Orange Skin in Toddlers: Carotenemia
The most likely cause of orange skin in a toddler is carotenemia from excessive dietary carotene intake, which requires no laboratory testing in typical cases—diagnosis is clinical based on yellow-orange discoloration of palms and soles with sparing of the sclera. 1
Clinical Diagnosis
Carotenemia is distinguished from jaundice by the absence of yellow pigment in the sclera and oral mucosa. 1 The key diagnostic features include:
- Yellow-orange discoloration most prominent on palms, soles, and nasolabial folds 1, 2
- Normal white sclera (not yellow) 1
- Normal oral mucosa 1
- Otherwise healthy, thriving child 1
Dietary History to Obtain
Focus your history on specific carotene-rich foods:
- Carrots (most common culprit), including commercial infant food combinations that may contain hidden large amounts of carrots 1
- Sweet potatoes, squash, pumpkin, and other yellow vegetables 1
- Green vegetables (spinach, broccoli) which also contain carotene 1
- Commercial nutrient supplements containing carotene 3
- Tomatoes in excessive amounts (causes lycopenemia, a similar condition) 1
Laboratory Testing
No laboratory testing is needed for typical carotenemia with classic presentation and dietary history. 1 However, consider testing only if:
- Scleral icterus is present (suggests jaundice, not carotenemia)—order bilirubin levels 1
- No clear dietary history of carotene intake—consider plasma carotenoid levels and evaluate for metabolic causes 2
- Associated symptoms suggesting underlying disease—screen for hypothyroidism (TSH), diabetes (glucose), hepatic disease (LFTs), or renal disease (BUN/creatinine) 1, 2
Management
Carotenemia is a benign condition requiring only dietary modification—reassure parents that vitamin A toxicity does not occur despite massive carotene doses because conversion to vitamin A is slow. 1
- Reduce or eliminate carotene-rich foods from the diet 1, 2
- Skin discoloration typically resolves gradually over weeks to months after dietary changes 2
- No treatment is necessary beyond dietary modification 1
Important Caveats
- Metabolic carotenemia (genetic defect in carotene metabolism) is rare but possible if discoloration persists despite 8 months of carotene-deficient diet 2
- Mothers may unknowingly give excessive carrots through commercial infant food combinations—review all food labels carefully 1
- The condition is completely benign and exists primarily to avoid confusion with jaundice and unnecessary diagnostic workup 1