Carotenemia: When Skin Turns Orange

Table of Contents

1. What Carotenemia Looks Like
2. Where the Color Comes From
3. Carotenemia Is Not Vitamin A Poisoning
4. How Long the Color Takes to Fade
5. Conditions It Can Accompany
6. Lycopenemia, the Red-Orange Variant
7. How It Is Told Apart From Jaundice
8. When a Lab Test Is Fooled
9. Carotenemia in Babies and Young Children
10. What Is Not Known
11. Key Research Papers
12. Connections
13. Featured Videos

What Carotenemia Looks Like

The color is a yellow to orange tint, and it is not spread evenly. Case reports and reviews consistently place it most strongly on the palms of the hands and the soles of the feet. A 2006 series of infants from a children’s hospital in Liverpool and a 2022 Japanese dermatology report both add the nasolabial folds — the creases that run from the sides of the nose to the corners of the mouth — as a typical spot.

The reason for this pattern has a likely explanation. In the 2022 report, a team examined skin from a person with carotenoid-colored skin under a fluorescence microscope and also measured skin carotenoids with a handheld optical meter. The patient’s skin scored higher than the average of 24 healthy volunteers, and the deposit was most pronounced in the stratum corneum, the dead outermost layer of the skin. The authors wrote that their findings in the outer skin and the sweat glands support the long-held idea that carotenoids are released in sweat and deposited in the outer skin.

Just as important is where the color does not appear. The whites of the eyes (the sclerae) stay white. Five infants described in a 1989 Canadian report all had white sclerae despite yellow skin, and a 2019 American case report describes carotenemia as occurring in the absence of yellow sclerae. This single feature is the main clinical clue that separates carotenemia from jaundice (see below).

The 2022 report describes the condition itself as benign and harmless, and notes that its cause inside the skin is still not fully understood. When carotenemia travels with other problems in the case reports — missed periods, weight loss, an underactive thyroid — those come from the accompanying condition, described below.

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Where the Color Comes From

The most common cause, by a wide margin, is eating large amounts of carotenoid-rich food for a long time. A 2004 report in Pediatric Dermatology names excessive and prolonged eating of yellow or orange foods such as carrots and winter squash as the most common cause. A 1981 review in Clinical Pediatrics names carrots as the usual cause, while adding that many other yellow vegetables, and some green vegetables, can do the same. Case reports widen the list:

• Green beans. The 2004 report describes an 8-month-old girl whose carotenemia followed a high intake of commercial green-bean baby food — a reminder that green foods carry carotenoids too, hidden under the green chlorophyll.
• Papaya and mango. A 2019 case report from a Chicago hospital describes carotenemia from eating large amounts of these two fruits.
• Leafy greens. A 2014 British case report describes a 36-year-old woman who ate a fixed menu made up mostly of leafy greens and had carotenoderma for 5 years.
• Red palm oil and regional staples. A 1988 report describes yellow-orange palms and soles in a man who had eaten great quantities of red palm oil while living in Liberia, and a 2025 dental case report describes a patient from Nigeria whose high intake of a beta-carotene-rich West African dietary staple tinted the floor of the mouth and the soft palate.
• Persimmon and tomatoes. These cause the red-tinged variant called lycopenemia, covered below.

Supplements can produce the same picture. A 2006 Japanese report describes a 66-year-old woman who developed carotenemia after taking oral carotene supplements in the hope of improving bleeding at the back of her eye; the authors noted that supplements can cause skin changes as side effects. A 2018 review in Clinical Nutrition ESPEN states that high blood carotene develops in people eating high levels of carotenoid-rich foods or taking beta-carotene supplements above 30 mg a day over a period of months — the color builds slowly, not after a single large meal.

Diet pattern matters as well as single foods. A 1983 report in JAMA described ten women with carotenemia who all ate a purely or mainly vegetarian diet with no red meat, and a 2017 New Zealand report describes a child with eczema on a restrictive exclusion diet whose carotenemia came from unbalanced eating with a large share of fruits and vegetables.

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Carotenemia Is Not Vitamin A Poisoning

Beta-carotene is a provitamin A: the body can split it into vitamin A. A natural worry is that orange skin means vitamin A is building up to toxic levels. The 1981 Clinical Pediatrics review addressed this directly, stating that vitamin A poisoning does not occur despite massive doses of carotene because the body’s conversion of carotene to vitamin A is slow. In the 1989 Canadian report, all five infants with carotenemia had normal vitamin A levels.

The distinction is between carotenoids and preformed vitamin A (retinol and its relatives, found in liver, fish-liver oils and many supplements). The 2017 New Zealand report notes that carotenemia is benign, but that unusual diets combined with preformed vitamin A from health supplements can lead to vitamin A toxicity. Orange skin from vegetables and an overdose of preformed vitamin A are therefore two separate things. The site’s page on Hypervitaminosis A covers the second.

A separate question is whether high-dose beta-carotene supplements carry risks beyond skin color. The large prevention trials in smokers found that they did; that story is told on The Beta-Carotene Supplement Paradox. Carotenemia itself is not a measure of that risk.

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How Long the Color Takes to Fade

When carotenemia comes from food, the reports agree that it clears once the high intake stops. How fast it clears varies more than is often assumed, because carotenoids are fat-soluble and are stored in body tissues, not only carried in the blood.

• In the 1989 Canadian report, removing the carotene-rich foods led to clearing of the yellow color and a return of blood carotene to normal in all five infants.
• In the 1988 red-palm-oil case, the man had not eaten red palm oil or any other concentrated carotene source for about three months, and his blood beta-carotene was only slightly above normal — yet his palms and soles were still colored. The authors explained that, because carotenoids dissolve in fat, enough remains in the tissues to keep the skin discolored for up to five months, regardless of blood levels.
• In the 2014 British case, the carotenoderma subsided after 6 months of changes to diet and lifestyle, and her condition had relapsed by the 2-year follow-up.
• In the 2007 Italian persimmon case and the 2006 Liverpool infant series, the color disappeared with a change in diet; in the infants it resolved on its own as their diet changed with age, without any treatment.

One exception stands out. A 1995 Swedish report describes a 3-year-old girl with long-standing yellow skin and a 3-fold rise in blood carotenoids, without any history of high carotene intake. After 8 months on a carotene-poor diet she still had some yellow color in the nasolabial folds and on the palms and soles. A test feeding of beta-carotene (1 mg per kilogram of body weight) pointed toward an inborn problem with carotenoid metabolism. When the color does not fade after the diet changes, this kind of non-dietary cause is what the reports discuss.

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Conditions It Can Accompany

The 2004 Pediatric Dermatology report lists the conditions most often linked with carotenemia: hypothyroidism, diabetes mellitus, anorexia nervosa, liver disease and kidney disease. The 1981 review adds an important point: these conditions may be associated with carotenemia but are not caused by eating carotene. The direction runs the other way — the condition can make carotenoids build up.

Underactive thyroid (hypothyroidism)

A 1993 Austrian study measured blood beta-carotene in 36 people: 16 with an overactive thyroid, 8 with an underactive thyroid and 12 with normal thyroid function. The underactive-thyroid group averaged 1.1 micrograms per milliliter, significantly higher than the 0.6 in the normal group, while the overactive group averaged 0.3. The authors explained that the thyroid hormone thyroxine speeds up the conversion of beta-carotene into vitamin A, and that the characteristic yellow tint of hypothyroidism comes from high beta-carotene. With less thyroid hormone, conversion slows and more unconverted pigment stays in circulation. The 2018 review adds that people with hypothyroidism and diabetes tend to develop high blood carotene on an ordinary intake of carotenoid-rich foods.

Diabetes

A 2013 Indian case report describes a man with known, poorly controlled diabetes who developed yellow palms and soles without eating carotenoid-rich foods; the discoloration improved after his blood sugar was brought under control. The authors note that how often this happens in diabetes is unknown and that the link between skin color and blood carotenoid level is disputed.

Anorexia nervosa and restrictive eating

A 1994 Toronto study measured blood carotene in 46 adolescent girls aged 13 to 18 with eating disorders and compared them with girls who had inflammatory bowel disease or other acute illnesses, and with children who had stomach complaints. High carotene was found in 6 of 46 (13.0%) with eating disorders, against 2 of 80 (2.5%) in the comparison groups. It was found in 4 of 21 girls with anorexia nervosa and in none of 17 with bulimia nervosa. The authors judged the test too insensitive for screening, but noted a specificity of 97.5%, and found no link between high carotene and liver-enzyme abnormalities.

A 2021 Austrian study of 62 women (18 with anorexia nervosa, 44 of normal weight) found higher blood beta-carotene in the anorexia group, though the difference was not statistically significant. Beta-carotene was strongly linked with less fat under the skin (a correlation of −0.742 within the anorexia group). The authors’ interpretation is that the little fat tissue that remains has less room to store carotenoids, so more stays in the blood, and they raised the hypothesis that high beta-carotene may mark slower weight recovery — an idea they describe as needing intervention studies.

Missed periods

The 1983 JAMA report described ten women with carotenemia and absent ovulation, nine of them without periods. The authors pointed out that the classic explanation, weight loss or anorexia nervosa, did not seem to fit, as the carotenemia appeared diet-induced, and they reported that changing the diet both lowered carotene and improved menstrual status. The 2014 British case of a woman of normal weight reached a different conclusion: her carotenoderma subsided after 6 months while she remained without periods up to 12 months later, and the authors concluded that the skin change and the missed periods were both signs of a highly restricted lifestyle rather than one causing the other.

Liver and kidney disease

The reviews and reports read for this page list liver and kidney disease among the associated conditions but do not describe the mechanism in their abstracts. The site does not fill that gap with a guess.

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Lycopenemia, the Red-Orange Variant

Lycopene is the red carotenoid of tomatoes, watermelon and some other fruits. Unlike beta-carotene, it is not converted into vitamin A. The 1981 Clinical Pediatrics review describes lycopenemia as a similar disorder to carotenemia, with orange-yellow skin from eating large amounts of tomatoes. A 2000 Italian report calls it a rare skin condition linked to high intake of tomatoes.

The case reports describe a slightly redder tint. A 2007 Italian report describes a 68-year-old woman with red-orange palms and soles whose diet included about 1 kilogram of kaki fruit (persimmon) a day; laboratory testing showed raised lycopene, and the color disappeared after her eating habits changed. The 2022 Japanese report examined a person with carotenoderma from lycopene-rich vegetables and fruits and found the pigment concentrated in the outermost skin layer, as described above.

One case shows that lycopenemia does not always come from the plate. A 2009 French report describes a 61-year-old woman with yellow-orange discoloration and fatty skin deposits (xanthomas) who had a rare blood-fat disorder, type III hyperlipoproteinemia, and a high blood lycopene level. The authors described it as the first case of lycopenemia not involving excessive dietary intake. After 14 weeks of lipid-lowering treatment, the deposits and discoloration improved and blood lycopene returned to normal. The site’s Lycopene page covers the pigment itself.

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How It Is Told Apart From Jaundice

Jaundice is yellowing caused by a buildup of bilirubin, a breakdown product of red blood cells that the liver normally clears. It can signal liver disease, blocked bile ducts or fast red-cell breakdown, which is why the two are worth telling apart. The reports describe three main differences:

1. The eyes. In jaundice the whites of the eyes turn yellow; in carotenemia they stay white. A 1988 report in Cutis explains why: bilirubin has an affinity for the elastic tissue of the sclera, while high carotene, lycopene and riboflavin do not stain it. The same report notes that some drugs, such as quinacrine, can also stain the sclerae.
2. The pattern on the skin. Carotenemia concentrates on the palms, soles and nasolabial folds. In the 1988 case, the authors used this placement on the palms and soles, together with white sclerae, to point toward carotenemia even though the man had a history of hepatitis and malaria.
3. The blood test. The 2019 Japanese report states that measuring blood bilirubin is necessary to accurately distinguish jaundice from carotenemia. In carotenemia, bilirubin is normal (with one laboratory exception, below) and blood carotene is high.

The 1981 review also lists the inside of the mouth as a place where yellow pigment is absent in carotenemia. A 2025 dental case report shows that this is not absolute: a patient from Nigeria with a long-term high beta-carotene diet had a clearly yellow floor of the mouth and soft palate, normal liver tests, and no skin discoloration. The authors described the oral mucosa as a site where carotenemia can show.

Several reports make the same practical point: knowing about carotenemia spares families confusion with jaundice, worry and costly tests. The site’s Jaundice page covers the causes of true jaundice.

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When a Lab Test Is Fooled

Laboratories measure bilirubin with several different chemical methods. A 2019 report in the Journal of Nutritional Science and Vitaminology describes a Japanese man aged 59.8 years with yellow skin from high beta-carotene. His muscle enzymes were raised, and his results pointed to a thyroid-related muscle disorder (hypothyroid myopathy). His liver tests and direct bilirubin were normal. Yet his total bilirubin, measured by the bilirubin oxidase method, came back markedly above the upper limit of normal.

The team then ran laboratory experiments and found that beta-carotene interferes with the bilirubin oxidase method, pushing the result upward. Their conclusion was that the very high beta-carotene had likely caused a falsely high total bilirubin. The title of the paper sums up the risk: a case of carotenemia misdiagnosed as jaundice. The case links two threads of this page — an underactive thyroid raising carotene, and that carotene distorting a test used to diagnose jaundice. Whether other bilirubin methods are affected in the same way is not covered by this single report.

Older carotene tests have their own measurement history. A 1990 German study of children with Down syndrome found high carotene in 14 of 44, and its author pointed out that earlier reports had used older spectrophotometric methods with a very different normal range from the newer chromatography method. The way carotene is measured changes what counts as high.

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Carotenemia in Babies and Young Children

Babies are a common group in the carotenemia literature, because puréed orange and yellow vegetables are standard first foods. The 1981 review noted that mothers may unknowingly be giving infants large amounts of carrots in commercial infant food combinations. The 2004 report states that carotenemia is not uncommon in children, even though few cases have been published since the first descriptions in the late 1800s and early 1900s.

The 1989 Canadian report describes five infants aged 8 to 11 months with yellow skin from carotene-containing foods. All had white sclerae. All had normal vitamin A, white blood cell counts, blood sugar, blood fats, and liver and thyroid tests. Removing the foods cleared the color and returned blood carotene to normal; the author emphasized that the condition is benign.

The 2006 Liverpool report reviewed infants seen over 3 years (1999 to 2002) at a specialist children’s hospital. The authors describe infant carotenemia as relatively rare, benign and of dietary origin, and noted the trend toward puréed vegetables and commercial infant food; whether that trend has raised the number of cases was unclear to them. In their series the color resolved on its own as the children grew and their diets changed.

Not every case in a child is dietary. The 1995 Swedish girl had no high intake and kept some color after 8 months of a carotene-poor diet, and the 2017 New Zealand child on an exclusion diet also had an enlarged liver (hepatomegaly), which resolved with dietary management. The 2018 review mentions rare genetic defects of the enzyme that splits beta-carotene as a cause of carotenemia on a normal or low intake.

Newborn jaundice is a separate and common condition with its own causes; the site covers it on Neonatal Jaundice.

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What Is Not Known

• How common it is. Most of the literature is single case reports and small series. The 2013 diabetes report states that the frequency of carotenemia in diabetes is unknown, and the 2006 Liverpool authors could not say whether infant cases are rising.
• Why some people color and others do not. The 2018 review notes that some studies found no major link between carotenoid intake and high blood carotene, which points to a genetic factor; the review concludes that people may need a genetic predisposition. Which genes, and how often, is not settled.
• The exact threshold. The 2018 review gives beta-carotene supplements above 30 mg a day, taken over months, as one setting where high blood carotene develops, and the 2013 report notes that the link between skin color and blood level is disputed. No single blood level reliably predicts visible color.
• The link with missed periods. The 1983 report raised the possibility that carotenemia is related to the loss of ovulation; the 2014 report concluded that both are signs of a restricted lifestyle rather than one causing the other. The question remains open.
• The role in anorexia nervosa recovery. The 2021 Austrian idea that high beta-carotene might slow weight regain is a hypothesis from a cross-sectional study of 18 patients; its authors called for intervention studies.
• Liver and kidney disease. The association is listed in reviews, but the abstracts read for this page do not explain the mechanism.

Questions about an unexplained change in skin color are for a clinician, who can check the eyes, the bilirubin and the thyroid.

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Key Research Papers

1. Sale TA, Stratman E. Carotenemia associated with green bean ingestion. Pediatr Dermatol. 2004;21(6):657-9. PubMed PMID: 15575851
2. Kemmann E, Pasquale SA, Skaf R. Amenorrhea associated with carotenemia. JAMA. 1983;249(7):926-9. PubMed PMID: 6823046
3. Kiuchi S, Ihara H, Koyasu M, Tani A, Hashizume N. A Case of β-Carotenemia Misdiagnosed as Jaundice by the Bilirubin Oxidase Method. J Nutr Sci Vitaminol (Tokyo). 2019;65(5):451-454. PubMed PMID: 31666483
4. Takita Y, Ichimiya M, Hamamoto Y, Muto M. A case of carotenemia associated with ingestion of nutrient supplements. J Dermatol. 2006;33(2):132-4. PubMed PMID: 16556283
5. Lascari AD. Carotenemia. A review. Clin Pediatr (Phila). 1981;20(1):25-9. PubMed PMID: 7449242
6. Leung AK. Benign carotenemia in children. Can Fam Physician. 1989;35:81-3. PubMed PMID: 21253272
7. Karthik SV, Campbell-Davidson D, Isherwood D. Carotenemia in infancy and its association with prevalent feeding practices. Pediatr Dermatol. 2006;23(6):571-3. PubMed PMID: 17156001
8. Priyadarshani AMB. Insights of hypercarotenaemia: A brief review. Clin Nutr ESPEN. 2018;23:19-24. PubMed PMID: 29460797
9. Sherman P, Leslie K, Goldberg E, Rybczynski J, St Louis P. Hypercarotenemia and transaminitis in female adolescents with eating disorders: a prospective, controlled study. J Adolesc Health. 1994;15(3):205-9. PubMed PMID: 8075090
10. Aktuna D, Buchinger W, Langsteger W, Meister E, Sternad H, Lorenz O, Eber O. [Beta-carotene, vitamin A and carrier proteins in thyroid diseases]. Acta Med Austriaca. 1993;20(1-2):17-20. (Article in German.) PubMed PMID: 8475673
11. Julka S, Jamdagni N, Verma S, Goyal R. Yellow palms and soles: A rare skin manifestation in diabetes mellitus. Indian J Endocrinol Metab. 2013;17(Suppl 1):S299-300. PubMed PMID: 24251193
12. Lackner S, Meier-Allard N, Mörkl S, Müller W, Fürhapter-Rieger A, Mangge H, Zelzer S, Holasek S. Hypercarotenemia in Anorexia Nervosa Patients May Influence Weight Balance: Results of a Clinical Cross-Sectional Cohort Study. Front Psychiatry. 2021;12:758300. PubMed PMID: 34992554
13. Nyekiova M, Ghaderi S, Han TS. Carotenoderma in a young woman of normal body mass index with hypothalamic amenorrhoea: a 2-year follow-up case report. Eur J Clin Nutr. 2014;68(12):1362-4. PubMed PMID: 24986820
14. Svensson A, Vahlquist A. Metabolic carotenemia and carotenoderma in a child. Acta Derm Venereol. 1995;75(1):70-1. PubMed PMID: 7747541
15. Stack KM, Churchwell MA, Skinner RB Jr. Xanthoderma: case report and differential diagnosis. Cutis. 1988;41(2):100-2. PubMed PMID: 3345684
16. Tanaka A, Miyauchi T, Kitamura S, Iwata H, Hata H, Ujiie H. Carotenoderma due to lycopenemia: A case report and evaluation of lycopene deposition in the skin. J Dermatol. 2022;49(12):1320-1324. PubMed PMID: 35938228
17. Caroselli C, Bruno G, Manara F. A rare cutaneous case of carotenosis cutis: lycopenaemia. Ann Nutr Metab. 2007;51(6):571-3. PubMed PMID: 18227626
18. Royer M, Bulai Livideanu C, Periquet B, Maybon P, Lamant L, Mazereeuw-Hautier J, Ferrières J, Paul C. [Orange skin and xanthomas associated with lycopenaemia in a setting of type III dyslipoproteinemia]. Ann Dermatol Venereol. 2009;136(1):42-5. (Article in French.) PubMed PMID: 19171229
19. La Placa M, Pazzaglia M, Tosti A. Lycopenaemia. J Eur Acad Dermatol Venereol. 2000;14(4):311-2. PubMed PMID: 11204525
20. Edigin E, Asemota IR, Olisa E, Nwaichi C. Carotenemia: A Case Report. Cureus. 2019;11(7):e5218. PubMed PMID: 31565621
21. Gangakhedkar A, Somerville R, Jelleyman T. Carotenemia and hepatomegaly in an atopic child on an exclusion diet for a food allergy. Australas J Dermatol. 2017;58(1):42-44. PubMed PMID: 26490299
22. Brooks JK, Kim JH, Mazza DB, Sultan AS. Hyperpigmentation of the oral mucosa caused by dietary beta carotene: a case report. Gen Dent. 2025;73(1):30-33. PubMed PMID: 40079879
23. Storm W. Hypercarotenemia in children with Down's syndrome. J Ment Defic Res. 1990;34 (Pt 3):283-6. PubMed PMID: 2143233

PubMed Topic Searches

1. PubMed: carotenemia
2. PubMed: carotenoderma
3. PubMed: lycopenemia
4. PubMed: hypercarotenemia and hypothyroidism
5. PubMed: hypercarotenemia in anorexia nervosa

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Connections

• Beta-Carotene Benefits Deep Dive — the hub for these articles
• Beta-Carotene Food Sources and Absorption — the richest foods and how fat and cooking change absorption
• The Beta-Carotene Supplement Paradox — what the high-dose supplement trials found
• Hypervitaminosis A (Vitamin A Toxicity) — the condition carotenemia is not
• Jaundice — yellow skin and eyes from bilirubin
• Lycopene — the red carotenoid behind lycopenemia
• Hypothyroidism — slower carotene conversion with low thyroid hormone
• Anorexia Nervosa — one of the conditions carotenemia can accompany

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