BG12 Carotenaemia: a persistent orange hue

Abstract Carotenaemia is characterized by an abnormal yellow–orange pigmentation of the skin, most prominently observed on the palms and soles. Its aetiology encompasses excessive dietary intake of carotene-rich foods and supplements, as well as medical conditions such as diabetes, hypothyroidism and anorexia nervosa (Maharshak N, Shapiro J, Trau H. Carotenoderma – a review of the current literature. Int J Dermatol 2003; 42: 178–81). We describe the case of an 80-year-old woman with persistent carotenaemia. Her initial presentation, 6 years ago, involved yellow–orange discoloration of her hands and feet. At that time, she was taking vision supplements containing high levels of vitamin A, which she promptly discontinued following a dermatology review. She also significantly reduced her intake of beta-carotene-rich foods, consuming oranges only twice weekly and avoiding other sources such as carrots and sweet potatoes altogether. Despite these adjustments, her skin discoloration has persisted, accompanied by consistently elevated serum beta-carotene levels. Her medical history is notable for hypothyroidism, managed with a low dose of levothyroxine. Carotenoids are pigments found as amorphous solids or crystals within plant cells, responsible for the yellow and orange hues of many fruits and vegetables. These compounds are a key source of dietary vitamin A. Carotenaemia is a benign condition with no associated long-term complications. Impaired conversion of carotene to vitamin A may occur due to inborn metabolic errors or hepatic dysfunction. Further investigations in this case revealed normal kidney and liver function tests. While hypothyroidism is a known factor in carotenaemia, our patient’s condition is well controlled with medication. The persistent nature of her skin discoloration, despite active avoidance of beta-carotene-rich foods and discontinuation of high-dose vitamin A supplements, presents an unusual clinical consequence. This case underscores the multifactorial nature of carotenaemia and the potential for prolonged discoloration in the absence of ongoing dietary or supplementary carotene excess. It also highlights the need for further investigation into other, perhaps less well-understood, mechanisms contributing to persistent carotenaemia. While benign, the condition can cause cosmetic concern and may warrant dermatological follow-up for reassurance and management guidance.