A good history and physical exam are key and often lead to the diagnosis. The following are the main items that should be addressed in the patient interview and physical examination.

History: A detailed history should be taken, including dietary history. The focus should be on the history of food consumption with high carotene with the estimation of the amount taken and duration. Screening should be made for other conditions that could present with carotenemia such as diabetes, anorexia, hypothyroidism, and liver and kidney diseases.

Physical Exam: Yellow-orange skin pigmentation is the hallmark of the condition. Pigmentation spares the sclera and mucous membranes (unlike jaundice) and concentrates in the palms, soles, forehead, the tip of the nose, and nasolabial folds.[1] Examiner should also seek signs of diabetes, anorexia, and liver and kidney diseases.

A good history and physical exam help narrow down the laboratory investigation necessary. Laboratory investigation reveals elevated serum carotene level, often in the range of 250 to 500 microgram/dl, with normal or slightly elevated liver enzymes. Vitamin-A level is normal[13] except in the rare case of inherited enzyme deficiency where the level will be low.[14] The evaluation must also include liver enzymes with bilirubin, thyroid function test and screening for diabetes. Extensive investigations are seldom needed.

Reassurance should be provided to the patients and their families as this is a benign condition and unlikely to lead to any serious consequences. The mainstay of treatment is reducing the amount of carotene in the diet, which will eventually lead to the resolution of skin pigmentation.[15] Consultation with a dietitian may be useful in some cases.[9]

Yellow skin discoloration has been reported in uncontrolled diabetes with no history of excess carotene ingestion. Often, the yellow pigmentation resolves with regulating blood sugar.[16] Hypercarotenemia may also be seen in anorexia nervosa.[17][18][19] Lycopenemia, a variant of carotenemia, is a yellow skin pigmentation caused by excessive tomato ingestion.[20][21] Carotenemia has also been associated with a variety of other conditions such as hypothyroidism, hypopituitarism, hypothalamic amenorrhea, liver disease, inborn errors of metabolism, nephritic and nephrotic syndromes.[6] In most of the above condition, Hypercarotenemia is probably associated with hyperlipidemia or impaired conversion of carotene to vitamin A.[9] Ingestion of some other chemicals besides carotene could lead to yellow skin staining. Examples include saffron, quinacrine, tetryl, picric acid, and dinitrophenol.[6] Carotenemia was also reported as a presentation for systemic lambda-type AL amyloidosis.[22] Neurological degenerative diseases and brain tumor seem (through unclear mechanisms) to affect carotene metabolism and could lead to carotenemia in the context of normal dietary carotene intake.[23] Some studies also suggested a correlation between biliary dyskinesia, celiac disease, and high carotene levels.[24][25]

The condition is fairly benign and seldom lead to any serious complications. Toxic retinopathy has reported due to excess canthaxanthin, which is a toxic carotenoid metabolite, however, changes are reversible and no long-term sequelae have been reported [26].

Patient education in collaboration with a dietitian improves the outcome of the condition and prevent further unnecessary investigations. Physicians and nurse practitioners should provide a simple explanation of the problem and how it is linked to the diet. This will help with treatment compliance. Assurance and education should also be provided to the referring primary care physicians and pharmacist.