Jaundice is Always a Generalized Systemic Condition
Jaundice cannot be "non-generalized" because it is defined by systemic hyperbilirubinemia that causes diffuse yellow pigmentation of tissues throughout the body when serum bilirubin exceeds 2.5-3 mg/dL. 1, 2 The yellow discoloration affects skin and mucous membranes systemically due to excessive bilirubin deposition in tissues, not as a localized phenomenon. 3
Why Jaundice is Inherently Systemic
Jaundice occurs only when bilirubin circulates systemically in the bloodstream at elevated levels, causing widespread tissue deposition that manifests as generalized yellowing of the sclera, skin, and mucous membranes. 2, 3
The pathophysiology involves either bilirubin overproduction, impaired hepatic conjugation, biliary obstruction, or hepatic inflammation—all of which result in systemic hyperbilirubinemia that affects the entire body, not isolated anatomical regions. 4, 5
Clinical jaundice becomes visible when serum bilirubin levels exceed 2.5-3 mg/dL, at which point the pigment deposits throughout all vascularized tissues simultaneously. 1, 2
Common Misconception to Avoid
Do not confuse localized skin discoloration from other causes (such as carotenemia from excessive beta-carotene intake) with jaundice—these conditions may cause yellow skin but spare the sclera and do not involve hyperbilirubinemia. 3
While the underlying etiology of jaundice can be categorized as prehepatic (hemolytic), intrahepatic (hepatocellular), or posthepatic (obstructive), all three mechanisms produce systemic hyperbilirubinemia with generalized tissue involvement. 1, 3, 6
Clinical Presentation Pattern
Jaundice typically becomes first visible in the sclera (whites of the eyes) due to high elastin content that has particular affinity for bilirubin, followed by generalized skin involvement as levels rise further. 5
The distribution is always diffuse and bilateral when true hyperbilirubinemia is present, affecting all body tissues proportionally based on their vascularity and tissue composition. 3