Carotenemia in an Infant

Patricia Garcia, MD
Connecticut Children’s Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut

CITATION:
Garcia P. Carotenemia in an infant. Consultant. Published online August 1, 2017. https://www.consultant360.com/articles/carotenemia-infant

A 9-month-old boy presented for his routine wellness checkup and was noted to have yellow skin. The infant was the product of a full-term gestation and was healthy with normal growth. His parents had introduced homemade pureed solids at 4 months of age, and the infant’s diet was limited to sweet potatoes, pumpkin, carrots, plantains, and formula.

Physical examination. Examination showed yellowing of the skin, most prominently over the palms, soles, and nasolabial folds (Figures 1-4). Laboratory test results revealed a normal white blood cell, differential, and platelet counts, as well as normal hepatic function, blood urea level, serum creatinine level, and thyroid function.

Discussion. Carotenemia is a benign clinical condition in which the skin takes on a yellow pigmentation due to increased levels of β-carotene in the blood. This is due to excessive consumption of carotene-rich foods. Carotenemia is more easily visualized in light-skinned individuals and in areas with thick stratum corneum, such as the palms and soles. It does not cause scleral icterus, allowing it to be clinically distinguished from true jaundice.

Carotenemia is seen in infants more often than in older individuals, because pureeing foods results in destruction of cell walls and increases the bioavailability of carotene. All pigmented fruits and vegetables contain some carotenes, but foods that are yellow or orange, such as carrots, sweet potatoes, and squash, have higher concentrations. Excessive ingestion of carotenoids is nontoxic and will not result in hypervitaminosis A.¹

Although carotenemia is typically dietary in origin, it can also result from underlying disease processes such as hypothyroidism, diabetes mellitus, hepatic disorders, and renal disorders. Laboratory testing is not recommended in healthy individuals with a positive dietary history, but serum carotene levels may be elevated.²

A low-carotene diet will lead to the skin returning to its normal color. However, carotenoids are lipophilic, so it may take several weeks to months for the skin to return to its normal color. Additionally, parents should be counseled that many green vegetables, such as spinach and green beans, are also high in carotenoids and should be avoided.²

References:

1. Anjay MA, Palanivel V, Nirmal S. An infant with yellow skin [published online January 8, 2009]. BMJ Case Rep. doi:10.1136/bcr.2008.139014.
2. Karthik SV, Campbell-Davidson D, Isherwood D. Carotenemia in infancy and its association with prevalent feeding practices. Pediatr Dermatol. 2006;23(6):571-573.