An infant with yellow skin

CASE REPORT

A 1-year-old boy was referred with a history of yellowish tinge to the skin over the past few months. Parents were worried that he was jaundiced. On examination he had striking yellow-orange discolouration of palms, feet (fig 1), soles, knees and nasolabial folds. The sclera was white. Systemic examination was unremarkable. Parents revealed that he still preferred to have pureed baby food, which contains carrots and meat. Most of these were orange in colour. The overall clinical picture was strongly suggestive of beta-carotenemia. Blood investigations were normal, including liver and thyroid function tests. But the serum beta-carotene level was significantly elevated. Parents were reassured and appropriate dietary advice was given. A review after 6 months revealed normal skin colour.

Figure 1. Yellow-orange discolouration of palms and soles contrasted with the mother’s normal skin colour.

Carotenemia is a clinical condition associated with yellow pigmentation of skin owing to increased beta-carotene levels in blood. It is often confused with jaundice but the lack of pigmentation in the sclera is diagnostic. The condition is more common in infants and young children, most probably because of excessive and prolonged consumption of carotene-rich foods such as carrot and cow's milk.¹ Most of the baby jar food available in the market is rich in carotene. Although visually striking, this is usually a benign condition. It can be rarely associated with serious conditions such as hypothyroidism and diabetes mellitus.² Management involves reassuring parents and change in diet to alleviate parental anxiety.