From the Research
The best site to assess jaundice in an individual with dark skin is the sclera, as it is free of skin pigment and allows for earlier detection of yellow discoloration. This is supported by a study published in 2019 in the journal Biomedical Optics Express, which introduced the "Jaundice Eye Color Index" (JECI) to quantify the yellowness of the sclera in jaundiced patients 1. The sclera is especially useful for assessing jaundice in dark-skinned individuals because it is less affected by skin pigmentation, making it easier to detect yellow discoloration.
When examining for jaundice, it is essential to have the patient look down while gently lifting the upper eyelid to expose the sclera in natural light if possible. The conjunctiva should also be examined, but it can sometimes appear yellow due to other conditions like pinguecula. Other alternative sites for assessing jaundice include the oral mucosa, particularly under the tongue, and the palms and soles of the feet, as they contain less melanin and make bilirubin pigmentation more apparent.
These alternative examination sites are crucial because traditional assessment of jaundice on the face or trunk can be difficult to detect in patients with darker skin pigmentation, potentially leading to delayed diagnosis of important hepatic or hematologic conditions. A more recent study published in 2022 in the journal Digestive Diseases supports the importance of a thorough clinical examination, including the assessment of the sclera, in the evaluation of jaundice 2. However, the 2019 study 1 provides the most direct evidence for the use of the sclera as a site for assessing jaundice in dark-skinned individuals.
Some studies, such as the one published in 2025 in the American Family Physician, focus on the evaluation and management of jaundice in adults, but do not specifically address the best site for assessing jaundice in dark-skinned individuals 3. Other studies, such as the one published in 2017 in Current Opinion in Gastroenterology, discuss the diagnosis and evaluation of hyperbilirubinemia, but do not provide specific guidance on the assessment of jaundice in dark-skinned individuals 4.
In clinical practice, it is essential to prioritize the assessment of the sclera, as well as other alternative sites, to ensure early detection and diagnosis of jaundice in dark-skinned individuals. This approach can help reduce the risk of delayed diagnosis and improve patient outcomes. The study published in 2016 in Seminars in Interventional Radiology provides a systematic approach to patients with jaundice, but does not specifically address the assessment of jaundice in dark-skinned individuals 5.