Carotenemia

Carotenemia is a clinical condition with yellow pigmentation of the skin associated with increased blood carotene levels. In most instances it is associated with large consumption of carotene in the diet. It has been confused with jaundice.
Carotene is derived from plants and it is the chief precursor of Vitamin A. Carotene is converted to Vitamin A in the mucosal cells of the small intestine. Absorption is aided by pancreatic lipase, bile salts, fat, and thyroid hormone. The absorption is enhanced by increased fiber content of the plant and the smaller the particular size of the food. Cooking, mashing, and pureeing make the carotene more available for absorption. This is thought to be secondary to rupture of cell membranes. Serum carotene levels are a good index of fat digestion and absorption. Carotene is excreted in the stool, skin, and urine.
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http://www.nejm.org/doi/pdf/10.1056/NEJMicm050780

 

Etiology

  1. Increased dietary content . Carotene is found in all pigmented fruits and vegetables. The content may be masked by the presence of chlorophyll. Ripening increases the food content of carotene.
  2. Foods high in carotene- Breast milk, carrots, squash, sweet potato, pumpkin, spinach, beans. Also, egg yolks, corn and yams.
  3. Homogenizing the food will increase the availability of carotene compared to pureeing.
  4. Carotenemia is rare in other conditions but has been found with hypothyroidism, diabetes mellitus, anorexia nervosa, liver disease, renal disease, and familial.
  5. Familial forms have been described with mutations in beta-carotene 15,15'-dioxygenase (the enzyme that converts beta carotene to 2 molecules or retinol)

carotenemia.jpg

 

Clinical Manifestations

  1. Yellow pigmentation of the skin that is enhanced by artificial light.
  2. Because carotene is excreted by sebaceous glands and in sweat, the greatest concentration is in areas with increased sweat glands

    1. palms
    2. soles
    3. nasolabial folds.
  3. Sclera and mucous membranes are spared.
  4. There is a variation of yellow pigmentation between individuals with equal amounts of carotene in their diet
  5. Elevated serum carotene levels
  6. Most often recognized in toddler and younger age group.

 

Differential Diagnosis

  1. Jaundice
  2. Lycopenemia- orange-red discoloration associated with excessive intake of lycopene found in tomatoes and beets.

 

Complications

  1. Benign and harmless.
  2. Not associated with increased levels of vitamin A and toxicity which is associated with
    1. alopecia,
    2. rashes and pruritus
    3. anorexia,
    4. increased intracranial pressure
    5. weight loss

 

Treatment

  1. Reduce ingestion of foods mentioned above
  2. Reassure and watch

 

Reference

  1. Leung, Alexander. Carotenemia. Advances in Pediatrics. 34: 223-248. 1987
  2. Karthik SV et al. Carotenemia in infancy and its association with prevalent feeding practices.  Pediatric Dermatology 2006;23:571

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