What is Carotenemia?
Carotenemia was first identified in 1919 by Hess and Meyers as a condition causing the skin to turn a yellow-orange color due to an excess of carotene in the blood. This often happens when a person eats too many fruits and vegetables that are high in carotene. The condition has been noted in medical reports for many years, and was particularly common during World Wars 1 and 2 when people ate a mainly plant-based diet because of food shortages.
Carotenoids are natural substances found in a variety of plants and foods, with beta-carotene being the primary one found in plants and commonly causing this condition. Individuals mainly discover they have carotenemia through their primary doctors. While the condition itself is harmless, it can sometimes be mistaken for jaundice which can lead to unnecessary medical tests.
The condition doesn’t harm your health, but it can sometimes cause a wrong diagnosis; for example, of jaundice. An orange hue to the skin can also hold symbolic significance. The condition was first observed and called “xanthosis diabetica” by von Noorden in 1904. He noted that it was most noticeable on the palms of hands and soles of feet, as well as in the folds of skin around the nose and mouth.
What Causes Carotenemia?
Carotenoids, which are mainly found in certain fruits and vegetables, enter the human body through food. Eating too much (over 30 mg per day) for a long time could result in carotenemia, a condition characterized by high levels of carotene in the body. Some of the fruits rich in carotene are apricot, cantaloupe, mango, orange, papaya, peaches, and prunes. The list of vegetables includes carrots, green beans, asparagus, broccoli, cucumber, lettuce, parsley, spinach, squash, mustard, pumpkins, kale, and sweet potatoes. Carotene is also high in butter, eggs, milk, and palm oil.
While diet is frequently the cause of carotenemia, the condition can also result from certain inherited disorders. In these disorders, the body is unable to turn carotene into vitamin A due to a lack of a specific enzyme, called beta-carotene-15-15′-dioxygenase.
Carotenemia due to diet is most commonly seen in infants and young children. Parents might unintentionally cause carotenemia if they feed their young children large amounts of carrots, particularly in commercial baby food. In addition to this, vegetarians are more likely to have carotenemia than nonvegetarians, and people taking dietary supplements high in carotene may also develop this condition.
Certain illnesses such as underactive thyroid, liver disorders, diabetes, anorexia nervosa, and kidney diseases could also lead to carotenemia.
Risk Factors and Frequency for Carotenemia
Although there’s not a lot of data, it’s relatively common for pediatricians and family doctors to see cases of carotenemia. In one study from Sri Lanka, 2% of 615 children eating a diet high in carotenoids had carotenemia. It’s mainly seen in children, with the average age of onset being around 13 months. However, it can occur in all age groups.
- Carotenemia, while we don’t have much data, is something pediatricians and family physicians often see.
- In a study from Sri Lanka, 2% of 615 kids who ate a lot of carotenoids showed signs of carotenemia.
- It typically affects children, with most cases appearing when the child is around 13 months old.
- However, it can happen at any age.
- Another study found that about 22% of children with mental disabilities had carotenemia. This could be due to their different feeding habits compared to other children.
Signs and Symptoms of Carotenemia
Getting a clear medical history and performing a thorough physical checkup are crucial for diagnosing conditions. Here’s what doctors should focus on when interviewing a patient and conducting a physical exam:
In the interview, doctors should obtain a comprehensive medical history. This includes the patient’s diet, with particular attention to any foods high in carotene. They should also note how much of these foods the patient consumes and how long they’ve been eating them. Besides, doctors should check for other conditions that might cause carotenemia, including diabetes, anorexia, underactive thyroid, and diseases of the liver or kidneys.
Sometimes, a person might have carotenemia due to a genetic issue that affects how their body handles carotenoids, even without consuming excess carotene. Carotenemia is also linked to amenorrhea (missed periods) mostly in vegetarians. Some patients might report symptoms like itching, abdominal pain, tiredness, and weight loss, which could be due to less common causes of carotenemia. Also, a strong desire to eat large amounts of carrots, which is seen in people with iron deficiency (also known as “pica”), could lead to carotenemia.
During the physical exam, doctors will notice a yellow-orange skin color, which is a telltale sign of carotenemia. This change in skin color doesn’t affect the white part of the eyes or the wet surfaces inside the body (unlike jaundice), but it’s commonly seen on the palms, soles, forehead, tip of the nose, and areas where the skin folds near the nose and mouth. The skin pigment spots usually appear first in these areas, gradually spreading over the body. Sometimes, carotenemia can change the color of the roof of the mouth. This color change is due to carotene building up in the outermost layer of the skin. Doctors also need to look for signs of diabetes, anorexia, and diseases of the liver and kidneys. Kids who have carotenemia due to reasons other than diet may show physical signs of the underlying disease. In some cases, an orange color in certain skin conditions might be due to carotenemia.
Testing for Carotenemia
In simple terms, for a condition called “diet-associated carotenemia” which changes your skin’s color, you typically don’t need lab tests to diagnose it. In most cases, your doctor will be able to identify it simply by asking you questions about your health and doing a physical examination.
However, if lab tests are needed, they usually show that levels of a substance called carotene in your blood are higher than normal. They often fall between 250 and 500 micrograms per deciliter. Your liver tests might also be either normal or only slightly elevated.
For a closer look at the skin, doctors might use reflection spectroscopy or Resonance Raman spectroscopy. These two techniques are noninvasive and help measure the amount of carotenoid antioxidants, a type of carotene, in your skin. Interestingly, the antioxidant ‘health’ of your blood could be predicted by the levels of carotenes in your skin.
It’s worth noting that sometimes, a method called the “bilirubin oxidase method” can mistake carotenemia for another condition called jaundice.
In some cases, a doctor might take a small sample of your skin, known as a biopsy. This can show autofluorescence in the top layer of skin and a pattern similar to another skin condition called pemphigus.
Even though carotenemia is linked with increased carotene levels, the levels of vitamin A in your body are typically still normal. The exception to this is a rare genetic enzyme deficiency that can lower vitamin A levels.
Doctors might also check your liver function, thyroid function, and screen for diabetes as part of the evaluation process. But mostly, extensive investigations are not usually necessary.
Treatment Options for Carotenemia
Doctors should comfort patients and their families, letting them know that this is a harmless condition that isn’t likely to cause severe issues. The primary way to treat it is by cutting down on the amount of carotene in the diet, which will eventually clear up the skin’s discoloration. Parents should be aware that many green vegetables, like green beans and spinach, are full of carotene. In some cases, it might be useful to talk to a dietitian for further advice.
What else can Carotenemia be?
Sometimes, your skin can turn yellow if your diabetes is not well-controlled, even if you haven’t been eating a lot of foods high in carotene. This yellow coloring usually disappears once your blood sugar levels are stable. Additionally, people with eating disorders like anorexia nervosa can also experience a yellow skin tone.
Eating too many tomatoes can lead to a specific type of yellow skin color, called lycopenemia.
There are many other medical conditions that could cause your skin to turn yellow. These might include thyroid disease, liver disease, rare genetic disorders that alter metabolism, and problems with kidney function.
In most of these situations, the yellow color of the skin is likely due to an excess of fats in the blood (hyperlipidemia) or difficulty in turning carotene into vitamin A.
There are some other chemicals besides carotene that could change your skin color to yellow. These include substances found in saffron, certain medications, and specific chemicals.
Interestingly, yellow skin has been recognized as a symptom of a very rare blood disorder called AL amyloidosis. Also, some types of brain diseases or tumors can affect how carotene is processed in our bodies, resulting in a yellow skin tone even if you’re not consuming more carotene in your diet than usual.
Interestingly, some studies point to a potential link between high carotene levels in the blood and two digestive disorders: biliary dyskinesia, a condition affecting the gallbladder, and celiac disease, a disorder where the body cannot properly digest gluten.
What to expect with Carotenemia
If you cut down on foods high in carotene, it can gradually get rid of yellowish skin color. Even after carotene levels get back to normal, the yellow skin might stick around for several months. This is because carotenoids, the compounds that give carotene its color, are fat-soluble and can linger in the body. Carotenemia, the medical term for having too much carotene in your body, is a harmless condition.
Possible Complications When Diagnosed with Carotenemia
Generally, this condition tends not to cause any serious problems. However, there have been reports of toxic retinopathy, which is a type of eye damage, due to excessive intake of canthaxanthin, a harmful byproduct of carotenoid. Don’t worry! These effects can be reversed and they don’t usually cause any long-term issues. It’s unlikely for vitamin A poisoning to occur, even if you take in extremely high doses of carotene. This is because the body slowly converts carotene to vitamin A, hence the risk is minimal.
Nevertheless, it was reported that a man who ate 6-7 pounds of carrots each week suffered from constipation, hypercarotenemia (an excess of carotenoids in the blood), increased liver enzymes, and potential vitamin A toxicity. Thus, moderation is always key!
Preventing Carotenemia
Parents should be comforted knowing that diet-induced carotenemia, a condition common in children, is generally harmless and doesn’t require any treatment. However, if parents are especially worried, doctors can provide information about diets that are high in carotene, and may recommend a diet for the child that is low in carotene.
