Yellow Skin
 
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Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056


Clinical Problem :
A 9 years old girl presented with yellowish skin for 15 days without high colored urine. She also had fever, rash and yellow skin 3 months ago. She had neonatal hyperbilirubinemia at 1½ months of age. Mother had yellow skin 3 times in past 9 months. On examination, apart from yellow skin, there was no abnormality. Liver function tests were normal. Urine did not show any bile salts or bile pigments.


Question :
What is the diagnosis_?

Expert Opinion :
Carotenemia. There was history of excessive carrot intake in the entire family. Ingestion of excessive amounts of carrots is the usual cause of carotenemia, but it can also be associated with ingestion of many other yellow vegetables, as well as some green vegetables which contain high levels of carotene {precursor of vitamin A}. {1} As a precursor for vitamin A, carotene is converted in the body to retinol, which is one the most active forms of vitamin A. As a lipochrome, carotene contributes to the yellow component of normal skin. {2} Carotenemia is a benign condition` vitamin A poisoning does not occur despite massive doses of carotene because the conversion of carotene to vitamin A is slow. {1} Blood carotene levels are elevated. Carotenemia may be observed 4 to 7 weeks after initiation of a diet rich in carotenoids. {2} Hypothyroidism, diabetes mellitus, hepatic and renal diseases may be associated with carotenemia, but are not caused by ingestion of carotene. The absence of yellow pigment in the sclera and oral cavities distinguishes carotenemia from jaundice. A similar disorder, lycopenemia, is associated with an orange-yellow skin pigmentation as a result of ingestion of large amounts of tomatoes. {1} Therapy is based on dietary modification by reducing the carotene consumption. It may take several months before the skin color normalizes.

References
1. Lascari AD. Carotenemia. A review. Clin Pediatr {Phila}. 1981` 20: 25-29.
2. Yao P. Carotenemia. Available at website: ww.med.ucla.edu, modules, wfsectionperrticle.php_?articleid=316. Accessed on 17th November 2014


Correct Answers :  yes 15%
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