments for routine follow-up are made in order to track the development of carotenemia and evaluate the patient’s reaction to dietary changes. 
• Healthcare providers may evaluate changes in skin pigmentation and adjust dietary recommendations as needed based on the individual’s response. 

Symptomatic Relief (Optional): 

• In cases where individuals are concerned about the cosmetic appearance of their skin, symptomatic relief measures such as skincare recommendations or cosmetic procedures may be considered. 
• These interventions are optional and typically reserved for individuals who desire additional support for managing skin discoloration. 

Addressing Underlying Conditions (If Applicable): 

• If carotenemia is secondary to an underlying medical condition such as hypothyroidism or liver disease, treatment of the underlying cause may be necessary. 
• This phase involves identifying and managing any comorbidities contributing to carotenemia to achieve optimal outcomes. 

Medication

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References

Carotenemia:ncbi.nlm.nih