Clinical Dermatology

Diagnostic Hallmarks

Distribution- generalized, sclerae involved

Skin is normal in texture on palpation

Clinical Presentation

File earliest stage of jaundice is often hard to recognize because the normal skin color masks the yellow hue. There is not a exact correlation between bilirubin levels and the degree of jaundice. However, bilirubin levels generally need to be above 2.5 mg/100 ml before yellow color becomes apparent. Yellowing of the sclerae is usually the first sign of jaundice to be noted. Eventually, the entire skin surface and the mucous membranes are involved. Jaundice, itself, is asymptomatic, but the underlying liver disease may result in the presence of pruritus.

Carotenemia is the major condition to be considered in the list of differential diagnoses. Increased serum levels of carotene are seen in some diabetic patients, in some individuals with exercise-induced rapid weight loss, and in those who ingest large amounts of yellow and green vegetables. The skin of patients with carotenemia becomes diffusely yellow, but the scleral color remain normal. This observation allows for differentiation from jaundice.

Pathogenesis

Jaundice occurs when liver function deteriorates to the point where bilirubin and related pigments cannot be eliminated quickly enough to avoid buildup in the serum. Sometimes, massive hemolysis, which releases huge amounts of pigmented compounds, results in the presence of jaundice even when hepatic function is normal.

Course and Prognosis

The outcome is determined by the course of the underlying disease. If liver function returns to normal, the pigment is slowly lost from the skin, and completely normal color returns.

Therapy

Therapy is, of course, primarily directed toward the underlying disease. However, bilirubin and related products can be metabolized in the skin through the use of ultraviolet light in the UVA spectrum. This type of therapy is commonly used for jaundice of newborn infants.

This entry was posted on Wednesday, August 8th, 2007 at 4:36 am and is filed under Lesions. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.