A 29-year-old woman presented with a 6-month history of yellowing skin on her palms and soles. She was previously healthy, did not consume alcohol, and had no personal or family history of liver disease. She took no prescription medications; however, approximately 6 months prior to the onset of symptoms, she began taking a nutritional supplement (Nature Made Beta Carotene, Otsuka Pharmaceutical) manufactured in Japan and available online in China. This supplement contained 1.8 mg of beta carotene per tablet, and she had been taking 2 tablets daily for the past 6 months. She had no other dietary changes during this period, in particular, no increased intake of carrots or other yellow- or orange-colored fruits or vegetables. Physical examination revealed yellow-orange pigmentation of her palms and soles (Figure). There was no scleral icterus. Results of laboratory tests, including measurement of aspartate aminotransferase, alanine aminotransferase, hemoglobin A1c, and total and direct bilirubin levels, ratio of blood urea nitrogen to creatinine, as well as fasting lipid profile and thyroid function tests, were normal.
Wang Z, Liu X, Li J. Woman With Yellow Palms and Soles. JAMA. 2017;317(15):1574-1575. doi:10.1001/jama.2017.1229